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Configural paths for IoTs and big IoTs and BDA

technologies
data analytics acceptance for
healthcare improvement:
a fuzzy-set qualitative
comparative analysis Received 19 October 2022
Revised 1 February 2023
12 April 2023
Abeeku Sam Edu Accepted 3 May 2023
Department of Operations and Management Information Systems,
University of Ghana Business School, Accra, Ghana

Abstract
Purpose – This study investigates the pathways for adopting IoTs and BDA technologies to improve
healthcare management.
Design/methodology/approach – The study relied on 445 healthcare professionals’ perspectives to explore
different causal pathways to IoTs and BDA adoption and usage for daily healthcare management. The Fussy-set
Qualitative Comparative Analysis was adopted to explore the underlying pathways for healthcare management.
Findings – The empirical analysis revealed six different configural paths influencing the acceptance and use
of IoTs and BDA for healthcare improvement. Two key user topologies from the six configural paths, digital
literacy and ease of use and social influence and behavioural intentions, mostly affect the paths for using digital
health technologies by healthcare physicians.
Research limitations/implications – Despite this study’s novel contributions, limitations include the
fsQCA methodology, perceptual data and the context of the study. The fsQCA methodology is still evolving
with different interpretations, although it reveals new insights and as such further studies are required to
explain the configural paths of social phenomena. Additionally, future research should consider other
constructs beyond the UTAUT and digital literacy to illustrate configural paths to healthcare technology
acceptance and usage. Again, the views of healthcare professionals are perceptual data. Hence future research
on operational data will support significant contributions towards pathways to accept and use emerging
technologies for healthcare improvement. Lastly, this study is from a developing country perspective where
emerging digital healthcare technology is still emerging to support healthcare management. Hence, more
investigation from other cross-country analyses of configural paths for digital technology deployment in
healthcare will enhance the conversation with IoTs and BDA for healthcare management.
Practical implications – Holistically, the acceptance and use of healthcare technologies and platforms is not
solely on their capabilities, but a combination of distinct factors driven by users’ perspectives. This offers
healthcare administrators and institutions to essentially reflect on the distinct combinations of conditions
favourable to health professionals who can use IoTs and BDA for healthcare improvement.
Originality/value – This study is among the few scholarly works to empirically investigate the configural paths
to support healthcare improvement with emerging technologies. Using fsQCA is a unique contribution to existing
information system literature for configural paths for healthcare improvement with emerging digital technologies.
Keywords Healthcare, IoTs, BDA, Configural paths, fsQCA, Topologies
Paper type Research paper

