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 seekto better understand how HIS afford or constrain the action of local actorsin provisioning health care in developing countries. We developed atheoretical perspective based on institutional theory that served as a lensto interpret the relationship between institutions and users’ perceptions ofIT constraints and affordances. We found how identities constitute sensemakingdevices through which users make sense of the cultural resourcesavailable in their institutional environment and use them to shape theirperception of IT affordances. In addition, we found how contradictionsbetween users’ perceived IT affordances constituted the source and meansof identity work processes through which users either modified orreinforced their identities. The paper contributes toward an increasedunderstanding of how IT affordances (or constraints) link to institutions,thereby influencing processes of institutional change and socio-economicdevelopment.