Enacting technology: Accounting for the interplay between mHealth solutions and existing paper-based data reporting practices

The purpose of this paper is to discuss implications of human-technology interaction in organizational change, especially where mobile phones are introduced to replace paper-based reporting.

The paper employs a case study approach, focusing on implementation of mobile technology for health (mHealth) solutions to support remote data communication, between health facilities and a district health office (DHO), in Malawi.

The findings suggest that mobile phones are relevant to parts of multi-stage tasks such as data reporting, which comprise compilation, transportation, and digitization of data, and delivery of feedback. Consequently, innovation due to the introduction of mobile phones, is found in their interaction with other artefacts (paper, desktop computers, etc.), and existing paper-centric and emerging work practices.

Although lessons from this study could be transported across contexts, practitioners, and researchers should pay particular attention to contextual differences.

In accounting for the mutual shaping between technology and context/work practices the paper demonstrates that mHealth innovation demands significant practical work.

mHealth research is often preoccupied with capabilities of mobile devices. First, the authors account for interaction between artefacts, existing, and emerging use contexts, and the use process, at multiple levels of organization. Through this, the authors argue for a need to seriously consider idiosyncrasies of artefacts and tasks at hand, as well as distributed affordances across artefacts, in mHealth implementations. Second, the authors argue that contrary to the general focus on mobile phones as tools for supporting people on the move, their relevance might actually be found in reducing people’s mobility.