Growing Trend of Health Infomediaries in Developing Economies: Understanding Motivations, Affordances and Constraints

Abstract

Information Technology (IT) plays a key role in health care management. Over the years, numerous IT artifacts have been introduced to improve health care delivery and access. These artifacts are often largely under the control of health professionals with little or no patient involvement. Recently however, there is a growing phenomenon of user-controlled health IT artifacts that give direct power and control to its users. One of such health IT artifacts are so-called infomediaries which augment decision making of patients, caregivers, and healthcare providers by creating awareness and knowledge sharing of healthful living, wellbeing and wellness among Online Health Information Seekers. There has been a pragmatic development of health infomediaries recently on online media platforms including conventional web portals (like websites, online forums, and chat rooms), social media, mobile Apps and blogs. Considering the rate of use of infomediaries, there are research gaps that need to be addressed, especially to understand the factors that enable the setting up of infomediaries as well as the affordances and constraints. In light of this, Technology Affordance and Constraint Theory was chosen as a theoretical lens to investigate the motivational factors, affordances and constraints behind the establishments of health infomediaries in a developing economy where challenges to health care access and delivery make health infomediaries potent alternatives to health information access. The study used the critical realism paradigm, qualitative research methodology and a case study research strategy to explore the phenomenon. The findings revealed that inherent motivation behind the development of online health platform is not necessarily sequential nor predictable but dynamic due to the changing demand of users, thus the development of health infomediaries is relatively purposive. Also, the findings revealed that there are both intrinsic and extrinsic motivational factors that drive organizations or individuals’ mission to establish health infomediaries. Motivational factors for the development of online health platforms are largely datafication and commodification. Datafication employs collective tools, technologies and processes to ‘data mine’ user data with a view to serving them better through content tailoring. Commodification on the other hand, refers to the way in which user data is transformed into monetary value. In Ghana, infomediaries are more commodification oriented than datafication. In this case study, no evidence was found of infomediaries in Ghana, purposively collecting user data to provide better services or sell the data to other interest parties. Rather, health infomediaries in Ghana apart from providing health information, also advertise and sell health products to consumers. One significant finding was that, some infomediaries even advertise non-health products. It can be inferred that in Ghana, commodification is the main affordance of health infomediaries beyond their primary purpose of providing health information to online health information seekers. The research also found other affordances or action possibilities with health infomediaries in Ghana such as self-aggrandizement, where individuals establishing infomediaries use the medium to promote or make themselves visible to society, possibly for future roles such as pioneer of a health infomediary. In terms of constraints to infomediaries, the research found that the survival and sustenance of online health information platforms is dependent on the management and technical handling of the IT infrastructure. Since most health infomediaries in Ghana are operated by individuals rather than organizations, they tend to lack managerial, financial or technical competencies of maintaining these platforms. The study offered a considerable understanding to the motivational factors behind the development of health infomediaries. Practically, the study will serve as a guide for practitioners to develop health infomediaries not only from the individual’s motivation but inculcate the consumers’ needs. Furthermore, the study advocates for government to institute very effective policies and guidelines and ensure its compliance to achieve an effective publication and use of online health information and development of health infomediaries. The study recommends developers of health infomediaries to identify and also understand the challenges besetting the development of online health platforms. Again, developers of health infomediaries should clearly define the purpose of setting up online health platforms to meet the needs of health consumers. That notwithstanding, commodification of the platform should not override the content related to health. Additionally, developers should be guided by the accepted standards of development of online health platforms. Future research will focus on other actors in the online health information such as regulators and how they perceive issues of privacy and security as well as conflict of interest situations in developing countries.