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Title: Information Systems Innovation Adoption and Institutionalization of Healthcare Systems in Ethiopia: The Case of Telemedicine at Black Lion Hospital
???metadata.dc.contributor.*???: Dr. Monica Garfield
Dr. Asfaw Atnafu
Hailemariam, Getachew
Keywords: Adoption;Information System Innovation;Compatibility Beliefs;Institutionalization;Telemedicine;E-Health;Organizing Vision
Issue Date: Jul-2015
Publisher: Addis Ababa University
Abstract: The use of ICT in the healthcare arena has attracted the attention of low-income countries and donors to leverage technology to expand healthcare services in order to rectify shortage of qualified medical personnel and health facilities. In this regard, over the past decades, various telemedicine and e-health projects have been initiated by donors primarily and African Governments. Preliminary studies in this area were inconclusive. Signs of system under- utilization and stunting projects have been reported without uncovering the root causes. This study has been motivated to investigate information systems innovation adoption and institutionalization phenomena from different perspectives in order to draw better understanding about issues related to telemedicine systems adoption and use. To this end, case study approach was employed to closely and thoroughly investigate the phenomena in specific context using multiple sources of evidences. The phenomena under investigation have been viewed from two theoretical perspectives: technology acceptance and use theory and institutional theory. The study used multiple sources of data including, quantitative data (gathered through structured questionnaire), qualitative (interview), document analysis, telemedicine and e-health conference and workshop proceedings from school of medical sciences, and through observation made at the operation of the telemedicine center. Validated measures developed by Karahana et al. (2006) and Venkatesh et al. (2003) were used with minor modification followed by pretesting and piloting while designing the survey instrument. Interview items were drawn from the conceptualization of “Organizing Vision” Swanson & Ramiller (1997) and from the concepts of “Actors Practice” Lawrence & Suddaby (2006). These items were used to capture key concepts surrounding the intent, practices and actions of university management and the medical school regarding the introduction and appropriate use of telemedicine systems. Subjects of the study included senior and junior medical professionals at Black Lion Teaching Hospital (BLTH). A survey was conducted and 205 valid observations were obtained. Moreover, interviews were conducted with twelve key informants identified from various entities including, the university management/medical school, from partners/donors, technical personnel, ministry of health, and ministry of education. Smart PLS 2.0 software package was used for model validation and analysis. The result of the quantitative analysis shows that 10 out of 13 hypotheses initially drawn were proven relevant. From the ten empirically supported hypotheses, six belong to UTAUT3 telemedicine research model developed for this study. This implies all the hypothesized relationships between the newly introduced three constructs and other constructs taken from the original UTAUT model Venkatesh et al. (2003) are empirically supported. Unlike some of the prior studies that uncovered strong relationship between “Intention” to use a technology and actual use behavior of a technology, this study has not found strong empirical support between these two constructs. Advanced statistical analysis conducted revealed “Facilitating Conditions” as the most prominent construct in explaining the dependent variable “Use behavior” followed by “Compatibility with Medical Practice” and “Compatibility with Physicians Preferred Work Style”. Apart from exploring and figuring out determinants of telemedicine, the theoretical relationships established proved that the overall explanatory and predictive capability of the proposed UTAUT3 telemedicine model is found to be minimal but encouraging given the context of the study. The qualitative analysis result shows that the university’s management/ medical school lack clear “Organizing Vision” and strategy for institutionalizing and integrating telemedicine in the healthcare system as the very idea of telemedicine was not originated from the university or from the medical school. Actor’s role is found to be quite minimal and lack the necessary power and command over resources in order to change the institutional context. The existing telemedicine systems are not integrated well with the clinical practices and the educational system. As a result, the telemedicine systems have not become part of the daily routine of the medical practice and the teaching, learning, and research system. This has eventually impacted the overall use of the system. The study has come up with relevant theoretical and practical contributions. From theoretical perspective, the study has achieved encouraging results to draw UTAUT model to the context of e-health systems through identifying salient determinants of telemedicine adoption and use. From technical perspective, the study proposes a conceptual model for designing and aligning telemedicine systems to medical practices. Finally, from organizational and institutional perspectives, the study proposes appropriate structural and institutionalization mechanisms for integrating telemedicine in the healthcare system.
Appears in Collections:Thesis - Information Science

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