Identities: The Missing Link between IT Affordances and Institutions for Better Health Care in Developing Countries

Using a case study of health information systems (HIS) in Kenya, we seek to better understand how HIS afford or constrain the action of local actors in provisioning health care in developing countries. We developed a theoretical perspective based on institutional theory that served as a lens to interpret the relationship between institutions and users’ perceptions of IT constraints and affordances. We found how identities constitute sense-making devices through which users make sense of the cultural resources available in their institutional environment and use them to shape their perception of IT affordances. In addition, we found how contradictions between users’ perceived IT affordances constituted the source and means of identity work processes through which users either modified or reinforced their identities. The paper contributes toward an increased understanding of how IT affordances (or constraints) link to institutions, thereby influencing processes of institutional change and socioeconomic development.