Workplace affordances for learning in rural primary care

The rapid pace of digitalization in health care demands continuous learning as health-care professionals adapt to new tools, systems and processes (Vallo-Hult, 2021; Öberg et al., 2018). Learning at work is a dynamic, complex process, shaped by interactions among individuals, technologies, organizational structures and broader social contexts (Lizier and Reich, 2020). In primary care, health-care professionals engage in continuous informal learning within their everyday work environment, which includes not only routines and practices but also patients, colleagues and technological tools (Mogensen et al., 2010; Stabel et al., 2022).

The introduction of e-health has been described as a transformational change in both health-care practice and its underlying values (Boers et al., 2020). In this study, we define e-health as the use of digital technologies to deliver, support or enhance health-care services and information (Boers et al., 2020; da Fonseca et al., 2021; Van Velthoven and Cordon, 2019), including telehealth consultations, documentation systems, self-monitoring devices and digital check-in systems. These technologies are embedded in clinical routines, care relationships and organizational structures. From a sociotechnical perspective, e-health adoption involves not only technical implementation but also the negotiation of values, practices and learning processes at workplace level (Sittig and Singh, 2010).

We approach e-health as a practice-based, context-sensitive phenomenon, rather than a uniform technological intervention. In rural primary care, e-health has the potential to bridge geographic barriers by expanding access for people in remote areas (Gabrielsson-Järhult et al., 2021; Kirby and Yabroff, 2020; Mackwood et al., 2024). However, integrating e-health into practice presents both opportunities and challenges for workplace learning. While digital tools create new learning opportunities, requiring digital literacy and adaptation to changing patient interactions (Jung et al., 2022), implementation often demands overcoming organizational, technical and social barriers (Cresswell and Sheikh, 2013; Van Velthoven and Cordon, 2019).

Previous research shows how conditions for primary care differ between urban and rural settings (Aubrey-Basler et al., 2024; Ekman et al., 2019; Lindberg and Carlsson, 2018). Yet knowledge about learning processes during e-health implementation in rural primary care – and the impact of these technologies in rural health care – remains limited (Hage et al., 2013; Nasir et al., 2023; Salmi et al., 2025). Little is known about how e-health is integrated into the daily practice of rural health-care professionals (Woods et al., 2024). Addressing this gap is essential for unlocking the potential of e-health in rural health care (Butzner and Cuffee, 2021).

Workplace affordances refer to opportunities and constraints within a work environment that shape how individuals engage in learning and professional development (Billett, 2001a; Stabel et al., 2022). These emerge through the interplay of organizational structures, social interactions and available tools, influencing both formal and informal learning.

The aim of this study is to explore workplace affordances for informal learning among health-care professionals in rural primary care during e-health adoption:

The empirical data were collected at a rural primary health-care unit in Sweden, through interviews with doctors, nurses, medical secretaries, psychologists and managers (n = 19).

Several studies have shown that there are differences between rural and urban primary care (cf. Ekman et al., 2019; Lindberg and Carlsson, 2018). In Sweden, as in most other organization for economic co-operation and development countries, the rural population is slightly older than the urban population and tends to have poorer health, lower education levels and lower income (Swedish Agency for Health and Care Services Analysis, 2021). In general, patients in rural areas often face difficulties accessing primary care, due to factors such as provider shortages, rural hospital closures and greater geographical distances to health-care services (Murphy et al., 2019). Furthermore, rural patients often experience higher rates of chronic health conditions that require regular treatment through primary care (Lindberg and Carlsson, 2018; Mackwood et al., 2024). Due to staff shortages and limited access to specialized care, rural physicians frequently work long hours and perform a broad range of medical procedures (Groenewegen et al., 2020; Petrazzuoli et al., 2023).

E-health presents opportunities for improving primary care in rural settings, helping to bridge gaps in primary care access by enabling medical consultations and continuous care without extensive travel (Butzner and Cuffee, 2021; Ekman et al., 2019; Lindberg and Carlsson, 2018; Mackwood et al., 2024). It has been shown that e-health offers significant advantages for rural patients, reducing anxiety and improving recovery times (LeBlanc et al., 2020), while health-care professionals benefit from closer connections to colleagues and improved support for complex care, particularly valuable in rural settings where resources may be limited (LeBlanc et al., 2020).

