Journal of the Association for Information Systems


Free telemedicine camps (telecamps) are emergent joint initiatives of healthcare organizations, national and local governments, and not-for-profit nongovernmental organizations (NGOs) with the goal of alleviating the health divide for underprivileged individuals in rural areas of less developed countries. Our study seeks to understand the effectiveness of physician-patient communication at telecamps with several salient characteristics: rural underprivileged patients, physicians in remote cities, and frugal telemedicine technology—specifically, videoconferencing—deployed in Hospitals on Wheels and appropriated by operators. We adopt a multiple-actor perspective, propose a decomposed affordance-effectivity framework, and combine variance and process perspectives to examine the phenomenon of interest. We collaborated with Apollo Hospitals, a leading hospital system in India, and collected multisource data from two major telecamps in rural South India. Based on an analysis of survey data from 216 telecamp participants through a variance perspective, we found support for the fit of patient-perceived media richness with two contingency factors—(1) disease diagnostic complexity and (2) patient healthcare needs fulfillment—in influencing patient satisfaction with teleconsultation. Based on an analysis of 46 sessions of teleconsultation video archives through a process perspective, we found that technology appropriation is realized through verbal and nonverbal communication events between patients and physicians, with on-site operators playing multiple roles that serve as “compensatory user effectivity.” Our findings yield theoretical and practical implications for how effective telemedicine encounters using frugal technologies can be designed in combination with other cost-effective support personnel resources to broaden healthcare access for underprivileged individuals in less developed countries and, more broadly, to actualize technology affordances in use situations involving multiple actors.