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.
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Ahluwalia, P., & Varshney, U. (2009). Composite quality of service and decision making perspectives in wireless networks. Decision Support Systems, 46(2009), 542–551.
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.
Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs: Prentice-Hall.
Akter, S., & Ray, P. (2010). mHealth- an ultimate platform to serve the unserved. IMIA Yearbook of Medical Informatics, 94–100.
Akter, S., D’Ambra, J., & Ray, P. (2010). Service quality of mHealth: development and validation of a hierarchical model using PLS. Electronic Markets, 20(3), 209–227.
Akter, S., D’Ambra, J., & Ray, P. (2011). Trustworthiness in mHealth information services: an assessment of a hierarchical model with mediating and moderating effects using partial least squares (PLS). Journal of the American Society for Information Science and Technology, 62(1), 100–116.
Alter, S. (2010). Viewing systems as services: a fresh approach in the IS field. Communications of the AIS, 26(11), 195–224.
Andaleeb, S. S. (2001). Service quality perceptions and patient satisfaction: a study of hospitals in a developing country. Social Science & Medicine, 52(9), 1359–1370.
Anderson, E. W., & Sullivan, M. W. (1993). The antecedents and consequences of customer satisfaction for firms. Marketing Science, 12(2), 125–143.
Au, N., Ngai, E. W. T., & Cheng, T. C. E. (2002). A critical review of end-user information system satisfaction research and a new research framework. Omega, 30, 451–478.
Baroudi, J. J., & Orlikowski, W. J. (1988). A short-form measure of user information satisfaction: a psychometric evaluation and notes on use. Journal of MIS, 4(4), 44–59.
Barrett, C. R. (2008). Perspectives on inclusive ICT business by intel. Electronic Markets, 18(4), 300–301.
Bauer, H., Grether, M., & Leach, M. (2002). Building customer relations over the internet. Industrial Marketing Management, 31, 155–163.
Bejou, D., Ennew, C. T., & Palmer, A. (1998). Trust, ethics and relationship satisfaction. International Journal of Bank Marketing, 16(4), 170–175.
Bhattacherjee, A. (2001a). An empirical analysis of the antecedents of electronic commerce service continuance. Decision Support Systems, 32, 201–214.
Bhattacherjee, A. (2001b). Understanding information systems continuance. An expectation–confirmation model. MIS Quarterly, 25(3), 351–370.
Bhattacherjee, A. (2002). Individual trust in online firms: scale development and initial test. Journal of Management Information Systems, 19(1), 211–241.
Bhattacherjee, A., & Premkumar, G. (2004). Understanding changes in belief and attitude toward information technology usage: a theoretical model and an empirical test. MIS Quarterly, 28, 229–255.
Blau, P. M. (1964). Exchange and power in social life. New York: Wiley.
Brady, M. K., & Cronin, J. J. (2001). Some new thoughts on conceptualizing perceived service quality: a hierarchical approach. Journal of Marketing, 65(July), 34–49.
Brady, M. K., & Robertson, C. J. (2001). Searching for a consensus on the antecedent role of service quality and satisfaction: an exploratory cross-national study. Journal of Business Research, 51(1), 53–60.
Brommey, M. (2003). Challenges in e-health service delivery. 2nd annual online summit. Available at: http://www.health.gov.au/healthonline/docs/summit2/brommeyer.pdf [accessed 2010 September 24].
Chatterjee, S., Chakraborty, S., Sarker, S., Sarker, S., & Lau, Y. F. (2009). Examining the success factors for mobile work in healthcare: a deductive study. Decision Support Systems, 46, 620–633.
Chin, W. W. (1998). The partial least squares approach to structural equation modeling. In G. A. Marcoulides (Ed.), Modern business research methods (pp. 295–336). Mahwah: Lawrence Erlbaum Associates.
Chin, W. W. (2001). PLS – graph user’s guide version 3.0. Houston: Soft Modeling Inc.
Chin, W. W. (2010). How to write up and report PLS analyses. In V. Esposito Vinzi, W. W. Chin, J. Henseler, & H. Wang (Eds.), Handbook of partial least squares: Concepts, methods and application (pp. 645–689). Germany: Springer.
Chin, W. W., & Newsted, P. R. (1999). Structural equation modeling analysis with small samples using partial least squares. In R. Hoyle (Ed.), Statistical strategies for small sample research (pp. 307–341). Thousand Oaks: Sage Publications.
Chiou, J., & Droge, C. (2006). Service quality, trust, specific asset investment, and expertise: direct and indirect effects in a satisfaction-loyalty framework. Journal of the Academy of Marketing Science, 34(4), 613–627.
