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Health information systems (HIS) in most low-and middle-income countries (LMICs) have been often implemented under the international pressure of accounting for health care investments. The idea behind robust and efficient HIS is that health information can allow for better planning and monitoring of the health service, which may translate into better health outcomes. Yet, the use of HIS as accountability tools has often been criticized as being counterproductive by making health information more meaningful to national governments and international agencies rather than those in charge of local health services. The objective of this paper is to analyse how HIS influence the emergence of local accountability practices and their consequences for the provision of health care. A theoretical perspective from structuration theory is built and integrated with the technology domain of HIS. This perspective is used in the analysis of a case study of HIS in Kenya. This study raises implications for the use of structuration theory in understanding accountability and the role of IT materiality in processes of structuration. It contributes to a better understanding of how HIS can foster improved health care and human development. It also contributes to the understanding of IS not just as means for governing people's behaviour but also as means of socialization through which users can negotiate multiple accountability goals.

Clinical managers play a crucial role in securing the implementation and sustainability of information technology (IT) innovation in health care. Yet, not all clinical managers are willing and able to support IT innovation, particularly when the institutional logics of an IT innovation challenge their professional practice. We investigate how clinical managers use their hybrid identities to reconcile differences among competing institutional logics that affect IT innovation. Based on three examples of IT innovation (telehealth for obstructive sleep apnoea, telehealth for heart failure, and electrocardiograms) in a health care organization in England, we identify three roles in IT innovation (innovation advocate, innovation broker, and innovation laggard) that clinical managers enacted in response to three degrees of conflict between institutional logics (no conflict, moderate conflict, and high conflict), respectively. We make the following contributions. First, we demonstrate how clinical managers' perception of their hybrid role in relation to their professional identity influences their response to the conflicting institutional demands of IT innovation. We conclude that clinical managers' fragmented identities can compromise their ability to effectively manage IT innovation in health care. Second, our findings raise implications for understanding the role of professionals' hybrid identities in the implementation of digital transformation at the intersection of multiple institutional logics.

PurposeThe purpose of this study is to investigate how community attachment to an OHC reduces the OHC users' emotional distress and therefore improves their emotional well-being.Design/methodology/approachA survey study was conducted in one of the largest online health communities (OHC) for people with diabetes.FindingsOHC participants are likely to experience reduced emotional distress when they have developed an attachment to the community. This attachment is, in turn, positively associated with the normative expectations of reciprocity and the affective feeling of gratitude. However, some commonly used behavioral measures of community participation, such as visit frequency and membership tenure, have little to do with either community attachment or reduced emotional distress.Research limitations/implicationsThe research highlights the pivotal role of community attachment in appraising the much-debated benefits of OHCs. However, the cross-sectional survey study has its limitations in terms of establishing causality.Practical implicationsOHC managers need to look beyond some of the commonly used metrics, such as monthly visits and number of new postings, and focus on fostering a sense of attachment among existing users in order to fulfill the OHC's potential of emotional support. Our study implies that design features facilitating reciprocation and gratitude expression among users can lead to a strong emotional bond.Originality/valueThis is one of the first studies on the antecedents of community attachment and the relationship between community attachment and emotional distress in the context of OHC.

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