1. Introduction
Improving quality healthcare and advancing the accessibility of medical records while
providing affordable costs to healthcare management in healthcare sectors are challenging
for healthcare institutions globally. The challenges have further heightened with emergency
healthcare issues, compounding alerts with patient disease treatments, critical patient
Aslib Journal of Information
Management
Funding: This research was funded by the University of Ghana Business School (Award number: UGBS/ © Emerald Publishing Limited
2050-3806
RCC/2022-23/071). DOI 10.1108/AJIM-10-2022-0465
AJIM monitoring, healthcare professionals’ work conditions and many other related challenges
(Oleribe et al., 2019; Tortorella et al., 2020). Overcoming these limitations surrounding quality
healthcare and patient safety has seen several approaches within and outside healthcare
organisations. One key approach has been the deployment of Information Communication
and Technology (ICT) to promote healthcare delivery in a more accessible manner in the most
cost-effective way (Aceto et al., 2018). Deploying digital healthcare systems, in general, has
led to the development of telehealth, electronic health and mobile health systems, which
primarily augment existing healthcare infrastructure to support care administration and
patient safety (Khelassi et al., 2019). While the deployment and implementation of these
digital healthcare systems provide safe healthcare, challenging issues still confront health
institutions that need to be re-examined. More importantly, improving data sourcing (patient
records, biomedical data, administrative data), standardising and analysing conceivable data
and managing medical information to enhance patient-provider interactions. Again, in recent
years the synergy with existing digital healthcare systems has significantly extended from
primarily maintaining patient data. This has offered further deployment with other emerging
technologies to create value through data sourcing, data analytics and decision-making for
better health management (Loiselle and Ahmed, 2019; Dhanvijay and Patil, 2019; Zeadally
et al., 2019). Prior studies have explored how emerging technologies such as the internet of
Things (IoTs), Big Data and Cloud Computing can be adapted to facilitate healthcare
management (Hamidi, 2019; Farahani et al., 2020; Maria et al., 2019). However, these studies
have predominantly focused on the adoption of these technologies independently for
healthcare management. Accordingly, Dorrance and Clement (2021) advocated a need for
other studies to investigate the extent to which the integration of these technologies can be
deployed on a synchronised platform to improve healthcare management (Dorrance and
Clement, 2021). Thus, this research examines the pathways through which the integration
IoTs and Big Data Analytics (BDA) technologies improve healthcare management.
In addition, although emerging technologies are significantly spearheading digital health
across developed countries, there is uneven uptake across developing countries and a limited
understanding of health physicians’ preferred pathways to using IoTs and BDA for healthcare
management (Patrıcio et al., 2020). The need to highlight the diversity in health physicians’
preferences is also important to characterise peculiarities associated with factors influencing the
integration of IoTs and BDA usage for healthcare management. Therefore, this study discusses
how healthcare institutions can adopt IoTs and BDA technologies to accelerate patient safety in
a developing country. As human behaviour is multi-faceted and mostly influenced by a
combination of factors, it is vital to recognise the configural effect of different constructs. Also,
due to the inherent nature of disruptive technologies such as IoTs and BDA, the impact of a
single variable may not sufficiently explain users’ behaviour towards the adoption and use of
technologies. It is relevant for research to identify how different constructs combined can
provide significant effects of deploying and using IoTs and BDA to improve healthcare
management. Therefore, in addressing these gaps, the study relied on the unified theory of
acceptance and use of technology (UTAUT), the concept of digital literacy and qualitative
comparative analysis (QCA). Thus, using UTAUT and QCA to unravel the pathway through
which IoTs and BDA integration can enhance healthcare management and patient safety
through health physicians’ points of view. Therefore, the study proposes these contributions to
the discussions towards deploying emerging technologies to improve healthcare management
from a professional perspective. First, the study aims to provide contributing constructs that
facilitate the paths through which IoTs and BDA adoption can enhance healthcare management.
Secondly, the study identifies distinct users’ topologies to advance the paths through which IoTs
and BDA can improve healthcare management in Ghana. Lastly, the study adopted the UTAUT
and digital literacy concept to investigate users’ perceptions towards emerging technologies
usage in healthcare.
2. Related studies and theoretical underpinning IoTs and BDA
2.1 Integrating IoTs and BDA for healthcare improvement technologies
Emerging technologies are increasingly changing the phase of healthcare delivery systems
characterised by interconnected technologies to enable efficient diagnostics-related services.
For example, IoTs sensors support the acquisition of data in real time, which provide big data
capabilities for high levels of diagnostic analysis of patient data (Al-Turjman et al., 2020).
A framework to promote emerging digital technology to integrate will eventually transform
an entire healthcare delivery value chain. Continuously, healthcare service innovations must
be based on emerging technologies that support collaborations and scalability to promote
mHealth, and eHealth for diagnostics and functional assistance (Alloghani et al., 2018). Parimi
and Chakraborty (2020) proposed a framework to link emerging healthcare technologies
platforms to facilitate patient health monitoring and care delivery.
Also, Hong-tan et al. (2021) observed that applying big data analytics in an IoT-enabled
health environment underscores the critical need for mining healthcare data. Such digital
ecosystems integration platform generates real-time information and knowledge for
significant attention to critical patients. The capabilities and benefits of IoTs have
considerably facilitated and shaped the collaboration, interconnectivity and interoperability
of technologies through smart actuators, connected sensors, data availability and platforms
or applications (Dimitrov, 2016). Progressively, IoTs such as MIoTs (smart wearables,
medical data transfer devices, drug tracking devices, etc.) have transformed the phase of
healthcare delivery services. MIoTs also assist physicians and caregivers with real-time data
for diagnosing related patients’ problems (Lederman et al., 2021). This eventually enables
good quality healthcare delivery systems through predictive analysis of patient treatment
through MIoTs data (Jin et al., 2019). Based on data via MIoTs sensors, big data predictive
capabilities provide insights and create awareness of managing patients with severe diabetic
conditions. Implementing big data analytics promotes evidence-based medicine, remotely
monitoring patient profiles and supporting public health administration (Chakraborty et al.,
2020). Big data capabilities have become useful tools to analyse large data to help patient
surveillance, manage chronic disease and create new models for managing health-related
issues.
A framework proposed by Ahmed et al. (2021) for pandemic prediction advocated the
advantages IoTs and BDA analytics integration, which offers rapid data collection,
visualisation of pandemic information and descriptive and prescriptive analysis of the
COVID-19 pandemic.
The concerns with managing conceivable forms of unstructured medical data from
various MIoTs sources into clustered forms to provide quality information to understand
patient diagnostic has been improved through big data analytics algorithms. Significantly,
big data analytics has become the “game changer” for modern-day healthcare administration
(Dash et al., 2019). This further drives the healthcare industry to revolutionise its
technological infrastructure to integrate biomedical and health data for better healthcare
delivery service and cost management.
These emerging technologies, therefore, drive the focal change for healthcare
administration. Despite the accruing benefits from these emerging technologies, there
needs to be more empirical literature to explore the pathway for integrating IoTs and BDA in
healthcare. Accordingly, the acceptance of technologies for healthcare improvement reveals
health practitioners’ attitudes towards the “uptake and use” of integrating IoTs and BDA.
Also, whereas the taxonomy of prior studies seeks to examine the implication of IoTs and
BDA adoption in healthcare, studies still need to explain the configural paths for healthcare
technologies. In response, this study considers the UTAUT theoretical view and the digital
and data literacy conceptualisation to evaluate the configural paths through which emerging
technologies usage can improve patient care and healthcare delivery.
AJIM 2.2 Unified Theory of Acceptance and Use of Technology (UTAUT)
The UTAUT theory elucidates the extent of acceptance and the use of technology by
exploring the effects of four constructs: effort expectancy, performance expectancy,
facilitating conditions and social influence on behavioural intention (Venkatesh et al.,
2003). Ultimately, the theory was extended (UTAUT2) to examine further incorporating other
constructs to improve users’ behavioural intentions towards the use and acceptance of
technology (Venkatesh et al., 2012; Chang, 2012).
Albeit the extension of UTAUT theory, distinct contributions from recent studies have
explored constructs explaining behavioural intention towards digital innovations. For
instance, Ayaz and Yanartaş (2020) used the UTAUT theory to describe employees’
understanding and intention to use electronic data management systems. The study
observed that employees’ choice to use the system was largely explained by performance
expectancy and social influence. Similar research used UTAUT to investigate mobile
banking adoption among retail banks (Jadil et al., 2021). Other studies also combined UTAUT
theory with the technology acceptance model (TAM) and task-technology fit (TTF) to explain
users’ behaviour towards technology adoption and usage of emerging digital technologies
(Alazab et al., 2021; Buabeng-Andoh and Baah, 2020). In recent years, the choice of UTUAT
has been due to its robustness and parsimony and has proven superior to other frameworks
or models. The application of UTAUT also provides an understanding of technology usage
based on its broader factors driving acceptance. Despite its contribution, the UTAUT
constructs may not be sufficient to explain user acceptance of emerging technologies’ multi-
faceted user context. Although UTAUT has been used to define the readiness of healthcare
institutions or physicians to use emerging technologies to promote healthcare, limited
knowledge in a configural context is missing. Hence, utilising UTAUT constructs with digital
literacy through fsQCA methodology within the context of IoTs and BDA was considered
essential as the overarching theoretical view to explain the configural paths for this study.
This study relied on five UTUAT constructs and digital and data literacy to explore the
configural paths for using IoTs and BDA for healthcare management. Based on these
constructs, a research model (Figure 1 courtesy Senyo et al., 2021) was developed to explain
the combinatorial approach to explore the configural pathways through which IoTs and BDA
can improve healthcare. The constructs of UTAUT in this study were considered in a
configural context. Because this study sought to understand the configuration of pathways

