Digital inequality is one of the most critical issues in the knowledge economy. The private and public sectors have devoted tremendous resources to address such inequality, yet the results are inconclusive. Theoretically grounded empirical research is needed both to expand our understanding of digital inequality and to inform effective policy making and intervention. The context of our investigation is a city government project, known as the LaGrange Internet TV initiative, which allowed all city residents to access the Internet via their cable televisions at no additional cost. We examine the residents' post-implementation continued use intentions through a decomposed theory of planned behavior perspective, which is elaborated to include personal network exposure. Differences in the behavioral models between socio-economically advantaged and disadvantaged users who have direct usage experience are theorized and empirically tested. The results reveal distinct behavioral models and isolate the key factors that differentially impact the two groups. The advantaged group has a higher tendency to respond to personal network exposure. Enjoyment and confidence in using information and communication technologies, availability, and perceived behavioral control are more powerful in shaping continued ICT use intention for the disadvantaged. Implications for research and practice are discussed.

Digital inequality, or unequal access to and use of information and communication technologies (ICT), is a severe problem preventing the socioeconomically disadvantaged (SED) from participating in a digital society. To understand the critical resources that contribute to digital inequality and inform public policy for stimulating initial and continued ICT usage by the SED, we drew on capital theories and conducted a field study to investigate: (1) the forms of capital for using ICT and how they differ across potential adopters who are SED and socioeconomically advantaged (SEA); (2) how these forms of capitals are relatively impacted for the SEA and the SED through public policy for ICT access; and (3) how each form of capital influences the SED's intentions to use initially and to continue to use ICT. The context for our study involved a city in the southeastern United States that offered its citizens free ICT access for Internet connectivity. Our results show that SED potential adopters exhibited lower cultural capital but higher social capital relative to the SEA. Moreover, the SED who participated in the city's initiative realized greater positive gains in cultural capital, social capital, and habitus than the SEA. In addition, we find that the SED's initial intention to use ICT was influenced by intrinsic motivation for habitus, self-efficacy for cultural capital, and important referents' expectations and support from acquaintances for social capital. Cultural capital and social cultural capital also complemented each other in driving the SED's initial use intention. The SED's continued use intention was affected by both intrinsic and extrinsic motivations for habitus and both knowledge and self-efficacy for cultural capital but was not affected by social capital. We also make several recommendations for future research on digital inequality and ICT acceptance to extend and apply the proposed capital framework.

The United Nations’ Millennium Development Goals listed high infant mortality rates as a major problem in developing countries, especially in rural areas. Given their powerful information dissemination capabilities, information and communication technologies (ICTs) have been suggested as interventions to build infant care awareness and modify healthcare behaviors. We examine how the use of one ICT intervention—eHealth kiosks disseminating authenticated and accessible medical information—can alleviate the problem of high infant mortality in rural India. We investigate how mothers’ social networks affect th eir use of eHealth kiosks, specifically in seeking professional medical care for their infants and, ultimately, the effect on infant mortality . Drawing on the social epidemiology and the social network literatures, we focus on advice and hindrance from both strong and weak ties as the conduit of social influence on mothers’ health-related behaviors for the care of their infants. Over a period of 7 years, we studied 4,620 infants across 10 villages where the eHealth kiosks were implemented along with support resources for proxy use. The results revealed that (1) eHealth kiosk use promotes seeking professional medical care and reduces infant mortality, (2) mothers are especially vulnerable to hindrance from both strong and weak ties as they choose to maintain the status quo of traditional infant healthcare practices (e.g., reliance on untrained personnel, superstitions, fatalism) in villages, and (3) advice from both strong and weak ties offers the potential to break down misplaced beliefs about infant healthcare practices and to develop literacy on seeking professional medical care. In contrast, in a comparative group of 10 neighboring villages, the reduction in infant mortality was not as pronounced and the effect of professional medical care in reducing infant mortality was lower. Our findings suggest that an ICT intervention can effectively address one of society’s most important problems—infant mortality—even in parts of the world with limited resources and deep suspicion of technology and change. Overall, we believe such an ICT intervention will complement other investments being made including the facilitation of use (proxy use) and provision of professional medical facilities to reduce infant mortality.

Free telemedicine camps (telecamps) are emergent joint initiatives of healthcare organizations, national and local governments, and not-for-profit non-government organizations (NGOs) with the goal of alleviating the health divide for the underprivileged in rural areas of less developed countries. Our study seeks to understand the effectiveness of physician-patient communication in telecamps with several salient characteristics: rural underprivileged patients, physicians in remote cities, and frugal telemedicine technology—specifically, videoconferencing—deployed and appropriated by operators in hospitals on wheels. We adopt a multiple-actor perspective, propose a decomposed affordance-effectivity framework, and combine variance and process perspectives to examine the phenomenon of interest. We collaborated with Apollo Hospitals, a leading hospital system in India, and collected multi-source data from two major telecamps in rural South India. Based on an analysis of survey data from 216 telecamp participants through a variance perspective, we find support for the fit of patient perceived media richness with two contingency factors—(a) disease diagnostic complexity and (b) patient healthcare needs fulfillment—in influencing patient satisfaction with teleconsultation. Based on an analysis of 46 sessions of teleconsultation video archives through a process perspective, we find that technology appropriation is realized through verbal and non-verbal communication events between patients and physicians, with onsite operators playing multiple roles that serve as “compensatory user effectivity.” Our findings yield theoretical and practical implications for how effective telemedicine encounters using frugal technologies can be designed in combination with other cost-effective support personnel resources to broaden healthcare access for the underprivileged in less developed countries and, more broadly, to actualize technology affordances in use situations involving multiple actors.

Upcoming.