First impressions are lasting impressions: intention to participate in mobile health projects within developing countries

Abstract: With healthcare infrastructure and health services remaining inadequate in many countries, numerous mobile health (mHealth) development studies have been reported, especially in low- and middle-income countries. This reflects a broad recognition that mobile technologies can play an important role in the provision of healthcare services at the regional, community and individual levels. However, implementing large-scale mHealth programmes has proven difficult; hence the use of mHealth pilots or feasibility studies as precursors to full rollouts. Existing literature reports that social, cultural, economic, political, technological and institutional factors influence the successful implementation of mHealth artefacts, yet there remains a dearth of research investigating individuals’ intention to participate in mHealth feasibility projects. Typically, mHealth projects involve a number of key stakeholders, ranging from direct stakeholders (such as healthcare workers who use the applications) to indirect stakeholders (such as the patients themselves who are not direct users of the technologies). Through the lens of impression management and self-determination theories, this study examines the extent to which an indirect user’s first impression, i.e. their initial encounter with the project and the project team on the ground, influences their decision to engage with an mHealth pilot project. Findings indicate that initial impressions formulated by indirect users impact their intention to participate in larger scale mHealth implementations. Through these early impressions participants formulate their perceptions about the project, and this directly influences their decision to engage. Furthermore, an individual’s first impressions can influence other potential participants’ decision to participate, especially in the context of the healthcare worker–patient relationship. The paper concludes that understanding indirect users’ expectations regarding the role of mHealth in addressing societal problems is essential to the success of wider mHealth projects in developing countries.