Chou, S. W., & Chen, P. Y. (2009). The influence of individual differences on continuance intentions of enterprise resource planning (ERP). International Journal of Human Computer Studies, 67, 484–496.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: L. Erlbaum Associates.
Cronin, J., & Taylor, S. A. (1992). Measuring service quality: a reexamination and extension. Journal of Marketing, 56(July), 55–68.
Cronin, J. J., Brady, M. K., & Hult, G. T. (2000). Assessing the effects of quality, value and customer satisfaction on consumer behavioral intentions in service environments. Journal of Retailing, 76(2), 193–218.
Dabholkar, P. A., Shepard, C. D., & Thorpe, D. I. (2000). A comprehensive framework for service quality: an investigation of critical conceptual and measurement issues through a longitudinal study. Journal of Retailing, 76(2), 139–173.
Dagger, T. S., Sweeney, J. C., & Johnson, L. W. (2007). A hierarchical model of health service quality: scale development and investigation of an integrated model. Journal of Service Research, 10(2), 123–142.
Dahlberg, O., Mallat, N., Ondrus, J., & Zmijewska, A. (2008). Past, present and future of mobile payments research: A literature review. Electronic Commerce Research & Applications, 7(2), 165–181.
Davis, F. D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly, 13(3), 319–340.
Deluca, J. M., & Enmark, R. (2000). E-health: the changing model of healthcare. Front Health Service Management, 17(1), 3–15.
Efron, B., & Tibshirani, R. J. (1993). An introduction to the bootstrap. New York: Chapman and Hall.
Eisingerich, B. A., & Bell, J. S. (2008). Perceived service quality and customer trust: does enhancing customers’ service knowledge matter? Journal of Service Research, 10(3), 256–268.
Faul, F., Erdfelder, E., Buchner, A., & Lang, G. A. (2009). Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behavior Research Methods, 41(4), 1149–1160.
Flavian, C., Guinaliu, M., & Gurrea, R. (2006). The role played by perceived usability, satisfaction and consumer trust on website loyalty. Information Management, 43, 1–14.
Fornell, C., & Bookstein, F. L. (1982). Two structural equation models: LISREL and PLS applied to consumer exit-voice theory. Journal of Marketing Research (19), November 1982, pp. 440–452.
Fornell, C., & Cha, J. (1994). Partial least squares. In R. Bagozzi (Ed.), Advanced methods of marketing (pp. 52–78). Cambridge: Blackwell.
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 18(1), 39–50.
Gefen, D., & Straub, D. W. (2004). Consumer trust in B2C e-ecommerce and the importance of social presence: experiments in e products and e services. Omega, 32, 407–424.
Gefen, D., Karahanna, E., & Straub, D. W. (2003). Trust and TAM in online shopping: an integrated model. MIS Quarterly, 27(1), 51–90.
Geisser, S. (1975). The predictive sample reuse method with applications. Journal of the American Statistical Association, 70(350), 320–328.
Gotlieb, J. B., Dhruv, G., & Stephen, W. B. (1994). Consumer satisfaction and perceived quality: complementary or divergent constructs. Journal of Applied Psychology, 79(6), 875–885.
Gregor, S. (2006). The nature of theory in information systems. MISQ, 30(3), 611–642.
Gronroos, C. (1984). A service quality model and its marketing implications. European Journal of Marketing, 18(4), 36–44.
Gwinner, K. P., Gremler, D. D., & Bitner, M. J. (1998). Relational benefits in services industries: the customer’s perspective. Journal of the Academy of Marketing Science, 26(2), 101–114.
Hammond, A. L., Kramer, W. J., Katz, R. S., Tran, J. T., & Walker, C. (2007). The next four billion: Market size and business strategy at the base of the pyramid. Washington: World Resources Institute and International Finance Corporation.
Hart, S. L., & Milstein, M. B. (2003). Creating sustainable value. The Academy of Management Executive, 17(2), 56–67.
Hong, S.-J., & Tam, K. Y. (2006). Understanding the adoption of multipurpose information appliances: the case of mobile data services. Information Systems Research, 17(2), 162–179.
Ivatury, G., Moore, J., & Bloch, A. (2009). A doctor in your pocket: health hotlines in developing countries. Innovations: Technology, Governance, Globalization, 4(1), 119–153.
Jarvenpaa, S. L., Tractinsky, N., & Vitale, M. (2000). Consumer trust in an internet store. Information Technology and Management, 1(1–2), 45–71.
Jasperson, J., Carter, P. E., & Zmud, R. W. (2005). A comprehensive conceptualization of post-adoptive behaviors associated with information technology enabled work systems. MIS Quarterly, 29(3), 525–557.
Johnson, D., & Grayson, K. (2005). Cognitive and affective trust in service relationships. Journal of Business Research, 58, 500–507.
