Level of satisfaction of patients and healthcare providers in the context of health information digitalisation: a case study of two hospitals in Kinshasa, DRC

The digitalization of medical records began in the 1960s to improve patient care and reduce medical errors.¹ Despite these ambitions, paper-based systems persisted due to resistance from healthcare professionals, who considered digital systems costly and unreliable.¹ By the 1980s, advances in information and communication technologies (ICTs) enabled wider adoption of computerized records in North America and Europe, establishing patient files as the cornerstone of medical informatics.²

Today, Electronic Medical Records (EMRs) are fundamental tools for healthcare professionals, enhancing care continuity and multidisciplinary coordination.³ They improve data accuracy and accessibility by structuring patient information and optimizing collection.^3,4 Graphical and chronological summaries support monitoring of clinical parameters, strengthening decision-making.⁵ EMRs streamline workflows by reducing documentation time and minimizing errors.⁵ Unlike paper systems, they provide instantaneous access and greater security.⁴ Networked EMRs allow simultaneous consultations, reduce administrative workload, and facilitate retrieval of patient files.⁶ Digital platforms also enable direct transmission of lab results, imaging data, and referrals,⁷ fostering collaboration and preventing redundant testing.⁸ Beyond clinical care, EMRs support medical education and research by offering diagnostic pathways and indexed searches.

Digitalization also improves hospital logistics and resource allocation. Automated systems track medication stocks, equipment, and staff schedules, optimizing resources.^7,8 Together, EMRs and digital logistics enhance efficiency, reliability, and accessibility. Globally, 70% of countries have integrated digital tools, and over 80% of healthcare facilities in industrialized nations use Electronic Health Records (EHRs) to strengthen patient monitoring.⁹ In Africa, more than 30 countries have launched initiatives with support from WHO and the World Bank, notably through the Health Information System for Health (DISH2).

In the Democratic Republic of the Congo (DRC), however, hospital digitalization remains limited and uneven. Infrastructure challenges such as unstable electricity, poor internet connectivity, and inadequate hardware constrain implementation. Digital literacy among providers is variable, requiring training to ensure effective EMR use. Governance and regulatory frameworks are evolving, raising concerns about data protection and confidentiality. Despite these barriers, telemedicine platforms and hospital management systems are emerging, particularly in Kinshasa, signaling gradual modernization and improved access to services.^10–13

This study therefore aims to evaluate how digital health systems influence patient satisfaction and provider workflow efficiency in Kinshasa hospitals, and to identify the sociodemographic and institutional factors that shape these experiences.

METHODS

Study design and site

This study employed a cross-sectional case study design at two hospitals in Kinshasa: Alliance Hospital and Initiative Plus Hospital Center. Both institutions have established digital health systems, implemented eight years ago at Alliance and four years ago at Initiative Plus. Initiative Plus, launched in July 2020, was designed around an integrated digital health network and has expanded to 170 beds across multiple sites. Alliance Hospital, founded in 2016, has grown from 9 to 95 beds. These hospitals were purposively selected for their advanced digital infrastructures and diverse patient populations, making them suitable for assessing satisfaction with digital health services.

Study population and sampling

The study population included patients (outpatients and inpatients) and healthcare providers (doctors, nurses, and support staff) directly involved in patient care. A three-stage purposive sampling technique was applied:

1. Hospital selection – Alliance and Initiative Plus were chosen for their digital maturity.

2. Unit selection – Consultation, prenatal care, and pediatric units were targeted to capture diverse experiences.

3. Participant selection – From 200 registered patients, 182 were included; from 150 providers, 119 were selected.

Sampling proportions (91% of patients and 79% of providers) maximized representativeness while excluding those who declined participation or did not meet inclusion criteria (e.g., patients under 18 without parental consent, providers not engaged in direct care). Randomization within units reduced selection bias by randomly selecting eligible participants from rosters.

KEY VARIABLES

The primary variable was satisfaction with digital health services, assessed separately for patients and providers.

• Patients: consultation quality, clarity of medical information, waiting time, hospital stay, service adaptation, and management of medications and lab results.

• Providers: consultation quality using digital tools, effectiveness of digitalization in managing patient data, accessibility of records, workflow efficiency, and management of prescriptions and lab tests.

• Patient–provider relationship: politeness and communication style.

Satisfaction was measured using a five-point Likert scale (1 = very dissatisfied to 5 = very satisfied). Reliability was tested with Cronbach’s alpha, with values above 0.70 considered acceptable. Sociodemographic data (sex, age, marital status, occupation, education, and years of service for providers) were also collected.

