Brain injuries pose ongoing challenges that require robust self-management and support systems due to cognitive, emotional, and social impacts. Many patients now turn to social media for additional support, often relying on health communities where they can share experiences and seek advice. By offering emotional support and practical self-management strategies, these communities help patients improve their overall quality of life. This study conducts a comparative analysis of how the affordances of two types of social media health communities (small and closed vs. large and open) shape self-management strategies and interpersonal relationships for individuals with traumatic brain injuries. By analysing user engagement patterns and content shared within these communities, the study shows how different affordances contribute to different forms of support. The small, closed community fosters trust and privacy, encouraging deeper connections, tailored support, and a sense of safety. Conversely, the large, open community offers anonymity, a wider range of perspectives, and broader access to information, although interactions may lack personal depth. The study contributes to the literature on social media communities and health information technologies by deepening our understanding of how digital environments mediate support systems. The findings also provide insights for healthcare providers, patients’ families, and designers of social media communities.

This interpretative case study demonstrates how the work system properties and roles of clinical departments are perceived to shape their adoption of an organisation-wide electronic health record. In hospitals, with their heterogeneous and powerful clinical departments, partial or non-adoption by some departments may jeopardise effective overall use. Viewing a hospital’s EHR adoption from a sociotechnical fit perspective, we unravel how clinical departments’ adoption of this organisation-wide system was primarily shaped by their critical work system dependencies rather than their role during its implementation. From the interviewees’ accounts, three orientations emerge: (1) organisation-oriented resulting in unconditional adoption; (2) department-oriented resulting in problematic or delayed adoption with high compromise costs; (3) environment-oriented resulting in at least partial non-adoption or extra design costs. Our subsequent analysis leads to the identification of four types of subunit-level characteristics influencing adoption. Their interplay informs departments in balancing between accepting compromise costs and negotiating design costs. We develop a diagnostic system model of subunit-level adoption that takes the embeddedness of the subunit into account and thereby complements individual- and organisation-level adoption theories. An accompanying heuristic may enable hospital managers to better anticipate the heterogeneity in departments’ adoption.

Governing IT while incorporating stakeholders with diverse institutional backgrounds remains a challenge. Stakeholder groups are typically socialized differently and may have different perspectives on IT governance dilemmas. Yet, extant literature offers only limited insight on socialized views on IT governance. This study uses an institutional logics lens to examine how competing institutional logics get connected in IT governance practices through dominant stakeholders’ enactment patterns and how these enactment patterns may affect the organization’s IT performance. We find that logics were coupled to the three dominant stakeholder groups, but only loosely so. Congruence between the three logics they enacted depended on the IT governance dilemma at hand. Our findings demonstrate how within a triad of competing logics, switching rivalry among hybrid logics may develop. Here, the enactments led to two hybrid logics, none of which became dominant. Remarkably, the IT professionalism logic accommodated polarization between medical professionalism and the managerial logic, causing unstable IT governance. We propose that IT professionalism offers room for agency and is crucial in determining the resulting enactment patterns: polarizing, compromising or even synthesizing. This study may raise managers’ awareness of the competing logics underlying IT governance practices and clarify the pivotal role of IT professionalism in IT governance debates.

There is wide agreement that acceptance and resistance are crucial factors in information system (IS) adoption. Research has yielded many theories that have focused on either acceptance or resistance, often implicitly assuming that these are opposites. This paper proposes a two-factor view on acceptance and resistance, and shows how this idea may advance our knowledge of IS adoption. In developing a user reactions framework, we take a first step towards integrating the IS literature on acceptance and on resistance. This framework distinguishes between two behavioural dimensions, namely, acceptance, ranging from high use to non-use, and a dimension that ranges from enthusiastic support to aggressive resistance. Combining the two dimensions leads to four categories of user reactions. We show the framework's usefulness by analysing data from a telecare implementation project. The findings identify ambivalent reactions. Many clients are identified as supporting but non-using, while we also find telenurses and care coordinators that show themselves to be resisting but using. These findings support the view that non-acceptance and resistance are conceptually non-equivalent. Our data suggest voluntariness as one determinant of the variation in behavioural reactions encountered. We argue that the concepts are also functionally different: IS implementers will have to adapt their strategies to the different reactions described.

Implementing an inter-organizational system (IOS) requires significant organizational as well as technical changes. These will affect stakeholders (upon whom promoters depend) with varying degrees of power and with varying degrees of interest in the system. Identifying stakeholders and understanding the sources of their attitudes will enable promoters to meet their expectations more fully, and hence encourage acceptance. We examine these issues through a theoretically based study of an attempt to introduce an Electronic Patient File system in The Netherlands. All saw that the system would benefit patients, yet powerful players resisted its implementation, fearing it would affect their interests. This paper develops and tests a model of stakeholder management, showing that those with high interest in the system lacked the power to implement it, while those with low interest had the power to block it. These negative attitudes were shaped by concerns not about the system itself, but about the likely effects on working routines, power, culture and finance. This paper implies that those promoting an IOS (in any sector) should, from the outset of a project, identify their power sources and seek to reconcile stakeholder interests.

Decisions to invest in information systems (IS) are made by many organisations on a very regular basis. Such decisions can vary from quickly identifying the problem, screening options and choosing a solution in a very straightforward way, to very extensive and repeated search, screen, design and negotiation activities that can take many years. There has been little explicit research into the process by which managers and organisations decide to develop IS applications. This research addresses this by analysing 20 IS decision-making processes, using a phase-based as well as an attribute-based approach. Mintzberg's typology is used to characterise seven types of IS decisions from a phase-based or process-based perspective. For the attribute approach, the decisions have been analysed on the basis of subjective/objective and offensive/defensive contrasts and placed in one of the four following categories: innovative, rational, necessary or political. The paper concludes by identifying five factors that result in major differences in IS decision-making processes. These issues are: (1) whether there is scope to design a solution; (2) whether distinct alternatives have to be searched for; (3) the degree of urgency and necessity from the perspective of the decision-makers; (4) whether the decision can be subdivided in order to follow a gradual process path (planned vs incremental) and (5) the number and power of stakeholders involved in the process and the extent that their interests vary and contrast. The paper suggests that managers deciding on IS applications should be aware of these factors in order to design a process that fits best with the specific circumstances: no single process should be considered universally applicable. This conclusion is in contrast with many decision-making models rooted in the MIS-field, which suggest to use prescriptive and rational approaches to organise IS decision-making processes.