Health-care professionals play a crucial role in the adoption and success of e-health (Leigh and Ashall-Payne, 2019; Svensson, 2019). However, adopting e-health in rural areas can be challenging. These challenges include insufficient broadband infrastructure and lower health literacy among rural patients (Campos et al., 2024) but also the learning processes of health-care professionals (Al-Omary et al., 2024). Studies have shown that structured training programs aimed at building e-health skills among the rural health-care workforce are often scarce (Woods et al., 2024; Öberg et al., 2018). Moreover, when such programs do exist, their content may quickly become obsolete as technology evolves. Frequent updates mean that health-care professionals must continuously learn and adapt, which can be demanding in an already high-stress environment (Öberg et al., 2018). As a result informal learning, learning through everyday work activities, becomes essential when health-care professionals begin using e-health tools (Joynes et al., 2017; Stabel et al., 2022). Informal learning in health care is often triggered by new treatments, complex care needs, patient feedback, policy changes and revised guidance from professional bodies (Joynes et al., 2017; Stabel et al., 2022).

In this study, learning is understood as emerging through participation in work practices (Billett, 2001a, 2001b, 2022). Learning that takes place outside the classroom in everyday work situations, individually or together with others in a social process, is commonly conceptualized as “informal” (Cerasoli et al, 2018; Decius et al., 2019; Eraut, 2011; Manuti et al., 2015). Informal learning is directly related to activities in the work environment. It is a critical component in staff training, providing an organization with an important source of knowledge (Wihak and Hall, 2011).

The informal workplace learning in focus in this study refers to the process of spontaneous and unstructured acquisition of knowledge and skills within the context of day-to-day professional practice. Such learning can occur unconsciously or unintentionally, lacking explicit objectives, designated instructors or structured learning environments (Eraut, 2004). Informal learning occurs through interactions with colleagues, other health-care professionals, patients and workplace resources, including written materials and technological tools available in the workplace.

In primary health care, informal learning incorporates both intentional and incidental learning derived from trial and error, peer discussion and everyday work processes (Joynes et al., 2017). Learning can also be regarded as socialization, an unconscious appropriation of the norms and rules of action that exist in the environment in which the individual is located and develop in direct connection with concrete tasks (Johnson and Majewska, 2022). The result of learning often constitutes a kind of tacit, or embodied, knowledge that is part of the individual’s general ability, closely intertwined with work itself. This makes it difficult to treat learning as a separate everyday work activity, as it is an ongoing dimension of work (Eraut, 2007). The social, cultural, organizational and technical context in which work takes place is crucial for understanding how learning occurs (Le Clus and Volet, 2008; Bryson et al., 2006). As work practices and learning are closely intertwined, these processes take shape in distinct ways in each workplace (Derrick et al., 2022).

The theory of workplace affordances has been used to highlight the importance of context and individual perception in workplace learning (e.g. Billett, 2001a, 2001b; Brymer and Schweitzer, 2022; Stabel et al., 2022; Trisukhon et al., 2024). An affordance typically refers to the perceived opportunities and possibilities a work environment provides for employees to engage in specific behaviors, activities or interactions in their daily work (Billett, 2001a, 2001b, 2011). Understanding how workplaces enable learning opportunities and how individuals engage in these activities is crucial, as workplace affordances can either enable or constrain learning. Affordances concern both the workplace context and the individual learner’s agency, as individuals choose to engage based on their motivation, personal history, intentionality, preferences and habits. This connects affordances to motivational theories such as self-determination theory (Deci and Ryan, 2000), which help explain how intrinsic and extrinsic motivation influence learning.

Workplace affordances shape opportunities for learning, but how these affordances are realized depends on the nature of the learning environment (Billett, 2001a; Chen and Teherani, 2015; Fuller and Unwin, 2004). Fuller and Unwin (2004) distinguish between expansive and restrictive learning environments, where in the former, employees enjoy higher levels of autonomy and are actively involved in problem-solving processes. Restrictive learning environments, on the other hand, are characterized by limited work tasks, isolation and individualism with workers being excluded from decision-making. A restrictive learning environment might lead to low trust, a focus on routine and predictability (Fuller and Unwin, 2004). Linking affordances to the expansive/restrictive continuum enables a richer understanding of how rural primary care settings either support or constrain informal learning during e-health adoption. While the concept of affordances offers a theoretical lens for understanding the potentiality of workplace settings to support learning, the typology of expansive/restrictive learning environments provide an empirical and conceptual framework to characterize those settings in practice (Billett, 2001a; Fuller and Unwin, 2004). This combined approach has previously been explored by Bryson et al. (2006) in a case study in an industrial setting, who showed how expansive environments coincided with richer affordances, and conversely, how restrictive environments reflected limited affordances. However, such theoretical integrations remain rare, particularly in health-care research.