Figure 1.
Configural pathways
for IoTs and BDA to
improve healthcare
through which IoTs and BDA usage improves healthcare. Therefore, the UTUAT constructs IoTs and BDA
and DL were considered independent variables using the fsQCA proposition. The dependent technologies
variable (outcome) was measured by the combinatorial effects of the presence of the six
variables as either core conditions, peripheral, low or redundant conditions. Hereafter,
discussions of these six constructs are provided.
2.2.1 Facilitating conditions (FC). Technology use largely depends on the availability of
other digital resources and support. Facilitating conditions, therefore, indicate users’ decision
to use emerging technology as long as there is evidence of information technology (IT)
infrastructure and support services. Notably, facilitating conditions are a proxy for the
intention to use technology. In this context, facilitating conditions for IoTs and BDA relate to
the availability of computing platforms, data management services, application software,
physical facilities support, IT management and service platforms enabled by new technology
tools. Therefore, facilitating conditions explore the degree to which physicians believe
hospital management provides the needed IT infrastructure and support services for using
IoTs, and BDA will improve healthcare services. Existing studies further reiterated that
facilitating conditions’ availability influences emerging technologies’ use (Ayaz and
Yanartaş, 2020; Andrews et al., 2021). In particular, this study advocates that facilitating
conditions will improve the use of IoTs and BDA for healthcare management. Accordingly,
there is a link between facilitating conditions for IoTs and BDA usage for healthcare
improvement.
2.2.2 Performance expectancy (PE). Performance expectancy is viewed as users’ perceived
belief that using an emerging technology application can support the attainment of the
intended objective. From an empirical point of view, performance expectancy is among the
strongest predictors of intention to use most technologies and remains significant. Consistent
with other studies (Arfi et al., 2021), performance expectancy explains the degree to which
IoTs and BDA enable physicians to accomplish tasks on time and improve professional
profitability and sound medical management. Also, theoretical reviews show a relationship
between the performance expectancy of IoTs and BDA usage for healthcare improvement.
2.2.3 Effort expectancy (EE). Effort expectancy explains users perceived ease of using
technology (Chang, 2012). More importantly, acceptance and wide usage of technology
largely depend on ease of use regardless of its advantages (Jadil et al., 2021; Alazab et al.,
2021). Extant studies have further substantiated the impact of effort expectancy on
enterprises and individual adopters’ intention of IoTs and BDA (Khayer et al., 2021). The
proposition in this study with effort expectancy is perceived ease of use by healthcare
practitioners to interact with emerging medical applications. Besides, flexibility and a short
learning time to use IoTs and BDA applications promote healthcare safety and improvement.
Hence, this study proposes a relationship between effort expectancy towards IoTs, BDA and
healthcare management.
2.2.4 Social influence (SI). Social influence describes how the view of important others,
such as colleagues or friends, affects a user’s decision to use new technology. Social influence
is also acknowledged as an important determinant of behavioural intention to use
technology with the notion that an individual is influenced by a positive perception of
technology by others (Tarhini et al., 2016; Baabdullah et al., 2019; Manrai et al., 2021). The
rationale, therefore, for social influence in this context is to understand how close associates
within the healthcare industry influence physicians’ use of IoTs and BDA. This study opined
that IoTs and BDA are emerging technologies deployed among health institutions. This
raises the need for further studies to establish the social influence on physicians’ readiness to
use these applications and platforms to improve healthcare. Consequently, the study
proposes a relationship between social influence in using IoTs and BDA for healthcare
improvement.
AJIM 2.2.5 Behavioural intention (BI). Consistent with underlying views, behavioural intention
explains the antecedents of individuals’ readiness towards a specific behaviour. Thus,
“individual actions are manifest as an observable response in a given situation concerning a
given target” (Tarhini et al., 2016; Ajzen, 1991). Accordingly, there has been substantial
evidence that behavioural intentions affect technology acceptance in information system
studies (Deniswara et al., 2021; Handoko, 2020). However, Petter et al. (2008) posit that
acceptance of a system is different from actual usage. Therefore, a clear understanding of
behavioural intentions and actual use is relevant. In this regard, exploring the relationship
between behavioural intention and usage of IoTs and BDA is imperative. Therefore, this
study proposes a relationship between behavioural intention and using IoTs and BDA for
improving healthcare.

