Eveline Hage

Implementation factors and their effect on e-Health service adoption in rural communities: a systematic literature review

BackgroundAn ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities?MethodsWe conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption.ResultsOf the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption.ConclusionsRural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).

The dual impact of online communication on older adults’ social connectivity

Purpose – In today’s aging world online communication is often viewed as a means to enhance social connectivity, and therefore well-being, of older adults. However, previous research on the influence of online communication on social connectivity largely disregards older adults, yields conflicting results and fails to assess the – debatable − causal direction of relationship. The purpose of this paper is to overcome these issues by developing four hypotheses related to who uses what, how, with whom. Design/methodology/approach – The authors use a panel data study to test the hypotheses, including 302 older adults. Response rates are between 62 and 75 percent. Findings – The authors find, first, that older adults differentiate between social connectivity with other village members, i.e., village connectivity, and connectivity with friends. Second, the impact of online communication varies among these two types of social connectivity. Where e-mail use has a negative impact on village connectivity, it does n...

Changes and variations in online and offline communication patterns: Including peer effects

The impact of online communication on offline communication has received considerable research attention. Yet predominantly single level studies yield conflicting research findings and lack theoretical foundation. This study deviates from previous studies by developing a peer effect model rooted in Adaptive Structuration Theory (AST) in which the individual is embedded in social and technological structures. Offline communication is dependent on own online communication as well as the opportunities to connect with peers online. We argue that own online communication is only supplemental to offline communication if substitution is hampered by infrequent online communication of peers within the local environment as “it takes two to tango”. Furthermore, frequent online communication of peers within the local environment results in a reduction in offline communication among users and non-users, resulting in non-users’ social exclusion both online and offline. Our model predicts that substitution and exclusion effects become stronger as the internet is used for more divers forms of interactive communication. Results from our analysis using a multi-country dataset covering the years 2002 to 2012 provide empirical support for our model. We contribute to online communication literature with an AST perspective including on peer effects and technological change. Research and policy implications are discussed.

Towards managed structuration : Exploring bridging mechanisms for IS enabled change in multi-site implementation projects

This paper aims to enhance our understanding of the bridging mechanisms underlying information system (IS) enabled change in multi-site implementation projects, and explore opportunities for intentionally shaping such change. To achieve this, we develop and empirically demonstrate the added value of a multi-site practice perspective. The perspective conceptualizes IS-enabled change as a product of interactions between processes in two related socio-technical systems: the project and local implementation sites. We introduce the term ‘bridging mechanisms’ to pin point three interaction types between the project and local site that contribute to IS-enabled change: practice alignment, shifting actors, and shared action. We analyse bridging mechanisms during the implementation process of a government funded project implementing IS in order to enhance older adults’ social networks and enable them to live at home independently at three local sites. Drawing on insights derived from this empirical analysis as well as previous literature, we discuss how the multi-site practice perspective brings together known change interventions in a holistic perspective on multi-site implementation. Moreover, we propose three practical applications of bridging mechanisms, i.e., bridging tactics, that allow for managed structuration during multi-site IS implementation.