In this study, we focus on affordances related to (1) opportunities for and barriers to participation, (2) access to guidance and support, (3) workplace norms and practices, (4) individual engagement in digital health and (5) technological affordances – the perceived opportunities of e-health.

These affordances were selected because they reflect central mechanisms that shape workplace learning, as emphasized in both Billett’s work and in empirical studies in health-care settings (e.g. Chen and Teherani, 2015; Liljedahl, 2018; Stabel et al., 2022). They capture how structural conditions, workplace culture and technology intersect with individual agency to enable or hinder learning in everyday work (Billett, 2001a; Eraut, 2004; Fuller and Unwin, 2004).

This study explores two central research questions:

RQ1. Which workplace affordances shape informal learning in rural primary care?

RQ2. How do these affordances influence e-health adoption?

Engaging with workplace affordances for learning is a complex, contextual and often subjective process, involving the personal experience and perception of individual health-care professionals. Semistructured interviews allowed participants to express these complex experiences in their own words, generating nuanced, detailed data that would not easily emerge from, for example, surveys or observational methods. Furthermore, the data were analyzed by means of thematic analysis, as it offers a flexible yet rigorous method for identifying and interpreting patterns of meaning across qualitative data (Braun and Clarke, 2006, 2012, 2022). As Nowell et al. (2017) note, it is well-suited to examining participants lived experiences and perceptions within complex social and organizational contexts, such as rural primary care.

All participants worked in the same primary health-care unit located in a rural municipality in Sweden. The study site was selected following a meeting in 2023 between the authors and a regional health-care authority, after which a manager at the health-care center agreed to participate, enabling data collection.

Health care in Sweden is governed by regional health-care authorities. Primary health care is regulated by health policy goals adopted by these authorities, meaning primary health-care centers need to work towards these goals to receive payment. For instance, one goal is that a certain percentage of all visits to primary care must be digital. To achieve this, the health-care unit in the study employed a doctor based outside Sweden who worked remotely from home, meeting patients through video calls.

The regional health-care authority also planned to implement a new electronic patient records system. To prepare, the health-care unit was implementing voice recognition software, a software converting speech into text supported by artificial intelligence (AI). This enabled doctors to produce medical documentation, a task traditionally performed by medical secretaries.

To streamline on-site visits, digital self-check-in kiosks were introduced with the goal of reducing waiting times and easing the workload for reception staff.

The health-care center was also preparing to launch blood pressure self-monitoring, enabling patients to measure and report their readings from home. This initiative was part of a broader effort to enhance patient engagement and improve the follow-up of chronic conditions.

This means a total of four e-health technologies were being implemented at the health-care center: Digital health meetings, medical documentation supported by artificial intelligence, digital self-check in kiosks and Self-monitoring of blood pressure.

Data were collected between January and August 2024 through semi structured interviews with health-care professionals (n = 19). The participants consisted of doctors (GP) (4), registered nurses (RN) (5), nurse assistant (NA) (2), medical secretaries (MS) (3), psychologists (PS)(3) and personnel in managerial roles (MGRS) (2). Participants were recruited via convenience and snowball sampling (Simkus, 2023).

An interview guide with open ended questions was used. The health-care professionals were asked about their individual experiences of using digital health technologies, their motivation for using digital health technologies, professional learning and development and the practical aspects of using digital health technologies in a rural setting. The interviews, which lasted between 35 and 70 min, were audio-recorded and transcribed verbatim. They were conducted face-to-face in private rooms at the health-care center, ensuring confidentiality.

The research team approached the study as outsiders to the specific health-care unit in the study. This outsider position supported a reflective and analytical stance, while minimizing potential bias or role conflicts in data collection and interpretation (Dwyer and Buckle, 2009). At the same time, the research team brought a multidisciplinary perspective, with backgrounds in informatics, nursing science, psychology and work-integrated learning.

