Sadly, underprivileged groups in less developed countries (LDCs) lack access to proper medical care and accurate medical information, resulting in high rates of mortality. As part of the United Nations (UN) Sustainable Development Goals (SDGs), which look to reduce maternal, infant, and child mortality, among other aims, information and communication technology (ICT) is seen as a critical tool. For instance, the Indian government, NGOs, and various private organisations have significantly invested in numerous ICT for development (ICT4D) initiatives, such as rural ICT kiosks (Internet-enabled computers) which provide information and services about on-going epidemics, preventative healthcare, and automation of health data. While these initiatives have greatly increased the opportunity for people living in rural India to access health information, studies reveal a low level of ICT use in these areas. Whether this is due to micro-level factors (e.g., a lack of skills and time) or macro-level factors (e.g., a lack of support from local government) is therefore worth investigating.

Aimed at improving the success of ICT initiatives in LDCs in general, and more precisely in India, a recent study by Viswanath Venkatesh, Tracy Ann Sykes, and Xiaojun Zhang looked to uncover the reasons for the success and failure of ICT4D initiatives. Specifically, what factors facilitate the use of ICTs and their downstream impacts in relation to women.

Drawing on social networks theory and social contagion theory in particular, the study examines how women in rural India are influenced by other women in their advice networks to use ICT kiosks, as well as the impact of ICT kiosk use on women’s health outcomes (i.e., seeking modern medical care and maternal mortality). The use of social networks to understand the health impacts of an ICT4D initiative in rural India was chosen for three reasons. First, literacy rates, especially computer literacy, in rural India are very low, making social networks vital to information diffusion. Second, India is a collectivist society, meaning that it emphasises the needs of the group over the needs of the individual. This is even more pronounced in rural areas, especially among women. Third, there is a strong oral tradition for information dissemination. Meanwhile, social contagion theory was chosen to explain the mechanisms underlying the behavioural changes resulting from an ICT4D initiative because it suggests that individuals’ thoughts, emotions, and behaviours are affected by the displayed thoughts, emotions, and behaviours of other individuals in the same network.

To tackle the issue, the authors developed a two-level model comprising a village level and an individual level. At the village level, the study proposes lead user network effects – a lead user being a woman who uses an ICT kiosk earlier and more frequently than the others. While at the individual level, it proposes structural network effects of other women in a focal woman’s network on kiosk use, seeking modern medical care, and maternal mortality.

Defining a woman’s strong/weak tie centrality as the extent to which a woman (not a lead user) is connected to other women who are widely connected via strong/weak ties, the study considers strong ties to be characterised by frequent interactions that create more opportunities for social influence. With that in mind, the study focuses on lead user network position (i.e., centrality) and network tie strength (i.e., strong/weak ties) as explanatory variables, arguing that strong tie centrality has an adverse effect on ICT kiosk use, whereas weak tie centrality has a favourable effect. Furthermore, in addition to proposing that ICT kiosk use has a positive effect on seeking modern medical care and a negative effect on maternal mortality, the authors also argue that seeking modern medical care has a negative effect on maternal mortality.

To empirically validate the model, it was tested against and mostly supported by individual and network data gathered over a period of approximately seven years from roughly 6,710 women from 10 villages in rural India in which ICT kiosks were installed. The villages were chosen as part of an ICT4D initiative aimed at providing villagers, especially women, with health-related information. Another group of 10 villages where the initiative was being deployed, but which were not implementing the kiosks, was used as the control group.

In developing a multi-level model to predict kiosk use, seeking modern medical care, and maternal mortality, the study finds that advice networks play both a positive and negative role in affecting the objectives of ICT4D initiatives. Not only does the study provide an important explanation as to why some initiatives fail in rural parts of LDCs, it also identifies potential solutions to address the problem.

The study makes invaluable contributions to research on ICT implementation, ICT4D initiatives, and e-government. As the authors point out, “By examining the consequences of such an ICT4D initiative, we develop a more holistic understanding of the nomological network around technology use, thus extending the theory bases used to understand technology adoption, use, and success”. The study also takes advantage of social networks research to better understand ICT implementation outcomes, thereby getting a clearer picture of the role of social influence in affecting ICT diffusion. Finally, not only does the model incorporate cross-level network effects to gain a better understanding of healthcare outcomes, it can also be “adapted to other domains that are important to advancing the human condition”.