2.3 Digital literacy and data literacy (DL)

The proliferation of big data has given rise to many firms considering unique digital
technologies to collect, create insight and store data. Accordingly, insight creation from data
has been recognised as a key resource in making meaningful decisions to gain a competitive
advantage (Ghasemaghaei and Calic, 2020; Edu et al., 2020). However, Faroukhi et al. (2020)
intimated that the process of insight creation derived from raw data extraction is complex.
Hence, although emerging digital technology capabilities play a role in gathering and
analysing big data, the key responsibilities of personnel to collect “the right data, prepare it,
analyse it, and interpret it” is significant for decision-making (Akter et al., 2019).
Consequently, exploring the concept of digital literacy and data literacy towards IoTs and
BDA usage is essential. Data literacy depicts the ability to read and meaningfully
communicate data in context towards an actionable outcome (Giudice da Silva Cezar and
Maçada, 2021). This study, therefore, posits that data literacy is the knowledge and skills
acquired from healthcare data by physicians to improve patients’ healthcare needs. Also,
digital literacy explains the use of digital technology tools to access, manage and create data
and information to generate knowledge (Mohammadyari and Singh, 2015). The concept of
digital literacy and data literacy jointly elucidate “users’ competence and skills to use
technology to access data, understand data, analyse data, generate insight and knowledge for
decision making” (Jeon and Kim, 2022). Therefore, combining digital and data literacy with
emerging technologies is significant to achieving healthcare improvement. Hence, the study
proposes a relationship between physicians’ digital and data literacy to IoTs and BDA usage
for healthcare improvement.

3. Methodology
3.1 Research design
In order to provide a holistic view and achieve the objectives above, the study deployed a set
of theoretical approaches and the qualitative comparative analysis (QCA) technique. The
QCA research design methodology aligns with the qualitative and quantitative research to
analyse multi-faceted causality and logical relations for necessary and sufficient conditions
to explain an outcome (Ragin, 2009; Rasoolimanesh et al., 2021; Chaparro-Pelaez et al., 2016).
The technique further provided a set of associations that seek to specify a closer nexus to
the theory adopted. The QCA premise is based on a set of theories using Boolean algebra to
assess associations between conditions and effects. The proposed research model in
Figure 1 considered six constructs: digital and data literacy, behavioural intentions,
performance expectancy, facilitating conditions, effort expectancy and social influence.
Using IoTs and BDA is the outcome variable for improving healthcare management and
patient safety.
3.2 Population, sample size and sampling technique IoTs and BDA
The study mainly concentrates on the healthcare sector in Ghana, a sub-Saharan African technologies
country. The healthcare sector is perceived as one of the important sectors that facilitate the
safety of health-related issues. On that score, health physicians, nurses, administrators,
pharmacists and biomedical and healthcare givers from healthcare institutions were key
participants in this study. In this regard, the study used convenient non-probability
techniques to select participants to elicit responses to the questionnaire provided. The
convenient sampling technique was preferred due to its usefulness in supporting large
sample collection for generalisation across healthcare institutions in Ghana.