Data collection continued until the data set was judged rich enough to support meaningful theme development (Braun and Clarke, 2021).

Thematic analysis was conducted following Braun and Clarke’s (2006, 2012, 2021, 2022) framework.

Braun and Clarke (2006) distinguish between a top-down (theoretical/deductive) thematic analysis, driven by the specific research question(s) and/or the analyst’s focus, and a bottom-up (inductive) analysis, driven by the data itself. In this study, the theoretical framework was used as a lens to guide theme development and interpretation. This represents a primarily deductive approach, in which theoretical constructs informed the analytic focus. By using theory to guide interpretation, we ensured analytic depth and coherence across themes while maintaining flexibility to capture unexpected patterns (Maguire and Delahunt, 2017).

In accordance with Braun and Clarke (2006, 2012, 2022), the analysis started with a familiarization phase where all interviews were listened to and transcribed verbatim. After the texts were produced, the transcripts were imported into NVIVO14 and read repeatedly while actively searching for patterns and meaning. Next, initial codes were generated. These codes identified a feature of the data (semantic and latent) that appeared meaningful to the aim of the study, i.e. a basic element of the raw data that could be assessed in a meaningful way.

The next phase focused on themes, using the workplace affordance framework as an interpretative lens. Significant patterns in the data were identified and codes were sorted into themes and sub-themes. All themes were later examined in more detail to exclude overlapping themes or themes with insufficient data. The review included each individual theme, as well as how they fit within the complete data set. Each theme was analyzed and refined, generating a clear definition and name. In the final phase, text extracts were chosen that relate to the analysis and the manuscript was drafted.

The study was approved by the Swedish Ethical Review Authority (dnr XXXX-XXXX-XX) and conducted in accordance with the Helsinki Declaration (World Medical Association, 2013). Given the single-unit focus, particular attention was paid to confidentiality and voluntariness. Participants were informed of the study’s aim both orally and in writing, provided written consent and were assured they could withdraw at any time without giving a reason. To ensure confidentiality, names and identifying details were removed from transcripts and replaced with participant codes, known only to the researchers.

Special care was taken to protect internal confidentiality, recognizing that participants could identify each other through shared experiences or specific quotations. Quotations were, therefore, selected and edited to remove or generalize identifying details such as job titles, anecdotes or workplace incidents, minimizing the risk of indirect identification.

The results are organized into four main themes as illustrated in Table 1. These reflects different dimensions of workplace affordances in rural primary care. Two of the themes – opportunities for and barriers to participation and workplace norms and practices – primarily concern general affordances shaped by the rural context and workplace culture. The other two themes – individual engagement: relevance and subject matter and technology: for whom and for what – focus on domain-specific affordances related to digital tools and e-health practices which professionals often described as “digital work.” This distinction helps illustrate how informal learning was supported or constrained depending on the content and context of work, with markedly different conditions surrounding “patient care” – direct patient interaction – and “digital work.”

Below, each theme is described with quotations from the interviews.

In the theoretical framework, opportunities for and barriers to participation indicate the presence of meaningful, diverse or challenging tasks, as well as engagement in work activities. It also encompasses factors that may hinder participation, such as workplace hierarchy or professional boundaries. This theme reflects general workplace affordances related to participation in rural primary care. The participants in the study describe the opportunities for participation at the health-care center as plentiful and immediate:

This automatic skill acquisition through informal learning is described as directly linked to the inherent conditions of rural primary care. Health-care professionals explained that due to earlier hospital discharges, they are increasingly obliged to manage complex cases that, in urban settings, would likely remain within hospital care. This necessitates broader medical competencies and problem-solving skills, as they must navigate conditions typically handled by specialists. The challenge of managing diverse and high-acuity cases fosters continuous professional learning as nurses and doctors must refine their clinical judgment, collaborate across disciplines and adapt to evolving patient needs. However, this increased responsibility also adds pressure and a greater professional workload, balancing the benefits of skill development with the strain of complex care demands:

The registered nurse expressed being torn between what is best for the patient and concern about an increased workload at the primary care center: an in-flow of patients from hospitals often means having to handle more complex care needs.

