Constructing the network of influence model
: and evidence-based theoretical framework to improve the implementation of Health Information Technology in developing countries

Student thesis: Doctoral Thesis


Electronic Health (e-Health) and Health Information Technology (HIT) projects offer considerable potential health benefits for both health professionals and patients. In developed countries, the technology is beginning to reach maturity, with a number of HIT products available to monitor health and well-being. Academic studies have also reported on the rollout of such systems in developing countries. However, there is a lack of empirical evidence from many developing countries in relation to how their IT solutions are implemented and evaluated.

The purpose of this research is to develop a new theoretical framework to critically evaluate the factors that influence the implementation of HIT in developing countries broadly and specifically in relation to Libya. It is intended that the ultimate model assists in (a) combating the high failure rate of HIT projects and (b) specifying significant adaptions for the Libyan Government to consider in relation to future HIT projects that might reduce the risk of failure.

Research Questions
This thesis seeks the answer to five research questions
RQ1. What distinct factors should be taken into consideration when HIT projects are implemented in developing countries compared to developed countries?
RQ2. To what extent has HIT been deployed in developing countries?
RQ3. What factors influence the success/failure of the adoption of HIT in developing countries?
RQ4. To what extent have HIT systems been deployed in Libya?
RQ5. What implementation metrics are being used in HIT projects in developing countries to measure success?

A comprehensive literature review of ICT projects in both developed and developing countries was undertaken and the results of that research distilled and condensed into the first version of the Network of Influence Model. Two mixed methods were conducted to collect qualitative and quantitative data. A Constructivist Paradigm was applied in analysing these data to produce version 2 of the model. A modified Delphi study approach was then applied to the model itself to test its suppositions and veracity.

Version 1 of the Network of Influence Model (NIM) was derived from secondary research. It attempts to model, at a high level, the factors that influence the adoption of HIT in developing countries. Version 2 (updated from primary research) attempts to model the complex relationships between these factors. A knowledge gap was identified in the published literature in relation to Libya, where it seems no assessments of ICT solutions in any profession have taken place at all.

Based on research findings, a novel evidence-based theoretical framework has been developed for addressing the drivers and barriers of HIT technology in developing countries. The Network of Influence Model identifies the following definitive factors which have not been previously highlighted in the literature: brain drain, capacity building, evidence base, and organisational memory. These factors have a profound impact on the success or failure of HIT systems in developing countries. This research can practically provide realistic guidance for the stakeholders involved in the process of planning, developing, implementing, using and adopting health information technology in developing countries. The model created should assist with the future study of any healthcare ICT solution implemented in a developing country. Although it did not prove possible to answer some of the research questions posed in full, the data obtained correlated with the suppositions made by the model.
Date of AwardDec 2017
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorPhilip Scott (Supervisor), Kate Dingley (Supervisor) & Jim Briggs (Supervisor)

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