More specifically, we ask what are the factors that influence the primary assessment of an mHealth tool in a developing country. Individual factors influence the positivity of the individual's primary assessment of an mHealth tool in developing countries. Social factors influence the positivity of an individual's primary assessment of an mHealth tool in developing countries.
In terms of stakeholders, the perceived opportunity to improve speed and efficiency was seen as an important factor that would influence the positive evaluation of the mHealth tool. There is a perceived threat from technical limitations regarding the sustainability of the mHealth tool among stakeholders. The first theme was concern about the technical limitation features of the mHealth tool in performing the intended tasks.
The second theme expressed concern about the limited technical features of the mHealth tool regarding treatments e.g. The third theme expressed concerns about the technical limitations regarding the robustness features of the mHealth tool, e.g. Technical limitations were highlighted by stakeholders as one of the significant factors that would influence a negative assessment for the mHealth tool.
Emerged constructs around the social factors
Process uncertainty was also identified by stakeholders as a persuasive factor that would influence a negative assessment of the mHealth tool. The use of the mHealth tool by RHCWs is the best way to bring treatment to rural communities” (Developer5). That is, the mHealth tool would help extend healthcare services to members of rural communities in the healthcare systems.
The perceived opportunity for improved diagnosis and treatment was seen by stakeholders as an important factor that would influence the primary positive evaluation of the mHealth tool. The fifth theme is the concern of stakeholders regarding the need for supervision during the use of the mHealth tool. This theme highlighted the importance of monitoring users during use to ensure that the mHealth tool is used as.
There is a perceived opportunity for improved healthcare outcomes as the introduction of the mHealth tool would lead to fewer under-five deaths. There is a perceived threat from a lack of government support regarding participation or partnership. There is a perceived threat from the lack of government support from the creation of enabling policies for the implementation and improvement of the mHealth tool.
There is a perceived threat of social exclusion for doctors who may feel that their primary job is being removed by the introduction of the mHealth tool. Perceived threat from lack of government support was seen by stakeholders as the most important factor that would influence the primary negative assessment of the mHealth tool. The reliability of the infrastructure was highlighted as one of the important factors that would influence the primary negative assessment of the mHealth tool.
Perceived stakeholder threat from a lack of infrastructure reliability will result in a negative primary rating. The first theme related to the concern that the mHealth tool will reduce their job security, e.g.
5 Discussion
The perceived opportunity to construct new information and communication channels arose from the stakeholders' perceptions of these other 'things' for which the mHealth tool could be used. This positive impact factor emerged from interacting with the mHealth tool's material agency (external material). The perceived opportunity for improved health outcomes in rural areas emerged from stakeholders' belief that health services would reach the unserved in rural areas.
These results resonate with previous work showing how perceived improvement in health outcomes can influence stakeholders' decision-making process towards a positive evaluation of an mHealth tool (Aranda-Jan, Mohutsiwa-Dibe, & Loukanova, 2014; Miah, Hasan, Hasan, & Gammack, 2017). Second, threat was found to play a significant role in delineating the internal and external factors that negatively influence stakeholders' primary evaluation of an mHealth tool through five constructs. The perceived threat of technical limitations construct appeared for stakeholders' internal concerns about technical functionalities and limited capabilities (J.-N. Lee, Huynh, & Hirschheim, 2008; Lim, Benbasat, & Ward, 2000) in the mHealth tool (Chang et al ., 2013).
This finding resonates with evidence in literature regarding stakeholders' high expectation of an mHealth tool (Chang et al., 2013). The perceived threat of process uncertainty construct emerged for stakeholders' internal perception of concerns about the fear of computers, preexisting practices, and counter-interactions with culture and norms. Cultural and social norms have been found to influence stakeholder decisions (e.g., Carter & Weerakkody, 2008; Srite & Karahanna, 2006).
The perceived threat of a lack of government support construct emerged for stakeholder concerns about government support for mHealth intervention. Absence of this support can lead to negative (threat) primary assessment of an mHealth tool (Aranda-Jan et al., 2014; Leon et al., 2012). The perceived threat of social exclusion construct manifested to stakeholders' concerns about the internal fear of technology and job loss due to the introduction of an mHealth tool (Chang et al., 2013; Maeder, 2014).
Some stakeholders expressed concern about the security of their jobs, as the introduction of an mHealth tool could mean that fewer employees would be needed (Chang et al., 2013; Xue et al., 2015). Other stakeholders (e.g., physicians) expressed concern about the possible change in the traditional way treatments are performed (Desai, Khan, Mistry, & Gaikawad, 2016; Malvey & Slovensky, 2014).
6 Summary and Conclusion
Habit as one of the perceived threats has been identified in previous works (Maier, Laumer, Weinert, & Weitzel, 2015; Recker, 2014). In this regard, it can be concluded that since technology is generally used in cultural contexts, culture can be said to play an important role in the evaluation of technology (Im et al., 2011). This concern resonates with previous work showing the impact of government support on the primary evaluation of an IT.
For example, lack of support from governments (external to users) in the areas of promulgating enabling policies, high-level strategic planning and financial support have been shown to hinder mHealth implementation in developing countries (e.g. Leon et al ., 2012; Mechael, 2009). The perceived threat from the unreliability of infrastructure construction reflects the reality that the unavailability of electricity supply and Internet access can have a negative impact on the successful implementation of mHealth in developing countries (Akter et al., 2010; Sanner, Manda , & Nielsen, 2014). Assessing the threat to infrastructure reliability, which is an external factor, is particularly important for stakeholders in rural communities where power outages and grid coverage are more pronounced.
The model presents a set of individual and social factors that governments, funding bodies and non-governmental organizations should consider before starting to introduce an mHealth tool to rural communities in developing countries. At the individual level, the perceived opportunities to improve speed and efficiency, reliability of results and simplification of tasks by the tool were seen as possible motivating factors that would influence stakeholders to positively evaluate a new mHealth tool. Perceived threats from technical limitations of tool functionalities and process uncertainty were seen by stakeholders to negatively impact the introduction of an mHealth tool.
At the societal level, perceived opportunities for new information and communication channels and improved accessibility of health services would have a positive impact on the primary assessment. Nevertheless, stakeholders felt that the perceived threats of lack of government support, lack of reliable infrastructure, and resulting social exclusion associated with the introduction of the mHealth tool had a negative impact on the primary assessment. First, the model offers researchers new perspectives on the primary evaluation processes and dynamics involved in introducing mHealth tools to new areas of developing countries.
Second, the model provides a new way to understand how users arrive at their primary rating behaviors and can thus provide a useful framework with which we can integrate adoption and resistance studies (Eze, Gleasure, & Heavin, 2016a). We therefore recommend a longitudinal study that could reveal other contributing factors that may arise as a result of reappraisal processes, as users may reevaluate and adjust their previous primary and/or secondary appraisals (Beaudry & Pinsonneault, 2005; Bhattacherjee et al., 2017).
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Appendix A – Data sources and interviewees’ roles
Appendix C – Research questions for Parents/Guardians (PGs)
Appendix D – Research questions for Facilitators
Appendix E – Research questions for Developers
Appendix F – Details of open, axial, and selective coding