The rural primary care center also treats many emergency cases, patients that would, in all likelihood, go to the Emergency Room (ER) at a hospital if they lived geographically closer to an ER:

However, the reluctance is not only related to the ER. A frequently mentioned aspect is how patients in rural areas are generally perceived to be reluctant to seek help from health care. When they do seek medical care, they might have been sick for a long time. Rurality, characterized by many older patients, their choices and long distances, influence everyday practice and, thus, learning in primary care:

While patients with complex care needs can lead to opportunities for learning, the workload might also prove to be a barrier to learning. The high workload at the health-care center, with many patients requiring complex care, prevents the staff from prioritizing learning about e-health:

While this theme focused on general participation and workload conditions, it is important to note that these general constraints also shaped how professionals approached digital work. The uneven use of e-health technologies, described below, reflects how time pressure and task prioritization can restrict domain-specific learning opportunities – setting the stage for the next theme on individual engagement in digital tools.

In the theoretical framework, individual engagement represents the alignment between what is afforded to individuals and their values, goals and understandings, i.e. how individual professionals perceive the relevance of the subject matter, i.e. the content of work. This theme centers on domain-specific affordances by exploring how professionals perceived and engaged with different kinds of work – particularly the contrast between “patient care work” and “digital work.”

In the professionals’ narratives, e-health is often described as “digital work,” roughly corresponding to (i) telehealth as in digital health-care meetings or remote monitoring, (ii) interprofessional work processes, such as the implementation of speech recognition software for medical documentation or (iii) self-check in terminals, where patients register their arrival on a terminal instead of talking to a receptionist. In the interviews, “digital work” is described as something that differs from ordinary day-to-day patient care. “Patient care work” refers to the direct work carried out with patients, such as triage, nursing, treatment and support.

The ways in which knowledge is shared among professionals are described as dependent on subject matter. While there are abundant descriptions of unstructured informal learning and knowledge sharing in relation to patient care work, when the subject shifts to digital work the focus turns to more structured forms of knowledge sharing during regular, scheduled workplace meetings that take place at fixed intervals. While daily knowledge sharing in patient care work is stated to happen on the spot, with ad-hoc problem-solving and spontaneous sharing of experiences initiated by health-care professionals themselves, knowledge sharing revolving around digital work is depicted as slower, more structured and initiated by the managers:

This illustrates a restrictive learning environment where the subject matter – digital care – is externally mandated rather than internally motivated. The affordance exists but is experienced as misaligned with individual engagement, a key dimension in Billett’s framework.

A technological affordance indicates whether a specific technology is perceived to facilitate or inhibit practice and participation. As such, this theme focuses on domain-specific affordances related to e-health practices. According to the health-care professionals in this study, the technological affordances of e-health mainly concern being a facilitator for patients, an enabler who helps rural patients avoid long journeys, so called telehealth. While health-care professionals describe how the COVID-19 pandemic gave rise to unstructured dissemination of knowledge concerning telehealth solutions and how some also used digital solutions when interacting with patients, i.e. digital care meetings, the use and somewhat unstructured learning, waned after the pandemic. E-health has not become what can be described as everyday practice among health-care professionals in general:

Albeit jokingly, the doctor expresses discomfort when it comes to digital care meetings. This is said despite the fact that the health-care center employs a GP who works remotely and psychologists who use digital care meetings in their daily work. However, knowledge about these practices does not appear to have spread.

How technological affordances can help rural health-care transcend geographic distances was frequently acknowledged during interviews: how older patients may find traveling to the health-care center unnecessarily strenuous. However, this identified technological affordance is not enough to induce co-participatory practice in digital health.

Some nurses expressed the notion that telecare might be more efficient for health-care professionals and how digital meetings can be more efficient as they are more to the point. Others pointed to the necessity of small talk; how small talk constitutes a social affordance of a physical meeting that might provide important information for the professional in their work. This affordance is also perceived as important for many older and lonely patients. A nurse stated:

This social affordance is also mentioned in relation to other technological artefacts. When commenting on the use of self-check in terminals, a medical secretary feared that the social interactions with receptionists would be lost when technology is introduced:

A frequently mentioned aspect is that to make a digital care meeting possible, the patient needs the necessary skills to use technology to connect to it, skills that are often missing. Another view is that it is not only about skills, but also about technology acceptance. If a digital care meeting is to take place, the patient needs to accept this form of communication, which is often not the case:

