The Digitization of Healthcare in Developing Countries: Examining Individuals’ Willingness to Disclose Personal Health Information A thesis submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy in Information Systems By Ernest Kwadwo Adu University of Canterbury 2019 DEDICATION This thesis is dedicated to the Blessed Virgin Mary, the Patroness of my studies, and my late father Mike Okrah i ACKNOWLEDGEMENTS I wish to express my profound gratitude to my supervisors, Associate Professor Annette Mills and Senior Lecturer Nelly Todorova, whose guidance, insights and constructive criticisms have been invaluable in successfully completing this thesis. Their motivation, patience and kindness have also been very helpful, especially during the days when the PhD journey was difficult to travel. I cannot forget the sacrifices they made in the latter stages of my studies to ensure this thesis was completed and submitted on time. Prof. Annette Mills, in particular, spent her entire time while on leave to work on the final chapters of the thesis, to which I am very grateful. I thank God for blessing me with such wonderful people as my supervisors. I would also like to thank the University of Canterbury for awarding me the UC Doctoral Scholarship without which it would have been impossible for me to pursue my PhD studies. I must also acknowledge the constant support and assistance provided by the administrative, academic, and technical staff of the Accounting and Information Systems department. You helped create a supportive, friendly, and conducive environment for learning and research, and for that, I am exceedingly grateful. Thank you also to the friends and colleagues with whom I shared this journey. Your friendship, encouragement, and support helped make pleasant my PhD journey. I am also greatly indebted to Dr Musah Adams of the Department of Information Studies, University of Ghana. Dr Adams taught me during my undergraduate studies and upon graduating, I worked as his teaching assistant. He has played a vital role throughout my academic journey by providing me with academic recommendations and offering needed advice and encouragement. Of course, I cannot thank enough my family and friends back home in Ghana for their constant prayers, love and support. They have been a strong pillar of support throughout my life and especially during this period of intensive learning. Finally, and most importantly, I am eternally grateful to God for his blessings and grace which have brought me this far in my academic career. To HIM be all GLORY, HONOUR, and PRAISE. ii TABLE OF CONTENTS DEDICATION .......................................................................................................... i ACKNOWLEDGEMENTS ........................................................................................ ii TABLE OF CONTENTS........................................................................................... iii LIST OF TABLES .................................................................................................. vii LIST OF FIGURES ................................................................................................ viii ABSTRACT ............................................................................................................ ix CHAPTER ONE: INTRODUCTION 1.1 Research Background .......................................................................................................... 1 1.2 Digitized Healthcare and the Research Context .................................................................. 3 1.3 Motivation and Justification of the Research....................................................................... 4 1.3.1 Summary of Gaps in Prior Research ......................................................................... 4 1.3.2 Importance of the Research Context ......................................................................... 6 1.4 Research Objectives ............................................................................................................. 7 1.5 Research Questions .............................................................................................................. 9 1.6 Research Methodology ........................................................................................................ 9 1.7 Research Contributions ........................................................................................................ 9 1.8 Outline of Thesis ................................................................................................................ 11 CHAPTER TWO: LITERATURE REVIEW 2.1 Information Privacy ........................................................................................................... 13 2.1.1 Historical Foundations ............................................................................................. 13 2.1.2 Privacy Definitions across Disciplines .................................................................... 14 2.1.3 Privacy Definition in Information Systems ............................................................. 16 2.2 Overview of IS Privacy Research ...................................................................................... 17 2.3 IS Privacy Research in Healthcare ..................................................................................... 20 2.3.1 PHI Privacy Concerns ............................................................................................. 21 2.3.2 Antecedents to PHI Privacy Concerns ..................................................................... 23 2.3.3 Trust ......................................................................................................................... 27 iii 2.3.4 Antecedents to Trust in HIT .................................................................................... 30 2.3.5 Outcomes of PHI Privacy Concerns and Trust ........................................................ 31 2.4 Gaps in Prior Research ....................................................................................................... 34 2.4.1 Measuring PHI Privacy Concerns ........................................................................... 34 2.4.2 Antecedents: PHI Privacy Concerns & Trust in HIT .............................................. 35 2.4.3 Antecedents to Willingness to Disclose PHI ........................................................... 37 2.4.4 Research Context ..................................................................................................... 38 2.5 Chapter Summary .............................................................................................................. 39 CHAPTER THREE: THEORETICAL FOUNDATION AND PROPOSED RESEARCH MODEL 3.1 The Privacy Calculus Theory............................................................................................. 40 3.2 The Justice Theory ............................................................................................................. 42 3.2.1 Distributive Justice .................................................................................................. 42 3.2.2 Procedural Justice .................................................................................................... 43 3.2.3 Interactional Justice ................................................................................................. 44 3.4 Research Model and Hypotheses ....................................................................................... 44 3.4.1 Privacy Antecedents ................................................................................................ 48 3.4.2 Drivers of PHI Disclosure ....................................................................................... 50 3.4.3 Inhibitors of PHI Disclosure .................................................................................... 53 3.4.4 Control Variables ..................................................................................................... 59 3.5 Chapter Summary .............................................................................................................. 59 CHAPTER FOUR: RESEARCH METHODOLOGY 4.1 Research Philosophy and Methodology............................................................................. 60 4.2 Research Setting................................................................................................................. 61 4.2.1 Brief Profile of the Study Country .......................................................................... 62 4.2.2 The Ghana Healthcare System ................................................................................ 62 4.2.3 Current State of e-health in Ghana .......................................................................... 64 iv 4.3 Sampling Procedure ........................................................................................................... 66 4.3.1 Recruitment of Survey Sample ................................................................................ 67 4.4 Survey ................................................................................................................................ 68 4.4.1 Survey Procedure and Pilot Testing ........................................................................ 68 4.4.2 Operationalization of Variables ............................................................................... 70 4.5 Data Analysis ....................................................................................................................