3.3 Data-collection method and analysis

The study adopted a survey approach using a questionnaire to collect data. Data was
collected through an online questionnaire due to the prevailing circumstance with COVID-19.
A period of eight months spanning October 2021–May 2022 covered the length of time for
data collection. The questionnaire was categorised into the demography part and the
perceived understanding and usage of IoTs and BDA deployment for healthcare
management. The demography part explored the characteristics of healthcare
professionals, which delineate their current position, their level of educational status and
the length of practising as caregivers within the healthcare sector. In addition, views on the
awareness of emerging digital technologies applications for healthcare delivery services, in
general, were obtained from the participants. This part sought to clarify the essential
applications, tools and platforms currently driving healthcare delivery services within the
country. Also, participants’ familiarity with IoTs and BDA applications usage for daily
delivery of patients’ diagnostics and internal use for general hospital administration was
useful information for this study. Essentially, this section of the questionnaire elicits
responses regarding current technology usage within the healthcare sector in Ghana. The last
part of section one of the questionnaire further provided a global view of specific IoTs and
BDA technologies used in the healthcare sector. The particular technology, IoTs or BDA, was
required within Ghana’s healthcare delivery context. The second part of the questionnaire is
developed to assess and evaluate the various healthcare practitioners’ perceptions about
using IoTs and BDA for healthcare. The study used a 7-point Likert scale ranging from
strongly agree to strongly disagree to evaluate the degree to which participants agree or
differ on the six different constructs using IoTs and BDA. Namely facilitating conditions (FC),
effort expectancy (EE), performance expectancy (PE), behavioural intentions (BI), social
influence (SI), digital and data literacy (DL) and an outcome (using IoTs and BDA) to improve
healthcare management and patient safety. Except for the digital and data literacy construct
(Giudice da Silva Cezar and Maçada, 2021), the remaining constructs relied on the UTAUT
theoretical propositions to investigate the configural path to improve healthcare
management.
Data collected were analysed in three stages: demography, construct measurement and
fsQCA analysis. After clarifying the characteristics of the participants, descriptive statistics,
correlations coefficient and Cronbach alpha were estimated for all constructs adopted for this
study in the second stage. These tests provided validity and reliability evidence that the data
collected offers sufficient evidence with the research model proposed. The third stage of the
analysis is the fuzzy qualitative comparative analysis (fsQCA) for data calibration, truth table
building and the configural paths. The fsQCA was deployed because the expected data
collected is not binary. Hence, the crisp set analysis involves binary conditions to develop
theoretically and empirically informed membership set scores ranging from “0” to “1”.
FsQCA, therefore, conceptualises the sets responses into linguistic variables with values from
“0” to “1” membership function as prescribed by Zadeh (1965). Given the corresponding
AJIM linguistic variables for all the constructs, the QCA measures the crisp and fuzzy sets for the
outcome and conditions, respectively. The procedure for fsQCA involves transforming
constructs into set calibration regarding three significant thresholds: full membership, cross
point and full non-membership set (Pappas and Woodside, 2021). This ensures the
fuzzification of Likert scale responses into 0 and 1 for the low and high extent of agreement,
respectively. The fsQCA further aligns with the configuration theories, which focus on the
principles of causal links through a combination or multiple combinations of conditions to
explain the existence of an outcome (Fiss, 2011). Based on the causal path, six corresponding
conditions were considered to explain the presence of outcome (i.e. the use of IoTs and BDA)
defined as high performance expectancy, high facilitating conditions, low effort expectancy,
high social influence, high behavioural intention and high digital and data literacy. The
combination of these causal conditions may lead to a high intention to use emerging digital
technologies. Also, there may need to be more than one condition among other causal
conditions to explain the presence of an outcome. In all, the fsQCA ensures the significant
analysis of data calibration, truth table estimation and causal paths to explain the presence of
IoTs and BDA usage (Thomann and Maggetti, 2020; Oana and Schneider, 2018).

4. Findings
4.1 Sample profiling and construct measurement
The demography characteristics of 445 participants from the data collected guaranteed
adequate representation of distinct perspectives from their responses presented. A pilot
study with 52 participants was conducted to ascertain the suitability of the questionnaire,
and the results revealed a good fit for the instruments selected for the proposed model.
Participants in this study were from different healthcare institutions across Ghana,
comprising doctors, administrators, pharmacists, laboratory scientists, nurses, paramedics
and physiotherapists. From the sampling profiling results (Tables A1 and A2), more than
50% of healthcare practitioners are female, and the dominant age group of the respondents is
between 31 and 40 years (frequency 5 214, 49%), followed by ages between 20 and 30
(frequency 5 202, 45.4%), respectively.
Also, the analysis reveals that 71.70% of respondents have obtained a diploma and first-
degree certification, and the remaining 28.3% have a certificate, master’s degree and
doctorate certification. Regarding professional qualifications, the results show that many
healthcare practitioners are nurses (frequency 5 190, 42.7%) and doctors (frequency 5 104,
23.4%). The remaining practitioners are health administrators (f 5 46, 10.3%),
physiotherapists (frequency 5 39, 8.8%), laboratory scientists (frequency 5 28, 6.3%),
pharmacists (frequency 5 26, 5.8%) and paramedics (frequency 5 12, 2.7%), respectively.
Additionally, the results indicate that most health professionals have worked between 1 and
20 years (frequency 5 434, 97.5%). Given that the years of services are between 1 and
20 years, it is indicative that most healthcare professionals are within the young age range of
20 and 40 years. The results also reveal the familiar emerging healthcare devices used across
healthcare institutions in Ghana. Among these smart devices, most healthcare professionals
indicated high familiarity and usage with medical data transfer devices (frequency 5 123,
27.6%) and mobile wearable devices (frequency 5 108, 24.3%). This is followed by cloud
connectivity platforms (frequency 5 88, 19.8%), remote monitoring devices (frequency 5 50,
11.2%) and medical refill reminder technology (frequency 5 29, 6.5%).
Based on the UTAUT theoretical lens adopted in this study and digital and data literacy,
constructs were measured to ensure the validity of the data collection instrument. In that
regard, correlation analysis and Cronbach alpha measurements were performed to explain
the relationship and reliability of the constructs, respectively. The results in Table 1 show
that the constructs measuring the use of IoTs and BDA to improve healthcare exhibit some
 Cronbach
IoTs and BDA
Constructs Mean Std. D Alpha 1 2 3 4 5 6 technologies
Usage 3.73 0.74 0.87 1
DL 3.48 0.75 0.83 0.69** 1
PE 3.21 0.70 0.82 0.61** 0.60** 1
FC 3.18 0.77 0.87 0.58** 0.58** 0.69** 1
EE 3.32 0.73 0.91 0.63** 0.61** 0.69** 0.78** 1
SI 3.45 0.63 0.82 0.63** 0.62** 0.67** 0.69** 0.76** 1
BI 4.24 0.46 0.81 0.19* 0.03 0.04 0.02 0.12* 1
Note(s): **Correlation is significant @ 0.01 level Table 1.
*Correlation is significant @ 0.05 level Construct
Source(s): Table by author measurements

