This project will conduct an indepth analysis of the processes of adoption and use of telecommunication technology (TC) by medical institutions and personnel in six rural Texas communities. The broad objective is to specify those factors that facilitate or hinder the acceptance and long-range commitment to two types of TC: two-way interactive video (TWIV) and continuing education (CE). Four categories of users will be studied: physicians, health-care organizations, community leaders and patients. The specific objectives are (1) the development of guidelines to aid in the determination of the best locations for the introduction of telemedicine. and (2) the development of optimal strategies for encouraging smooth adaption and maximum use of TC in rural areas. The concept of network will dictate the structure of the stud. The theoretical perspective guiding the analysis is resource dependence. The case study- method will be used to examine adoption and use in nine organizational settings. These cases represent both contextual and behavioral variation. Secondary analysis of documents from the adoption period will be analyzed. In five of the sites retrospective interviews with members of the decision network will be used to gather information on the adoption process. At the time of this study, the five sites will have had between five years and six months experience with TC. In the sixth site, the adoption process will be in the beginning stages, and prospective data will be gathered. Samples of patients and physicians will be interviewed to provide data on use. The secondary and primary data will be used to develop a model of the decision processes of networks operating within their social and economic environments. Similarly, an assessment of factors associated with initial and continued use of TC will be developed. Statistical tests of relationships will be used where appropriate in the comparative analysis. The study will be guided by a series of research generalizations drawn from the literature on adoption and diffusion, organizational change, and care-seeking behavior. The literature would lead us to expect that greater levels of consensus on and commitment to adoption of TC will be encouraged by decision network characteristics such as small size, high density, prior experience with health-care issues, community representation, and a past history of positive working relationships. The performance gaps perceived by network members will affect their assessments of the value of TC, and these perceptions will be influenced by the types of organizations that network members represent. We also expect that influential decision-makers in the network who maintain a defender orientation will reduce the likelihood of adoption. Even when the decision is for adoption, such an orientation will result in lower commitment (in terms of resource allocation and administrative support) to its use. Commitment to and continued use of TWIV will depend on factors such as the degree to which the adopter/user has a cosmopolitan orientation and a tolerance for non-traditional professional scripts.
