Electronic Markets

, Volume 23, Issue 1, pp 29–47 | Cite as

Continuance of mHealth services at the bottom of the pyramid: the roles of service quality and trust

  • Shahriar Akter
  • Pradeep Ray
  • John D’Ambra
Special Theme


Continued usage of information systems (or, IS continuance) has proven to be a critical success parameter for ICT implementation at the top of the global economic pyramid. However, there are few studies which have explored continued IS usage at the bottom of the economic pyramid (BOP) though it represents the majority of the world’s population. To fill this knowledge gap, this study develops an mHealth continuance model at the BOP framing the impact of two post adoption expectation beliefs (i.e., perceived service quality and perceived trust). This study extends ECM (expectation confirmation model) perspective synthesizing the extant literature on continued IS usage, service quality and consumer trust. The proposed model was empirically tested within the context of mHealth (mobile health) services at the BOP, applying PLS (partial least squares) under a cross sectional study. The findings confirm that both perceived service quality and perceived trust have significant explanatory power under an integrated ECM providing superior prediction of continuance intentions. The study concludes by discussing conceptual contributions, practical implications, limitations and future research directions.


ECM (expectation confirmation model) BOP (bottom of the pyramid) Service quality Consumer trust PLS path analysis 

JEL classification

M15 M31 L15 L86 



This research was funded by the Asia Pacific Ubiquitous Healthcare Research Centre (APuHC), The University of New South Wales, Australia. The authors appreciate and gratefully acknowledge the conceptual direction of late Prof. C.K. Prahalad (University of Michigan) and data analysis support of Prof. Wynne W. Chin (University of Houston). The authors also thank the data collection team of WHO global mHealth assessment project (Bangladesh Chapter) comprising Benzir Shaon, Saida Mona, Waheduzzaman Adnan, Ismat Ara and Shafayet Ullah for their invaluable help. Finally, the authors are grateful to Doug Vogel (Guest Editor) and two anonymous reviewers for their valuable comments and suggestions.


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Copyright information

© Institute of Information Management, University of St. Gallen 2012

Authors and Affiliations

  1. 1.School of Management and Marketing, University of WollongongNew South WalesAustralia
  2. 2.Australian School of Business, University of New South WalesNew South WalesAustralia

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