This highlights the complex role of technological affordances: while the tools exist, both patients’ digital literacy and professionals’ perceptions of relevance limit their actualization – showing how affordances are contingent upon cultural, social and motivational factors. Digital literacy is described as a factor among both patients – patients being old and lacking the necessary skills to, for instance, connect to a digital care meeting – and health-care professionals. Younger physicians often express how they are more digitally competent and confident than older physicians: how older doctors, nearing retirement age, are reluctant to learn about new technology. This view is not necessarily expressed in a negative way and instead a reluctance to learn when nearing retirement age is viewed as something natural.

In the theoretical framework, workplace norms and practices indicate the culture and social environment of the workplace, including its perceived inclusiveness and encouragement. It primarily reflects general affordances – such as flat hierarchies, collegial openness and strong interpersonal trust – that were deeply embedded in the rural primary care setting. These norms created an expansive learning environment, particularly in relation to patient care. However, the same inclusive culture did not automatically extend to digital work. Despite general openness to peer learning, knowledge and practice surrounding e-health tools remained fragmented, highlighting a lack of shared domain-specific learning infrastructure.

Participants described the health-care center as “open,” “without hierarchies,” “with no boundaries between professions,” supported by accessible leadership and a positive atmosphere – an open invitation to co-participate in learning. These affordances relied heavily on the social aspects of work and the rural context: collegial interactions, the ease of knocking on a colleague’s door and low hierarchy were integral to day-to-day learning. Such learning was often triggered by rural practice, with patients who had complex care needs, were well known to staff and sometimes required emergency care. The cultural dimension of affordance describes how workplace culture and context shape practice, experience and what is perceived as possible. In the interviews, “distance” and “close” emerged as recurrent codes. “Distance” referred both to geography – greater travel to services such as education, health care and transport – and to low population density, with residents spread over large areas. “Close” denoted social closeness: despite physical distance, communities are tight-knit, offering mutual support, often built over generations. It also described the relationship between patient and professional.

Knowing patients through prior interactions informed care decisions and reflected an expansive learning environment where social closeness and low hierarchy encouraged informal knowledge exchange. This closeness was contrasted with urban practice, as one nurse noted:

The purpose of this study was to explore workplace affordances for informal learning among health-care professionals in rural primary care during e-health adoption. In the following section, the findings of the study are discussed further.

In this study, subject matter refers to the domain-specific content of work tasks and activities. Workplace learning literature highlights that the nature of work (Eraut, 2004; Le Clus and Volet, 2008), including its goals, tools and relational aspects, significantly shapes how learning is afforded and enacted (Billett, 2001a; Fuller and Unwin, 2004).

The result shows a clear distinction between “patient care work” and “digital work” and how subject matter affords different opportunities for co-participation at work.

“Patient care work” was described as embedded in the rural context, shaped by geography, demographics and community closeness. Professionals emphasized that learning in this domain is informal, situated and immediate – emerging from the realities of day-to-day problem-solving, peer support and collegial collaboration. These activities reflect a high degree of autonomy and are perceived as meaningful, relational and consistent with professional identity. In this context, informal learning is expansive: knowledge is shared dynamically, decisions are discussed collaboratively and learning is driven by intrinsic motivation and mutual trust. Patient care is experienced as a socially and materially situated practice, inseparable from the rural context in which it unfolds. In this perspective, learning emerges not just from the tasks themselves but from how those tasks are enacted within a specific rural infrastructure and culture.

By contrast, “digital work” – telehealth consultations, digital check-ins and medical documentation supported by artificial intelligence – was often seen as organizationally mandated and disconnected from the clinical identity. Professionals described this work as externally imposed, framed by formal routines and often discussed in staff meetings led by management. Learning in this area was more structured, slower and less participatory, contributing to a restrictive learning environment where engagement was minimal and knowledge uptake uneven. The contrast between these domains is illustrated in Figure 1, showing how dissemination and motivation differ depending on the subject matter.

These results indicate that while both the unstructured and the more structured settings afford opportunities for learning, these affordances differ, with the daily “patient care work” to a larger extent being more co-participatory, engaging and focusing on communication (a two way dialogue) and “digital work” to a larger extent being more nonparticipatory, passive, focusing on information. This suggests that the subject matter is not a neutral backdrop but an active determinant of which affordances are realized.