association with each other and descriptive statistics. Except for DL showing low causation
with usage, all the constructs show positive causation. Significantly, there is a clear
correlation among the variables, and no multicollinearity exists. Additionally, the Cronbach
alpha values for all constructs are between 0.81 and 0.91 above the threshold of acceptable
internal consistency indices (Hair et al., 2017). Accordingly, the construct measurements
indicate reliability and satisfactorily support the research model.

4.2 Configural paths analysis

This study relied on the set-theoretic method grounded on the fsQCA analytic technique
through a set theory that considers the overall analysis of how different causal patterns
contribute to an outcome. The study performed a three-stage analysis of the fsQCA technique
adopted. Data calibration was first carried out to transform raw data into set membership
values ranging from 0 to 1 for the crisp set (outcome) and the six causal conditions to
constitute the ideal type of values for the variables. Secondly, a truth table was developed
based on the set values from the calibration process. The truth table matrix presents the
empirical information that outlines the sets from the data and indicates a set of configural
paths to explain the outcome variable. Using the minimum number of empirical cases related
to a configuration for assessing a pathway (Pappas and Woodside, 2021; Ragin, 2021), a
consistency threshold of value greater than 0.75 or closer to 1 was used to define causal
conditions for this study. A consistency closer to 1 provides evidence of a perfect association
between causal conditions and an outcome (Thomann and Maggetti, 2020; Greckhamer
et al., 2018).
Based on the threshold set above, the Quine–McCluskey algorithm is used to compute the
truth table to explain the configural path for IoTs and BDA usage. The truth table reveals
three solutions: complex, parsimonious and intermediate. Consistent with fsQCA literature
and counterfactual analysis, the study relied on parsimonious and intermediate. The
solutions show the logically possible combinations of causal conditions. The parsimonious
solution simplifies assumptions that present the core conditions for an outcome, and the
intermediate solution simplifies assumptions that present both core and peripheral
conditions. Combining both parsimonious and intermediate solutions suggest a more
detailed view of core conditions (significant contributing constructs) and peripheral
conditions (less significant contributing constructs) for theoretical and empirical findings
(Rasoolimanesh et al., 2021; Fiss, 2011).
Relying on the sufficiency analysis to display the equifinality of configural paths with the
outcome, the intermediate solution is presented in Table 2. The results show the measures for
reliability (consistency), the degree to which a configuration is sufficient for the outcome
AJIM Configural paths
Constructs 1 2 3 4 5 6

Digital and Data Literacy C C C C

Performance Expectancy C C • Ø
Facilitating Condition • • Ø Ø
Effort Expectancy • • • Ø Ø
Social Influence • C C C
Behavioural Intention • • • • •
Raw Coverage 0.538 0.542 0.613 0.736 0.113 0.242
Unique Coverage 0.008 0.111 0.021 0.083 0.002 0.021
Consistency 0.992 0.991 0.972 0.971 0.968 0.933
Overall solution coverage 0.823
Overall consistency coverage 0.947
Overall PRI 0.951
Table 2.
Configural Paths for Note(s): Black circles “C” indicate the presence of a condition, and circles with “Ø” indicate its absence or low
IoTs and BDA condition. Large circles depict core conditions, and small circles represent peripheral conditions. Blank spaces
deployment for indicate that the condition is redundant in a given path to achieve an outcome (Pappas and Woodside, 2021;
healthcare Thomann and Maggetti, 2020; Fiss, 2011)
management Source(s): Table by author

