Data collection tools.

Background
Whereas digital payments have been identified as a solution to health payment challenges, evidence on their adoptability among Community Health Workers (CHWs) is limited. Understanding their adoptability is crucial for sustainability. This study assessed the adoptability of digital payments for CHWs in Wakiso district, Uganda.
Methods
A convergent parallel mixed-methods study was conducted between November and December 2022, in Wakiso district, Uganda. We surveyed a random sample of 150 CHWs using a structured questionnaire and conducted key informant interviews among three purposively selected Digital payment coordinators. The study utilized the Technology Acceptance Model (TAM) framework to assess the adoptability of digital payments among CHWs. Factor analysis was performed to extract composite variables from the original constituting variables. Using the median, the outcome was converted to a binary variable and logistic regression was conducted to assess the association between the TAM constructs and adoptability of digital payments by CHWs. Quantitative data was analyzed using STATA 14, while qualitative data was transcribed verbatim and analyzed using ATLAS.ti 22.
Results
Nearly all participants (98.0%; n = 49) had previously received payments through mobile money, a digital payment method. (52%; n = 78) of CHWs said they intend to use digital payment modalities. Perceived risk of digital payments was associated with 83% lower odds of adoptability of digital payment modalities (OR = 0.17;95%CI:0.052, 0.54), while perceived trust had nearly three times higher odds of adoptability of digital payment modalities (OR = 2.82;95%CI:1.41, 5.67). Qualitative interviews showed that most CHWs reported positive experiences with digital health payments, including effectiveness and completeness of payments except for delays associated with mobile money payments across payment providers. Mobile money was reported to be easy to use, in addition to fostering financial responsibility compared to cash.
Conclusion
CHWs in Wakiso district intend to use digital payment modalities, particularly mobile money/e-cash. Perceived risk of the payment method and trust are key determinants of adoptability. Synergized efforts by both payment providers to manage payment delays and mitigate risks associated with digital payments could attenuate perceived risk and build trust in digital payment modalities.

研究背景
尽管数字支付（digital payments）已被证实可解决医疗支付难题，但针对社区卫生工作者（Community Health Workers, CHWs）采用数字支付的相关研究证据仍较为匮乏。了解其采用意愿对项目可持续性至关重要。本研究针对乌干达瓦基索区社区卫生工作者的数字支付采用情况进行了评估。

研究方法
本研究于2022年11月至12月在乌干达瓦基索区开展，采用汇聚式平行混合研究设计。研究通过结构化问卷对150名随机抽取的社区卫生工作者进行问卷调查，并对3名经目的抽样选取的数字支付协调员开展关键知情人访谈。本研究采用技术接受模型（Technology Acceptance Model, TAM）框架评估社区卫生工作者对数字支付的采用情况。通过因子分析从原始构成变量中提取复合变量，以中位数为界将结局变量转换为二元变量，并采用逻辑回归分析技术接受模型各维度与社区卫生工作者数字支付采用情况的关联。定量数据采用STATA 14进行分析，定性数据则逐字转录后使用ATLAS.ti 22进行编码分析。

研究结果
近98%的受访者（98.0%；n=49）此前曾通过移动货币（mobile money，一种数字支付方式）收取报酬。52%的社区卫生工作者（n=78）表示有意使用数字支付方式。数字支付感知风险与社区卫生工作者采用数字支付方式的比值比降低83%相关（优势比OR=0.17；95%置信区间CI：0.052, 0.54），而感知信任则使采用数字支付方式的比值比提升近两倍（OR=2.82；95%CI：1.41, 5.67）。定性访谈结果显示，多数社区卫生工作者对数字医疗支付体验持正面评价，包括支付的有效性与足额性，但不同支付服务商的移动货币支付均存在到账延迟问题。相较于现金支付，移动货币操作简便，且有助于培养财务责任感。

研究结论
乌干达瓦基索区的社区卫生工作者有意使用数字支付方式，尤其是移动货币/电子现金。支付方式感知风险与信任是影响其采用意愿的关键决定因素。支付服务商可通过协同合作解决支付延迟问题、降低数字支付相关风险，从而缓解社区卫生工作者的感知风险并建立其对数字支付方式的信任。