Data collection and analysis

Structured interviews were conducted using pre-tested questionnaires via KoboCollect. Instrument validity was ensured through expert review and pilot testing, and reliability confirmed with Cronbach’s alpha. Document review supplemented primary data, providing insights into hospital management and digital systems.

Data were exported to Excel and analyzed in SPSS version 26.

• Descriptive statistics summarized categorical variables as frequencies and percentages, and numerical variables as medians with interquartile ranges.

• Inferential analyses (Chi-square, Mann–Whitney U, logistic regression) identified sociodemographic and institutional predictors of satisfaction.

• Comparative analyses integrated patient and provider datasets to highlight perception gaps or alignments.

Bias mitigation

To mitigate bias, independent research assistants conducted interviews to reduce interviewer influence, while anonymity and confidentiality were assured to limit social desirability bias. Selection bias was addressed through randomization within purposively chosen units, though hospital choice may still reflect institutional bias. Recall bias was minimized with structured questionnaires and short recall periods, and measurement bias was reduced by validating instruments and confirming reliability with Cronbach’s alpha. Nonresponse bias was managed by adjusting sampling proportions, and confidentiality safeguards helped counter provider pressure to report positively. Despite these measures, residual bias remains an acknowledged limitation.

Ethics considerations

Informed consent was obtained from all participants. Ethical approval was granted by the Kinshasa School of Public Health Ethics Committee. Confidentiality was maintained through anonymized identifiers and restricted access to digital records. The study adhered to international ethical standards for human subjects research.

RESULTS

The study results are organized around three objectives: sociodemographic profiles, satisfaction with healthcare quality, and the perceived impact of digitalization.

Sociodemographic characteristics

Across both hospitals (Alliance, n=79; Initiative Plus, n=103; patients N=182; providers N=119), patients were slightly more female (54.4%) and mostly under 40 years (53.3%). Providers were predominantly female (78.8%), largely nurses (67.0%), and mostly with less than five years of experience (87.4%). A young, female-dominated population may influence expectations and adaptability to digital tools (Table 1).

Patient assessment of service efficiency and accessibility

Medication explanations were satisfactory for 65.4% but unclear for 34.6%. Laboratory services scored highest: 100% were promptly informed of results, 87.4% found them clear, and digital availability was strong (87.4%). Imaging was less common (12.6%); of these, 10.4% rated clarity and speed very satisfactory, while 1.6% were very unsatisfied. Costs were considered reasonable and well explained by 87.4% (Table 2).

Patient–provider relationship

Annoying remarks were rarely reported from doctors (80.2% never) but more frequent from nurses (62.1% never, 16.5% sometimes). Politeness was mixed, with 44.0% reporting no issues (Table 3).

Overall patient satisfaction and digital information

Consultation and welcome were rated very satisfactory by 60.4%, though 20.9% found them very unsatisfactory. Medical information was unclear for 34.6%. Waiting times were moderate (51.6% waited 10–30 minutes), with 60.4% very satisfied. Notably, 60% of patients did not use digital tools (Table 4).

Provider self-assessment of digitalization impact

Providers reported near-universal improvements in prescription, lab, imaging, and cost management. Yet contradictions emerged: while digitalization was credited with better lab management, providers denied faster result availability. Table VI showed strong endorsement of archiving, communication, and workflow efficiency, though service time reductions varied (67% Alliance vs. 78% Initiative Plus) (Tables 5 and 6).

DISCUSSION

The digitalization of healthcare services has transformed patient and provider experiences at Alliance Hospital and Initiative Plus Hospital Center. Most patients appreciated consultation quality and reception, though challenges remain in understanding medical information. Waiting times were generally well managed, and healthcare costs were widely perceived as affordable. On the provider side, digital tools were recognized for their benefits in record management, prescription organization, and workflow efficiency, facilitating medical exchanges and optimizing patient care.^11,12

Applying Donabedian’s model of healthcare quality (structure–process–outcome), digitalization improved the structure (availability of electronic records and digital tools), streamlined processes (prescription handling, lab test access, patient follow-up), and enhanced outcomes (patient satisfaction, reduced waiting times). However, gaps in communication highlight the need for tailoring information to patients’ literacy levels.¹⁴

Differences between hospitals are noteworthy: Alliance Hospital, with eight years of digitalization experience, reported more consistent efficiency gains in workflow and patient flow, while Initiative Plus, with only four years of exposure, showed higher variability in satisfaction scores. This suggests that longer exposure to DHI systems may foster greater institutional adaptation and sustainability.

