The Diffusion of the Internet amongst South African Primary Care Doctors: An Activity Systems View

Abstract

Introduction and Background: From Everett Rogers‟ theory of Diffusion of Innovations

(DoI) and Yrjö Engeström‟s Activity Systems Model (ASM), this thesis attempts to

create models of South African Primary Care doctors‟ Internet usage, with a view to

improving the delivery of Primary Care in South Africa.

It identifies the problems associated with the South African Primary Care doctors‟ access

to information, communication with colleagues, communication with patients, the patient

as partner, and practice management. It raises a practical research question of how the

Internet can best be used to serve the needs of South African Primary Care doctors in

dealing with these problems.

Theoretical Background: It then examines the two theoretical perspectives that guide the

research, the Activity Systems Model and Diffusion of Innovations, and raises two

research questions regarding the relationship of these theories to the South African

Primary Care doctors‟ use of the Internet.

Methods: The thesis then proposes a three part study: an international systematic

literature review of Internet use by doctors, a survey of South African Primary Care

doctors, and a series of interviews and focus groups using Grounded Theory to provide

explanations for the survey results.

The systematic literature review obtains descriptive data on usage, barriers and

motivations. Based on these figures and the theories, the thesis makes predictions about

usage by South African doctors. The survey of 2 600 South African Primary Care

doctors and follow-up interviews and focus groups with 19 doctors provide data against

which the predictions are measured, and the models of the South African usage patterns

developed.

Results: South African Primary Care doctors use the Internet in ways that are similar to

their International colleagues, but variations in the patterns exist. While differences are

caused by infrastructural shortcomings, organisational and social issues have a critical

effect.

Discussion: DoI and ASM theories are used to model usage patterns. The research

questions are answered through interweaving DoI and ASM. Both DoI and ASM are

appropriately modified, and provide an analytical framework for understanding Internet

usage among doctors. The final model produced is a DoI-ASM framework that describes

the transition of the doctors‟ practice in Primary Care within the context of the Internet

diffusion, and the impact of the changing nature of the patient as partner. The value of

the model lies in its predictive potential for future Internet usage patterns of the South

African Primary Care doctors