The government of Uganda has invested in E-learning pedagogy in many health training institutions. However, despite the high investment, there is a low adoption to this pedagogy. This study aimed at establishing institutional management framework (IMF) elements that could be used to improve e-learning adoption in midwifery schools in Uganda. The study used an explanatory sequential mixed method design to identify the most significant IMF dimensions. 210 participants from ten schools were sampled, and both qualitative and quantitative data were collected to determine the most relevant dimensions of IMF to e-learning adoption, and the detailed traits of each of the IMF dimensions relevant to e-learning adoption. Hierarchical linear regression analysis was used to establish whether background characteristics (gender, age, highest education level and role) and IMF elements (technology leadership, instructional design, online quality management and school financing role) had influence on e-learning adoption and it indicated that variability in e-learning adoption was more explained as a result of IMF elements, than background characteristics with 66.8% and 5.4% respectively. Instructional design (p=0.016), on-line quality management (p=0.000) and technology leadership practices of end users (p=0.000) were found to be the most significant IMF dimensions for e-learning adoption. Technology leadership practices accounted for 47.5% of the variance in e-learning adoption, with a moderate positive statistically significant relationship, and its salient traits were: commitment of school administration to provide technological facilities, encouragement of students and faculty to use technological facilities, a culture of appreciating those who excel at using technological facilities, grooming of technological champions, ambient and supportive environment for technological use, and institutionalising technological use in all teaching and learning activities of the school. Online quality management accounted for 55.5% of the variance in e-learning adoption with a strong positive statistically significant relationship, and its salient traits included: CD-ROMS-meeting expectation of users, collaborative improvement of online quality, LMS-meeting expectations of users, providing the best on-line experience, e-learning program being described as an excellent on-line learning experience, and guidelines for improving on-line quality. Instructional design accounted for 38.7% of the variance in e-learning adoption, with a moderate positive relationship and its key salient traits included: choosing an appropriate instructional design model to guide the entire e-learning process, interactivity of e-learning materials, collaborative working in developing and updating e-learning materials, eliciting feedback on instructional materials, and engaging in more than one e-learning activity. However, hierarchical linear regression, a special form of multiple linear regression analysis, highlighted that school financing mechanisms were not significant influencers of e-learning adoption. Therefore, midwifery schools might need to focus on the three most relevant dimensions of the IMF with their associated traits if they are to improve e-learning adoption.
Keywords: Institutional Framework, E-learning, adoption, Midwifery schools, Uganda, Developing country.