Understanding How Healthcare Access is Enriched Through Telemedicine: Taking an Affordance Actualization Perspective

This paper examines a telemedicine system connecting a super-specialty tertiary care hospital in northern India to rural areas in Eastern India. Using the affordances actualization lens, we elaborate and describe how telemedicine enriches access to healthcare. With a qualitative study conducted with stakeholders involved in the telemedicine program, we show that access is enriched by actualization of four affordances - consultability, cognizability, socializability, and mentorability. We contribute to the affordance literature in two ways. First, we present a method to identify actualization of affordances in a complex interaction as diverse actors interact with technology. While most of the affordance literature focuses on the interaction of a goal-directed actor with the technology, telemedicine systems are opportune in understanding how diverse actors actualize the affordances. Second, we illustrate a nuanced understanding of technology as a situated action where multiple and diverse actors interact with technology and amongst themselves. Specifically, we highlight that access not only depends upon the affordance envisaged in the technology design (consultability and mentorability) but also the configuration of technology, actors and processes as it is implemented (cognizability, socializability). These affordances are related to the contextual embeddedness of the technology, specifically in the public health organization in rural India.