The adoption of information and communication technologies by rural general practitioners: a socio technical analysis

This thesis has been supported by an ARC Industry Linkage grant and sought to explain the process of adoption of information technologies by comparing two main theories that have been developed to explain adoption of innovations, that of innovation diffusion and that of actor network theory. In the process of analysis for this thesis I decided very early on that the better way of explaining the pattern of adoption was by using the framework of actor network theory supported by qualitative methodology. A major contribution of this thesis could be seen as an ANT analysis of IT/IM in general practice. It appears that the multi partner, multi discipline research approach was a success for it created the opportunity to draw on diverse backgrounds. More importantly this research indicates that the qualitative research methodology of Actor Network Analysis has delivered an insight that is richer in data than the quantitative research that is usually undertaken in this field. This process assisted with enlightening the barriers and enablers to the adoption of information technology/information management (IT/IM) in general practice in a particular study area and to explain why, in the study area the pattern is fragmented and unclear. This study found it is important to note the difference between the adoption of IT/IM by general practice and adoption and use by general practitioners. The adoption process has been complex and many stakeholders have grappled with issues such as the cost of computerization, the rapid changes in technology, the lack of agreed standards and the problems of introducing technology information solutions in to the daily work place of general practice. Through comparison via case studies, extended interviews and implementing several study phases to develop a longitudinal aspect for the research, the teasing out of such issues as decision making in general practice and general practice as small business was undertaken. Through review of models that seek to explain adoption I will finalise by formalizing which theory of adoption better suits explanation of adoption of innovation within this study area. This thesis reports that while there are generally pockets of high uptake and use of IT/IM, this is not the complete picture across the study area and this reflects the situation in Australia. There are differences in adoption from one practice to another and even within practices; there are differences in adoption in terms of acceptance of an idea versus doing; in the study area there is only one practice which can reasonably claim to be paperless. Throughout this thesis a series of vignettes will be developed which set out to provide a whole play. Each vignette presents an aspect in the total picture of computerization. This thesis does not set out to provide the whole picture as that is still a work in progress, as such this thesis has no definite border, and the vignettes will sometimes show only the head and shoulders of the story with the background fading off. Other vignettes are very clear but as with all vignettes there are questions about the shaded areas. It is in these areas that questions arise to demonstrate there is greater depth in the story of the adoption of IT/IM in general practice in the study area, and, that adoption of IT/IM in general practice is complex and a continuing developmental story.