The United Nations' Millennium Development Goals listed high infant mortality rates as a major problem in developing countries, especially in rural areas. Given the powerful information dissemination capabilities, information and communication technologies (ICTs) have been suggested as interventions to build infant care awareness and to modify healthcare behaviors. We examine how the use of one ICT interventionÑspecifically, eHealth kiosks disseminating authenticated and accessible medical informationÑcan alleviate the problem of high infant mortality in rural India. We investigate how mothers' social networks affect their use of eHealth kiosks, seeking professional medical care for their infants and, ultimately, infant mortality. Drawing on the social epidemiology and social networks literatures, we focus on advice and hindrance from both strong and weak ties as the conduit of social influence on mothers' health-related behaviors for the care of their infants. Over a period of 7 years, we studied 4,620 infants across 10 villages where the eHealth kiosks were implemented along with support resources for proxy use. The results revealed that (1) eHealth kiosk use promotes seeking professional medical care and reduces infant mortality, (2) mothers are especially vulnerable to hindrance from both strong and weak ties as they choose to maintain the status quo of traditional infant healthcare practices (e.g., reliance on untrained personnel, superstitions, fatalism) in villages, and (3) advice from both strong and weak ties offers the potential to break down misplaced beliefs about infant healthcare practices and to develop literacy on seeking professional medical care. In contrast, in a comparative group of 10 neighboring villages, the reduction in infant mortality was not as pronounced and the effect of professional medical care in reducing infant mortality was lower. Our findings suggest that an ICT intervention can effectively address one of society's most important problems (i.e., infant mortality) even in parts of the world with limited resources and deep suspicion of technology and change. Overall, we believe such an ICT intervention will complement other investments being made, including the facilitation of use (proxy use) and provision of professional medical facilities to reduce infant mortality.
Despite the impressive progress in understanding the benefits and challenges related to enterprise system (ES) implementationsÑsuch as enterprise resource planning (ERP) systemsÑlittle is known about how the support structures traditionally used by organizations to help employees cope with a new ES affect employee outcomes related to the system and their jobs. Likewise, little is known about how existing peer advice ties in the business unit influence these outcomes after an ES implementation. Understanding employee outcomes is critical because of their ramifications for long-term ES success. This paper examines the impacts of four traditional support structures (namely, training, online support, help desk support, and change management support), and peer advice ties on four key employee outcomes (namely, system satisfaction, job stress, job satisfaction, and job performance). This paper also seeks to show that it is peer advice ties that best fill the complex informational needs of employees after an ES implementation by providing the right information at the right time and in the right context. The proposed model was tested in a field study conducted in one business unit of a large telecommunications company and gathered data from 120 supplier liaisons over the course of a year. Both traditional support structures and peer advice ties were found to influence the various outcomes, even after controlling for pre-implementation levels of the dependent variables. In all cases, peer advice ties was the strongest predictor, thus underscoring the importance of this critical internal resource.
The implementation of enterprise systems, such as enterprise resource planning (ERP) systems, alters business processes and associated workflows, and introduces new software applications that employees must use. Employees frequently find such technology-enabled organizational change to be a major challenge. Although many challenges related to such changes have been discussed in prior work, little research has focused on post-implementation job outcomes of employees affected by such change. We draw from social network theory— specifically, advice networks—to understand a key post-implementation job outcome (i.e., job performance). We conducted a study among 87 employees, with data gathered before and after the implementation of an ERP system module in a business unit of a large organization. We found support for our hypotheses that workflow advice and software advice are associated with job performance. Further, as predicted, we found that the interactions of workflow and software get-advice, workflow and software give-advice, and software get- and give-advice were associated with job performance. This nuanced treatment of advice networks advances our understanding of post-implementation success of enterprise systems.
Digital divide initiatives in developing countries are an important avenue for the socioeconomic advancement of those countries. Yet little research has focused on understanding the success of such initiatives. We develop a model of technology use and economic outcomes of digital divide initiatives in developing countries. We use social networks as the guiding theoretical lens because it is well suited to this context, given the low literacy, high poverty, high collectivism, and an oral tradition of information dissemination in developing countries. We test our model with longitudinal data gathered from 210 families in a rural village in India in the context of a digital divide initiative. As theorized, we found that the social network constructs contributed significantly to the explanation of technology use (R<sup>2</sup> D 0039). Also as we predicted, technology use partially mediated the effect of social network constructs on economic outcomes (R<sup>2</sup> D0047). We discuss implications for theory and practice.
With the strong ongoing push toward investment in and deployment of electronic healthcare (e-healthcare) systems, understanding the factors that drive the use of such systems and the consequences of using such systems is of scientific and practical significance. Elaborate training in new e-healthcare systems is not a luxury that is typically available to healthcare professionals—i.e., doctors, paraprofessionals (e.g., nurses) and administrative personnel—because of the 24×7 nature and criticality of operations of healthcare organizations, especially hospitals, thus making peer interactions and support a key driver of or barrier to such e-healthcare system use. Against this backdrop, using social networks as a theoretical lens, this paper presents a nomological network related to e-healthcare system use. A longitudinal study of an e-healthcare system implementation, with data gathered from doctors, paraprofessionals, administrative personnel, patients, and usage logs lent support to the hypotheses that: (1) ingroup and outgroup ties to doctors negatively affect use in all user groups; (2) ingroup and outgroup ties to paraprofessionals and administrative personnel positively affect use in both those groups, but have no effect on doctors' use; and (3) use contributes positively to patient satisfaction mediated by healthcare quality variables—i.e., technical quality, communication, interpersonal interactions, and time spent. This work contributes to the theory and practice related to the success of e-healthcare system use in particular, and information systems in general.
Prior research has extensively studied individual adoption and use of information systems, primarily using beliefs as predictors of behavioral intention to use a system that in turn predicts system use. We propose a model of acceptance with peer support (MAPS) that integrates prior individual-level research with social networks constructs. We argue that an individual's embeddedness in the social network of the organizational unit implementing a new information system can enhance our understanding of technology use. An individual's coworkers can be important sources of help in overcoming knowledge barriers constraining use of a complex system, and such interactions with others can determine an employee's ability to influence eventual system configuration and features. We incorporate network density (reflecting "get-help" ties for an employee) and network centrality (reflecting "give-help" ties for an employee), drawn from prior social network research, as key predictors of system use. Further, we conceptualize valued network density and valued network centrality, both of which take into account ties to those with relevant system-related information, knowledge, and resources, and employ them as additional predictors. We suggest that these constructs together are coping and influencing pathways by which they have an effect on system use. We conducted a 3-month long study of 87 employees in one business unit in an organization. The results confirmed our theory that social network constructs can significantly enhance our understanding of system use over and above predictors from prior individual-level adoption research.