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The striking growth of online communities in recent years has sparked significant interest in understanding and quantifying benefits of participation. While research has begun to document the economic outcomes associated with online communities, quantifying the social value created in these collectives has been largely overlooked. This study proposes that online health communities create social value by addressing rural-urban health disparities via improved health capabilities. Using a unique dataset from a rare disease community, we provide one of the first empirical studies of social value creation. Our quantitative analysis using exponential random graph models reveals patterns of social support exchanged between users and the variations in these patterns based on users' location. We find that, overall, urban users are net suppliers of social support while rural participants are net recipients, suggesting that technologymediated online health communities are able to alleviate rural-urban health disparities. This study advances extant understanding of value production in online collectives, and yields implications for policy.

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D espite the significant potential for performance gains from health IT (HIT), there has been limited study of the mechanisms underlying successful HIT implementations. We conducted an extensive longitudinal field study to gain an understanding of the interplay between technology and patterns of clinical work embodied in routines. We use the analytical device of narrative networks to identify where and how HIT influences patterns of work. We further draw upon adaptive structuration theory to conceptualize HIT as an intervention that alters the flow of events in a narrative network. Our findings suggest that the key to successful implementation is to manage the co-evolution process between routines and HIT and to actively orchestrate a virtuous cycle through agentic action. We propose a dynamic process model of adaptive routinization of HIT that delineates the major channels through which HIT and routines interact, identifies the different stages in the dynamic co-evolution process, and isolates the pivotal role of two forms of agency in enabling the virtuous cycle of co-evolution. This is one of the first studies to offer a processual, microlevel analysis of HIT implementation in a clinical setting.

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