The digitization of healthcare in developing countries: examining individuals’ willingness to disclose personal health information

In recent years, the increasing use of health information technologies (HITs) in support of healthcare services in developing countries has raised concerns about the privacy of digitized personal health information (PHI). However, there is little understanding of these concerns and their impact on individuals’ PHI disclosure behaviours. This study seeks to improve current understanding of the factors that influence the willingness of individuals in developing countries to disclose their PHI to receive care where the disclosed PHI is digitized. To pursue this objective, this study proposes and tests a model of antecedents to PHI privacy concerns, trust in HIT, and PHI disclosure. Drawing on the procedural and interactional dimensions of justice theory and prior research it is proposed that individuals’ characteristics, experiences, and perceptions form PHI privacy concerns and trust in HIT. Drawing on the privacy calculus, key factors that drive and inhibit individuals’ PHI disclosure are also examined. This study was conducted using a quantitative research design. The proposed model was tested using data collected from a survey of 276 individuals in Ghana, a Sub-Saharan African country. The data was analysed using the partial least squares approach to structural equation modelling (PLS-SEM). The findings of the study show trust in HIT directly influence PHI disclosure and fully mediates the influence of trust in healthcare providers. Convenience and computer experience also drive PHI disclosure. Trust in HIT is further shaped by privacy risk, government regulation, computer experience, and health concern. Perceived attitude of health workers affects trust in HIT through trust in healthcare providers. Regarding inhibitors of PHI disclosure, individuals’ perceptions of the negative consequences that may result from the exposure of their disclosed PHI decrease their willingness to disclose PHI. The results further show that individuals’ concerns about the collection of their PHI differ from concerns about the management of the collected and electronically stored PHI. For example, individuals’ express lower PHI collection concerns but greater concerns about PHI management. The results showed that PHI collection concerns decrease PHI disclosure whereas PHI management concerns increase PHI disclosure. PHI management concerns are shaped by computer experience, privacy orientation and trust in healthcare, with trust in healthcare providers mediating the influence of government regulation and perceived attitude of health workers on PHI management concerns. On the other hand, privacy risk, age, gender, and health concern form PHI collection concerns. The results also show past experience of privacy violation has different effects on PHI collection and PHI management concerns, increasing collection concerns but decreasing the management concerns. Overall, the findings of the study provide insights into the drivers and inhibitors of PHI disclosure, the dimensions of PHI privacy concerns and their antecedents, as well as the antecedents to trust in HIT. These findings provide useful contributions to the IS privacy literature and actionable insights for healthcare stakeholders especially in developing countries, as they leverage HITs in the provision of healthcare services