Kalil, T. (2009). Harnessing the mobile revolution. Innovations: Technology, Governance, Globalization, 4(1), 11–26.
Kandachar, P., & Halme, M. (2008). Sustainability challenges and solutions at the base of the pyramid. Sheffield: Greenleaf Publishing.
Kang, S. Y., Hong, S., & Lee, H. (2009). Exploring continued online service usage behavior, the roles of self image congruity and regret. Computers in Human Behavior, 25, 111–122.
Kaplan, W. A. (2006). Can the ubiquitous power of mobile phones be used to improve health outcomes in developing countries? Global Health, 2–9.
Kaplan, B., & Litwka, S. (2008). Ethical challenges of telemedicine and telehealth. Cambridge Quarterly of Healthcare Ethics, 17, 401–416.
Karahanna, E., Straub, D. W., & Chervany, N. L. (1999). Information technology adoption across time: a cross-sectional comparison of pre-adoption and postadoption beliefs. MIS Quarterly, 23(2), 183–213.
Kassim, N. M., & Abdullah, N. A. (2008). Customer loyalty in e-commerce settings: an empirical study. Electronic Markets, 18(3), 275–290.
Kim, D. J., Ferrin, D. L., & Rao, H. R. (2008). A trust-based consumer decision-making model in electronic commerce: the role of trust, perceived risk, and their antecedents. Decision Support Systems, 44, 544–564.
Liao, C., Chen, J.-L., & Yen, D. C. (2007). Theory of planning behavior (TPB) and customer satisfaction in the continued use of e-service. An integrated model. Computers in Human Behavior, 23(6), 2804–2822.
Limayem, M., Hirt, S. G., & Cheung, C. M. K. (2007). How habit limits the predictive power of intention: the case of information systems continuance. MIS Quarterly, 31(4), 705–737.
Lin, C. P., & Bhattacherjee, A. (2007). Extending technology usage models to interactive hedonic technologies: A theoretical model and empirical test. Information Systems Journal, 1–19.
Lin, C. P., & Bhattacherjee, A. (2009). Understanding online social support and its antecedents: a socio-cognitive model. The Social Science Journal, 46, 724–737.
Lin, C. S., Wu, S., & Tsai, R. J. (2005). Integrating perceived playfulness into expectation–confirmation model for web portal context. Information Management, 42(5), 683–693.
London, T. (2008). The base-of-the-pyramid perspective: A new approach to poverty alleviation. In G. T. Solomon (Ed.), Academy of Management Best Paper Proceedings (CD).
London, T. (2009). Making better investments at the base of the pyramid. Harvard Business Review, 87(5), 106–113.
London, T., & Hart, S. L. (2004). Reinventing strategies for emerging markets: beyond the transnational model. Journal of International Business Studies, 35(5), 350–370.
Mallat, N. (2007). Exploring consumer adoption of mobile payments – a qualitative study. The Journal of Strategic Information Systems, 16(4), 413–432.
Mechael, P. (2009). The case for mHealth in developing countries. Innovations: Technology, Governance, Globalization, 4(1), 103–118.
Morgan, R. M., & Hunt, S. D. (1994). The commitment-trust theory of relationship marketing. Journal of Marketing, July, 20–38.
Oliver, R. L. (1980). A cognitive model of the antecedents and consequences of satisfaction decisions. Journal of Marketing Research, 17(4), 460–469.
Oliver, R. L. (1993). Cognitive, affective, and attribute bases of the satisfaction response. Journal of Consumer Research, 20(3), 418–430.
Orlikowski, W., & Iacono, C. S. (2001). Research commentary: desperately seeking the “IT” in IT research—a call to theorizing the IT artifact. Information Systems Research, 12(2), 121–134.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: a multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1), 5–6.
Parthasarathy, M., & Bhattacherjee, A. (1998). Understanding post-adoption behavior in the context of online services. Information Systems Research, 9(4), 362–379.
Patterson, P. G., Johnson, L. W., & Spreng, R. A. (1997). Modeling the determinants of customer satisfaction for business-to-business professional services. Journal of the Academy of Marketing Science, 25(1), 4–17.
Prahalad, C. K. (2004). The fortune at the bottom of the pyramid: Eradicating poverty through profits. Upper Saddle River: Wharton School Publishing.
Prahalad, C. K., & Hammond, A. (2002). Serving the world’s poor, profitably. Harvard Business Review, 80(9), 48–57.
Prahalad, C. K., & Hart, S. L. (2002). The fortune at the bottom of the pyramid. Strategy + Business, 26, 2–14.
Premkumar, G., & Bhattacherjee, A. (2008). Explaining information technology usage: a test of competing models. Omega, 36, 64–75.
Quelch, J., & Klein, L. (1996). The internet and international marketing. Sloan Management Review, 1996, 60–75.
