The Information and Communication Technologies (ICT) are increasingly integrated in the health sector in a way that health is no longer a passive beneficiary, rather became a main driver for development and implementation of innovative technologies worldwide. The low adoption of eHealth applications in Egypt, which has been documented to be as low as 6.7% nationwide, as well as the concerning decrease in the Egyptian health workforce by around 67% in the past few years challenges the announced Egyptian vision to enhance health services for its citizens without understanding the factors influencing such low adoption of technology in the health system.

This research addresses the problem of how the perception and attitude of Egyptian health workers, and hence, their intention to use eHealth are motivated by different factors. The aim is to bridge the gap in the literature for the identified context by offering a model that integrates concepts from existing theories together into a conceptual model for empirical testing to develop recommendations and managerial implications. A set of 46 factors and 231 variables were identified from literature and later complemented with face-to-face semi-structured interviews with SMEs to elicit their views and opinions resulting in identifying 11 stressed-upon factors to have influence on eHealth adoption in Egypt.

A deductive worldview was adopted to conduct a questionnaire to validate the hypothesised model. Structural Equation Modelling was adopted to analyse a collected sample of 485 interviews following two main steps; a confirmatory measurement or factor analysis
specifying the relations of the observed measures to their posited underlying construct and then, a confirmatory structural model that specifies the causal relations of the constructs to one another as posited by proposed model. The final validated model integrates concepts and latent variables from the investigated theoretical foundation. For the overall sample, the Behavioural Intention (BI) to use EMRs was found to be influenced (both directly and indirectly) by nine main factors. Out of the nine, four are found to have direct influence on BI, namely: The health workers’ Perceived Usefulness - PU, Attitude – ATT, Professional Autonomy – PA, and Social Influence - SI. The indirect influence on BI was presented via Workload - WL, Anxiety - ANX, Perceived Ease of Use - PEU, Facilitating Conditions – FC, and Work Relationships - WRL. Attitude (ATT), on the other hand, was found to be influenced by four factors, namely, WL, Perceived Usefulness – PU, WRL, and FC.

The study provides several theoretical contributions in relation to identified factors, the generalisability and external validity of existing theories (e.g. UTAUT) in the health sector and identifying and integrating key theoretical factors from other theories or models, as well as re-tailoring and altering existing technology core factors to fit the Egyptian context. The study also provides methodological contributions in terms of examining the adoption of the technology for both physicians and non-physicians, the utilisation of paid advertisement for recruitment of interviewees in Egypt, and the adoption of SEM techniques for health sectorrelated studies in Egypt. Finally, the study provides practical and managerial implications with regards to strategy, governance, planning and capacities to provide an enabling environment for increased adoption of digital health in Egypt. Interesting characteristics and cultural findings were underscored in relation to the Egyptian HS, such as the culturally driven negative perception of female nurses towards technology. In general, this study introduces a tool to support the objective of strengthening health systems via increased adoption of eHealth.