Patient satisfaction was driven by consultation quality, reduced waiting times, and cost transparency.^13,15 However, one-third of patients struggled with unclear medical information, underscoring the importance of communication strategies adapted to diverse literacy levels. Comparisons with other studies reveal contextual differences: Marc K. Yamba Yamba reported 63.5% overall satisfaction at the University Clinics of Kinshasa, with poor reception quality,¹⁶ while Ali Habarek et al. (2017) at CHU Tizi Ouzou found dissatisfaction linked to medication availability and costs.¹⁷ Léonard Cissé et al. at CHU Treichville highlighted environmental concerns such as noise and high medication costs.¹⁸ These contrasts emphasize that satisfaction is shaped not only by digitalization but also by broader institutional and cultural contexts.

Providers reported strong benefits from digitalization, including improved data management, reduced errors, and enhanced workflow.^19–21 Yet, the uniform positivity (100% agreement in some areas) suggests possible response bias. To mitigate this, interviews were conducted by independent research assistants, and anonymity was assured, but social desirability bias may still have influenced responses. Future studies should incorporate triangulation methods (e.g., observational data, patient outcome measures) to validate provider-reported benefits.

Digital tools streamlined medical record management, strengthened prescription organization, and simplified lab result access, reducing errors and accelerating interventions.¹¹ Transparent cost structures fostered patient trust,^22,23 while workflow efficiency allowed providers to focus more on direct care.²¹ However, challenges remain: limited funding, insufficient technical skills, and coordination gaps among stakeholders hinder full adoption.¹⁵ Sustainability requires ongoing investment in infrastructure, staff training, and patient education. Importantly, Alliance Hospital’s longer exposure to digitalization appears to have facilitated smoother integration and greater efficiency gains compared to Initiative Plus, where adaptation is still evolving.

Strengths and limitations of the study

This study highlights the critical role of digitalization in enhancing healthcare services and satisfaction. By identifying best practices and challenges, it offers targeted recommendations for improving efficiency and patient-provider relationships.

However, limitations must be acknowledged. The sample size (182 patients, 119 providers) restricted subgroup analyses. The absence of probabilistic sampling may have introduced selection bias, and the uniform provider responses suggest social desirability bias. Mitigation measures included interviewer independence and anonymity assurances, but these cannot fully eliminate bias. Additionally, the study lacked a control group or pre-implementation comparison, limiting causal inference. Future research should adopt longitudinal designs to assess changes over time and compare hospitals with and without digital systems

CONCLUSIONS

Digitalization at Alliance and Initiative Plus hospitals has enhanced efficiency, patient satisfaction, and provider workflow through streamlined records, prescriptions, and lab access. Yet challenges in comprehension, digital literacy, and uneven adoption demand targeted interventions aligned with DRC health priorities. Hospitals should strengthen patient education, embed continuous digital training, and invest in resilient infrastructure and secure data systems, supported by policies ensuring confidentiality and interoperability. The comparison shows longer exposure fosters smoother adaptation, underscoring phased implementation. Ultimately, digitalization is a lever for health system strengthening, advancing universal coverage, equity, and trust in care.

ACKNOWLEDGEMENTS

We are grateful to all participants and health staff who contributed to this study.

DISCLAIMER

The views expressed in this article are those of the authors and do not necessarily represent the official position of their institutions.

ETHICS STATEMENT

Ethical approval was obtained from the Ethics Committee of the School of Public Health, University of Kinshasa (Approval No. ESP/CE/231/2024). Written informed consent was obtained from all participants prior to inclusion in the study.

DATA AVAILABILITY

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

FUNDING

This research received no external funding. The article publication charge (APC) was not funded by any external source.

AUTHORSHIP CONTRIBUTIONS

• Dan MULUMBA: Conceptualization, methodology, data analysis, manuscript drafting.

• Myriam SEKELE: Data curation, economic analysis, manuscript review.

• Bernard-Kennedy NKONGOLO: data analysis, manuscript editing, manuscript review.

• Rodriguez MBOMA: Methodology, statistical analysis, manuscript review.

• Jean-Paul SEKELE: Literature review, manuscript drafting, critical revisions.

• Dieudonné MPUNGA: Supervision, validation, final approval of the manuscript.

DISCLOSURE OF INTEREST

The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

Corresponding author:

Dan MULUMBA, dankoffis@icloud.com