Rangan, V. K., Quelch, J. A., Herrero, G., & Barton, B. (2007). Business solutions for the global poor: Creating social and economic value. San Francisco: Jossey-Bass.
Rosa, J. A., & Viswanathan, M. (2007). Product and market development for subsistence marketplaces. Oxford: Elsevier Ltd.
Rust, R. T., & Zahorik, A. J. (1993). Customer satisfaction, customer retention, and market share. Journal of Retailing, 69(2), 193–215.
Saga, V. L., & Zmud, R. W. (1994). The nature and determinants of IT acceptance, routinization, and infusion. In L. Levine (Ed.), Diffusion, transfer and implementation of information technology (pp. 67–86). Amsterdam: Elsevier Science.
Sen, A. (1999). Development as freedom. Oxford: Oxford University Press.
Spreng, R. A., MacKenzie, S. B., & Olshavsky, R. W. (1996). A reexamination of the determinants of customer satisfaction. Journal of Marketing, 60(3), 15–32.
Srideshmukh, D., Singh, J., & Sabol, B. (2002). Consumer trust, value and loyalty in relational exchanges. Journal of Marketing, 66, 15–37.
Stone, M. (1974). Cross validatory choice and assessment of statistical predictions. Journal of the Royal Statistical Society, 36(2), 111–147.
Tenenhaus, M., Vinzi, V. E., Chatelin, Y.-M., & Lauro, C. (2005). PLS path modeling. Computational Statistics and Data Analysis, 48(1), 159–205.
Teo, T. S. H., & Liu, J. (2007). Consumer trust in e-commerce in the United States, Singapore and China. Omega, 35(1), 22–38.
Teo, T. S. H., Srivastava, S. C., & Jiang, L. (2008). Trust and electronic government success: an empirical study. Journal of Management Information Systems, 25(3), 99–131.
Thong, J. Y. L., Hong, S.-J., & Tam, K. Y. (2006). The effects of post-adoption beliefs on the expectation–confirmation model for information technology continuance. International Journal of Human Computer Studies, 64(9), 799–810.
United Nations. (2008). The millennium development goals report. New York: United Nations.
United Nations Foundation and Vodafone Foundation. (2009). mHealth for development: The opportunity of mobile technology for healthcare in developing world. Available at: http://www.vitalwaveconsulting.com/insights/mHealth.htm [Accessed May 23, 2011].
Van der Heijden, H. (2004). User acceptance of hedonic information systems. MIS Quarterly, 28(4), 695–704.
Varshney, U. (2005). Pervasive healthcare: applications, challenges and wireless solutions. Communications of the Association for Information Systems, 16(3), 57–72.
Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003). User acceptance of information technology: toward a unified view. MIS Quarterly, 27(3), 425–478.
Viswanathan, M., Gajendiran, S., & Venkatesan, R. (2008). Understanding and enabling marketplace literacy in subsistence contexts: the development of a consumer and entrepreneurial literacy educational programs in south India. International Journal of Educational Development, 23(3), 300–319.
Vital Wave Consulting. (2008). mHealth in the global south: Landscape analysis. Available at: http://www.vitalwaveconsulting.com/pdf/mHealth_in_the_Global_South_Landscape_Analysis.pdf [Accessed May 23, 2011].
Walsham, G., Robey, D., & Sahay, S. (2007). Foreword: special issue on information systems in developing countries. MIS Quarterly, 31(2), 317–326.
Wetzels, M., Schroder, G. O., & Oppen, V. C. (2009). Using PLS path modeling for assessing hierarchical construct models: guidelines and empirical illustration. MIS Quarterly, 33(1), 177–195.
Whetten, D. A. (1989). What constitutes a theoretical contributions. Academy of Management Review, 14(4), 490–495.
World Bank. (2004). World development report: Making services work for poor people. New York: Oxford University Press.
World Health Organization. (2006). The world health report 2006—Working together for health. Geneva: WHO.
Zeithaml, V. (1987). Defining and relating price, perceived quality, and perceived value (pp. 87–101). Cambridge: Marketing Science Institute. Report No. 87–101.
Zeithaml, V. A. (2000). Service quality, profitability, and the economic worth of customers: what we know and what we need to learn. Journal of the Academy of Marketing Science, 28(1), 67–85.
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.
Responsible editor: Doug Vogel
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Akter, S., Ray, P. & D’Ambra, J. Continuance of mHealth services at the bottom of the pyramid: the roles of service quality and trust. Electron Markets 23, 29–47 (2013). https://doi.org/10.1007/s12525-012-0091-5
- ECM (expectation confirmation model)
- BOP (bottom of the pyramid)
- Service quality
- Consumer trust
- PLS path analysis