Health Care Professionals' Knowledge, Attitude, Practice, and Infrastructure Accessibility for e-Learning in Ethiopia: Cross-Sectional Study.

Background: Training of health care professionals and their participation in continuous medical education are crucial to ensure quality health care. Low-resource countries in Sub-Saharan Africa struggle with health care disparities between urban and rural areas concerning access to educational resources. While e-learning can facilitate a wide distribution of educational content, it depends on learners' engagement and infrastructure. Objective: This study aims to assess knowledge, attitude, practice, and access to infrastructure related to e-learning among health care professionals in primary health care settings in Ethiopia. Methods: In April 2023, we carried out a quantitative, questionnaire-based cross-sectional study guided by the knowledge, attitudes, and practice framework, including additional items on available infrastructure. The scores in each category are defined as "high" and "low" based on the median, followed by the application of logistic regression on selected sociodemographic factors. We included health care professionals working in general and primary hospitals, health centers, and health posts. Results: Of 398 participants (response rate 94.5%), more than half (n=207, 52%) reported feeling confident about their understanding of e-learning and conducting online searches, both for general (n=247, 62.1%) and medical-related content (n=251, 63.1%). Higher levels of education were associated with better knowledge (adjusted odds ratio [AOR] 2.32, 95% CI 1.45-3.68). Regardless of financial and personal efforts, we observed a generally positive attitude. Almost half of the participants (n=172, 43.2%) reported using the internet daily, compared to 16.8% (n=67) of participants who never used the internet. Higher education (AOR 2.56, 95% CI 1.57-4.16) and income levels (AOR 1.31, 95% CI 1.06-1.62) were associated with higher practice scores of e-learning-related activities. Women, however, exhibited lower practice scores (AOR 0.44, 95% CI 0.27-0.71). Regular access to an internet-enabled device was reported by 43.5% (n=173) of the participants. Smartphones were the primarily used device (268/393, 67.3%). Common barriers to internet access were limited internet availability (142/437, 32.5%) and costs (n=190, 43.5%). Higher education (AOR 1.56, 95% CI 0.98, 2.46) and income (AOR 1.50; 95% CI 1.21-1.85) were associated with increased access to infrastructure, while it was decreased for women (AOR 0.48, 95% CI 0.30-0.77). Conclusions: Although Ethiopian health care professionals report mixed levels of knowledge, they have a positive attitude toward e-learning in medical education. While internet use is common, especially via smartphone, the access to devices and reliable internet is limited. To improve accessibility, investments in the digital infrastructure and individual digital education programs are necessary, especially targeting women and those with lower income. Due to their widespread availability, e-learning programs should be optimized for smartphones.