(proportional reduction in consistency) and measures for empirical relevance (coverage). The
consistency thresholds of at least <0.90 with high solution coverage above 0.50 are
recommended for necessity and sufficient analysis for the outcome. The result in Table 2
shows that overall consistency (0.947) and solution coverage (0.823) values meet the
thresholds. A proportional reduction in consistency (PRI) value closer to 1 indicates an
acceptable configuration and is sufficient for a positive outcome.
This shows significant reliability of the empirical claim of constructs identified to present
the conditions leading to using IoTs and BDA for healthcare improvements. In addition, the
values for raw and unique coverage support the proportion of configural presence for IoTs
and BDA usage for healthcare management.
Finally, our fsQCA result reveals six empirical sufficient causal paths to IoTs and BDA
usage to improve healthcare management, as presented in Table 2.
For high usage of IoTs and BDA to improve healthcare management, configural path 1
indicates a combination of high digital and data literacy, high performance expectancy, high
facilitating condition, high effort expectancy and high social influence. This configural path
shows that digital and data literacy and performance expectancy are core conditions that
emphasise that the two conditions have a strong causal relationship with using IoTs and
BDA for healthcare improvement. Significantly, the absence of behavioural intentions in this
path has no consequence on the outcome of IoTs and BDA use. Considerably, this casual path
indicates that users’ perception of ease of use of technology with high performance
expectancy and high effort expectancy in high facilitating conditions promotes the use of
emerging technology to improve patient safety.
Configural path 2 shows a combination of high digital and data literacy, high performance
expectancy, high facilitation condition, high effort expectancy and high behavioural intention
advances the use of IoTs and BDA to improve healthcare. Coincidently, both configural paths
1 and 2 share similar core conditions, which reflects the presence of equifinality (Ham et al.,
2020). This explains that under distinct situations, high digital and data literacy and high
performance expectancy support the desired achievement of users’ perception of
technology usage.
Furthermore, in the absence of facilitating conditions, high effort expectancy, high social
influence and behavioural intentions drive the use of IoTs and BDA for healthcare
management (configural path 3). Similarly, high social influence and behavioural intentions IoTs and BDA
with high digital and data literacy lead to using IoTs and BDA for healthcare improvement, technologies
as shown in configural path 4. Configural path 5 indicates that the combination of high
behavioural intentions, low performance expectancy, low facilitating conditions and low
effort expectancy have an impact on the use of emerging technologies. Finally, configural
path (6) further indicates the combination of high social influence and behavioural intentions
could result in using IoTs and BDA to improve healthcare irrespective of either the absence or
low presence of other variables.
The underlining analysis from the fsQCA results shows two main topologies propositions
driving the use of IoTs and BDA to improve healthcare from the six configural paths. The
first topology is driven by technological skills and effort expectancy driven by high users’
perception of ease of use (configural paths 1, 2 and 5). Social influence and Behavioural
intentions with low facilitating conditions also define the second topology (configural paths 3,
4 and 6).
Table 2 further indicates that consistency values for the six configural paths demonstrate
consistency values close to 1, indicating acceptable, perfect consistency values and PRI also
close to 1 (Oana and Schneider, 2018; Greckhamer et al., 2018). In detail, the result presents the
presence of three (3) core conditions (digital and data literacy, performance expectancy and
social influence) and three (3) peripheral conditions (facilitating conditions, effort expectancy
and behavioural intentions).

5. Discussions
This section highlights the findings of this study by exploring the overarching impact of
emerging technologies on healthcare management. Therefore, the study examines the
configural paths of physicians’ perspectives through which IoTs and BDA adoption can
enhance healthcare management. Based on the constructs adopted, the results revealed six
configural paths explaining the conditions for achieving healthcare improvement. The
configural paths were further categorised into two distinct core conditions to explain the
topologies of users’ configural paths to IoTs and BDA deployment for healthcare
improvements. Within the study’s context and objectives of the study, the discussions of
the findings were also subjected to other theoretical and empirical findings.

5.1 Topology 1 – acceptance and usage are driven by digital literacy and ease of use
Configural paths 1, 2 and 5 propose that high digital and data literacy skills and high
performance expectancy are core conditions and facilitating conditions and effort expectancy
as peripheral conditions driving the use of IoTs and BDA. This suggests that physicians’
ability to use IoTs and BDA for healthcare activities largely depends on adequate
technological skills acquisition, perception of high accomplishments of tasks and the ease of
using these emerging technologies. Therefore, once physicians perceive adequate IT
infrastructure and support services to accomplish a task, there will be high usage of IoTs and
BDA applications for healthcare improvement.
Consistent with existing studies, topology 1 underscores that facilitating conditions with
high performance expectancy and ease of use is imperative for users with emerging
technologies usage (Andrews et al., 2021; Cabrera-Sanchez and Villarejo-Ramos, 2019).
Especially for IoTs and BDA in healthcare, beyond greater functionality and capabilities,
users are more concerned with ease of use to improve medical effectiveness on the job
and clear instructions concerning the use of medical technologies (Kang et al., 2019;
Lederman et al., 2021). Therefore, the propositions from this study for topology 1 show that
combining performance expectancy, digital and data literacy, facilitating conditions and
AJIM effort expectancy in using IoTs and BDA will support healthcare improvement. Additionally,
from their perspective, the interaction of IoTs and BDA promote health-related information,
patient–physician relationship and collaborative healthcare (Tortorella et al., 2020; Bhatt and
Chakraborty, 2021; Chen et al., 2020).