While scholars have recognized how affordances for learning vary depending on context, role and task (Bryson et al., 2006; Fuller et al., 2005; Liljedahl et al., 2022; Chen and Teherani, 2015) these insights remain analytically fragmented. To understand the divergence between “patient care work” and “digital work,” we propose a two-level typology of workplace affordances for informal learning: general affordances and domain-specific affordances, as depicted in Figure 2.

General affordances refer to opportunities broadly available in the organizational and social environment, such as open communication, peer support, flat hierarchies and cultural norms that encourage help-seeking and informal dialogue. These conditions are strongly present in the rural health-care setting studied, where proximity and familiarity with both colleagues and patients foster an expansive learning environment. These general affordances support learning across a wide range of professional activities, particularly in direct patient care, where professionals frequently describe spontaneous knowledge sharing and collaborative problem-solving.

In contrast, domain-specific affordances are tied to the specific knowledge, tools and practices required for a particular work domain – in this case, digital health. Examples include guidance on using telehealth platforms, role-relevant digital mentoring or embedded time for experimenting with new digital workflows. Our findings suggest that such affordances are less developed or unevenly distributed in the studied setting. Digital work is often perceived as peripheral or less meaningful, leading to lower engagement, especially when its implementation is experienced as top-down.

This two-level framework helps us understand how the same workplace can simultaneously support expansive learning in one domain (patient care work) and offer a restrictive learning environment in another (digital work). This complements and extends Billett (2001a) concept of affordances, as well as Fuller and Unwin’s (2004) typology of learning environments, showing how affordances are layered: General affordances form the foundation of an inclusive culture, while domain-specific affordances determine how well particular innovations, such as digital tools, are integrated into practice.

Practically, the findings highlight that successful digital transformation in rural health-care requires more than infrastructure or general support. It necessitates intentional strategies to create domain-specific affordances that make digital work relevant, engaging and professionally meaningful. The proposed two-level typology may help clarify how informal learning is not only socially and culturally embedded but also shaped by the content of what is being learned. Aligning domain-specific affordances with general workplace culture may, thus, be essential to achieving broader and more sustainable adoption of e-health in rural primary care.

This study asked (1) which workplace affordances shape informal learning in rural primary care, and (2) how these affordances influence the adoption of e-health. The findings show that general affordances support informal learning in traditional patient care, while weaker domain-specific affordances constrain learning related to digital tools. Consequently, e-health adoption is uneven, shaped by workload, motivation and perceived relevance. By identifying a duality of work – patient care vs digital work – and linking it to expansive and restrictive learning environments, we show how the same workplace can afford both rich and limited learning opportunities. Our two-level typology of general and domain-specific affordances clarifies how learning is unevenly distributed across work domains. This dual structure is shaped by the rural context, where social cohesion supports patient-centered learning, while time pressure and digital hesitancy constrain e-health engagement.

In practical terms, successful e-health adoption requires not only technical training but also deliberate efforts to make digital work meaningful, relevant and integrated into staff members’ professional identity and everyday practice. General workplace affordances (supportive culture, openness) are not enough; organizations should also foster domain-specific affordances – such as role-relevant mentoring, workflow-sensitive guidance and locally situated problem-solving for digital care.

More broadly, the study underscores the crucial role of context. Rural primary care is not just a backdrop but an active force shaping what is seen as relevant, feasible and worth learning. Implementing new digital tools demands engagement with local work practices and professional values, rather than assuming that general readiness or technical access will ensure adoption.

While presenting insights into workplace learning and digital health implementation in rural primary care, several limitations need to be acknowledged.

This study focused on a single rural primary health-care unit in Sweden. As is common in qualitative research, the aim was not statistical generalization but rather to generate context-sensitive insights into how workplace affordances shape informal learning during e-health adoption. While the specific organizational structures, digital tools and professional cultures may vary elsewhere, many of the underlying mechanisms identified – such as the interplay between rural context, perceived relevance of digital tools and co-participatory learning – may resonate across similar rural or resource-constrained health-care environments.

The authors would like to thank Thordénstiftelsen for funding, which made this research project possible.