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Participation was low, with only 36% attending at least two sessions. Paediatric ECHO sessions showed the highest attendance, while computer comfort and ICT self-motivation increased the likelihood of participation. In contrast, adequate ICT skills were associated with lower participation. 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Human Resources for Health (2026) 24:1  \n[https://doi.org/10.1186/s12960-025-00995-4](https://doi.org/10.1186/s12960-025-00995-4)  \nHuman Resources for Health  \n RESEARCH Open Access  \nWhat drives participation? A look at personal   influences on Tanzanian nurses in project ECHO  \nGodfrey Kacholi1,2*, Bahati Mfaki3, Idda Lyatonga Swai4 and Mackfallen G. Anasel 1,2  \nAbstract  \nIntroduction The Project Extension for Community Health Care Outcomes (Project ECHO) is a renowned collaborative model of medical education and care management. This model enhances the capabilities of primary care providers through telementoring, providing a promising and cost-effective approach to augmenting healthcare professionals’ knowledge. Participation in weekly ECHO sessions often falls short of expectations despite its benefits. This study examined the personal factors that influence Tanzanian nurses’ engagement with Project ECHO.  \nMethods We conducted a cross-sectional study involving 450 nurses from 42 primary healthcare facilities in Dar es Salaam, Tanzania. A standardised questionnaire served as the data collection tool. Descriptive analysis was performed to calculate means, frequencies and percentages for socio-demographic variables and the level of participation of nurses. Bivariate and multivariate logistic regression were used to test the association between the level of participation of nurses in ECHO sessions and their socio-demographic factors.  \nResults Only 36%(n= 162) of 450 nurses attended at least two ECHO sessions (median 2, IQR 1–2) . Paediatric ECHO sessions had the highest attendance (43 . 8%, n= 71) . Ease of computer use (AOR = 1 . 95, p = 0 . 015) and ICT self-motivation (AOR = 2 . 08, p = 0 . 003) significantly increased attendance. A majority (58%) lacked personal computers. Surprisingly, adequate ICT skills lowered the likelihood of attending at least two sessions (AOR = 0 . 37, p \u003C 0. 001) .  \nConclusion The study found low participation of nurses in ECHO sessions, with paediatric ECHO sessions showing the highest engagement. Comfort with online format and ease of instructions motivated attendance, while computer proficiency and ICT motivation were positive predictors. Surprisingly, adequate ICT skills correlated with lower participation. Enhancing basic computer literacy and ICT motivation is crucial for improved engagement. Future research should explore reasons for lower participation among digitally skilled nurses and tailor session content accordingly. Keywords Project ECHO, ECHO sessions, Participation, Health professional development, Nurses, Tanzania  \n*Correspondence: Godfrey Kacholi[gkacholi@gmail.com](gkacholi@gmail.com)  \n1 Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Mzumbe, P. O. Box 2, Morogoro, Tanzania  \n2 Centre of Excellence in Health Monitoring and Evaluation, Mzumbe University, Morogoro, Tanzania  \n3 Private Health Laboratory Board, Ministry of Health, Dodoma, Tanzania  \n4 Department of Local Governance and Management Studies, Mzumbe University, Morogoro, Tanzania  \nIntroduction  \nThe healthcare system in Tanzania is faced with significant constraints that limit its ability to provide quality healthcare services [1] . These restraints include a lack of financial resources, a geographically dispersed population, and a shortage of qualified healthcare professionals, particularly in rural areas [2, 3] . These challenges pose a considerable obstacle to ensuring access to high-quality healthcare services, thereby exacerbating ongoing health disparities throughout the country [4, 5] . In this context, innovative strategies are vital to boost the knowledge, skillsets, and capacity of  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or fo","cbCaijfezNlQLJJE","https://ap.wps.com/l/cbCaijfezNlQLJJE","pdf",705428,"English","# Abstract\n# Introduction\n# Methods\n# Results\n# Conclusion\n# Keywords","[{\"question\":\"How was nurse participation in Project ECHO measured in the study?\",\"answer\":\"A cross-sectional survey of 450 nurses used a standardized questionnaire. Participation levels were analyzed with descriptive statistics and logistic regression to test associations with socio-demographic factors.\"},{\"question\":\"What factors increased attendance at least two ECHO sessions?\",\"answer\":\"Ease of computer use and ICT self-motivation significantly increased attendance in the multivariate analysis.\"},{\"question\":\"Why might digitally skilled nurses participate less?\",\"answer\":\"The study found that adequate ICT skills correlated with lower participation. It recommends future research to explore reasons for lower engagement among nurses who already have digital skills and to tailor session content accordingly.\"}]","What drives participation - A look at personal influences on Tanzanian nurses in project ECHO | PDF",1790750092]