5.2 Topology 2 – acceptance and usage are driven by a social circle and behavioural
intentions
The results further demonstrate the configural relationship between social influence,
behavioural intention and effort expectancy towards using IoTs and BDA for healthcare
improvement. Topology 2 identifies social influence as a core condition with high behavioural
intentions significantly affect the actual usage of emerging digital technologies (Baabdullah
et al., 2019; Ayaz and Yanartaş, 2020; Manrai et al., 2021). This is because social influence and
behavioural intentions theoretically and empirically influence the level of technology
adoption and intention to use (Manrai et al., 2021; Venkatesh et al., 2003).
In healthcare, for instance, Arfi et al. (2021) observed that social influence is the most
important predictor for IoTs and big data technology acceptance and usage. This further
suggests that the presence of social influence as a core condition influences the use of
technology even though absence or low facilitating conditions and effort expectancy may
occur. Existing studies further posit that high behavioural intentions among users affect the
extent of technology usage (Alazab et al., 2021; Arfi et al., 2021). Understandably, analysis
from Alassafi (2021) reveals the crucial aspect of high behavioural intentions towards
utilising emerging technologies for healthcare improvement. In a nutshell, topology 2 clarifies
that where there is an absence or low facilitating conditions or the conditions of redundancy
of performance expectancy, high social influence and behavioural intentions will lead to IoTs
and BDA usage to improve healthcare services.
To this extent, Figure 2 depicts performance expectancy, digital and data literacy and
social influence as core conditions for using IoTs and BDA in healthcare management.

Figure 2.
Topologies for
configural paths
Accordingly, the six constructs considered in all the configural paths show significant IoTs and BDA
contributions towards IoTs and BDA usage for healthcare improvement. technologies

6. Implication of study
6.1 Theoretical implications
The outcome of the study highlighted two main theoretical implications. First, the application
of the fsQCA methodology elucidates new viewpoints on the acceptance and utilisation of
emerging technology. Considerably, the use of fsQCA in this study reveals different
configural paths to explain the use of IoTs and BDA to improve healthcare. Although
individual constructs have been used over time, this study combines the UTAUT and digital
and data literacy constructs to explore the multiple paths towards technology acceptance.
Hence, addressing the combinations of these conditions through fsQCA highlights a need for
researchers to refocus distinct constructs in a contextual consideration for technology
acceptance and usage.
Secondly, based on the six configural paths, the study developed two distinct topologies to
explain the acceptance and use of IoTs and BDA from physicians’ perspectives. Relying on
empirical and theoretical contributions, the constructs adopted for the configural paths
analysis reflect core and peripheral conditions to demonstrate users’ topologies. Thus,
technology usage is driven by digital literacy, ease of use for topology 1, and social cycle and
behavioural intentions for topology 2. Besides, this study’s proposed model and topologies
demonstrate emerging technologies’ considerable acceptance and usage. This study supports
the holistic addressing of the complexity and integration of digital innovation and users’
acceptance and use of IoTs and BDA for healthcare management (Bhatt and Chakraborty,
2021; Rajabion et al., 2019).

6.2 Practical implication

The findings from this study reveal a concern for healthcare institutions and health
administrators with emerging digital health technology adoption and usage. The results
underpin that physicians’ use of technologies is differentiated based on perceived social
inclinations, how the technology supports their work and the availability of such
technologies. This allows healthcare administrators and institutions to focus on the
distinct combinations of conditions favourable to physicians to use IoTs and BDA for
healthcare improvement. Acknowledging the distinct category of users will provide clarity of
core and peripheral conditions suitable to influence the use of IoTs and BDA for healthcare
improvement. Specifically, the findings provide a framework for healthcare institutions to
classify factors affecting the ease of use of technology and physicians’ behavioural intention.
More importantly, the acceptance and use of healthcare technologies and platforms are not
solely on their capabilities but a combination of factors that drive users’ perspectives. These
viewpoints guide healthcare managers and system implementers to be more user-focused
rather than pay attention to technology functionality. For example, topology 1 aligns with
users’ expectations that using IoTs and BDA can translate or help them achieve specific
tasks. Therefore, systems usefulness is essential to just the general functionalities of the
systems. Healthcare managers must provide bespoke functionalities of IoTs and BDA
applications, not off-the-shelf. Besides, the two topologies offer the underlying considerations
to developers and health policymakers the opportunity to look beyond just the functionalities
of these emerging technologies. The level of users’ digital literacy, systems readiness and
social influence plays a major role in technology acceptance and usage. Finally, the findings
advocate for better consideration of physicians’ perspectives on deploying and using IoTs
and BDA to improve healthcare services.
AJIM 6.3 Conclusion
This study applies the fsQCA and the theoretical underpinning of UTAUT with digital and
data literacy concepts to uncover the combination of conditions sufficient to explain the
configural paths to support healthcare improvement using IoTs and BDA. The study relied
on 445 healthcare professionals comprising doctors, health administrators, nurses,
pharmacists, laboratory scientists, paramedics and physiotherapists. Their perspectives
provided different pathways to the use IoTs and BDA applications for daily healthcare. Data
were analysed using SPSS and fsQCA 3.0 to explore the underlying pathways for healthcare
improvement. The empirical analysis reveals six configural paths to explain the paths to
using IoTs and BDA for healthcare improvement. The configural paths were summarised
into two topologies driven by healthcare professionals’ pathways for using technologies to
improve healthcare. More importantly, the overall solution coverage of 0.823 indicates the
extent to which the six configural paths explain the use of IoTs and BDA for medical
improvement. These findings advance theoretical, empirical and practical discussion of
emerging healthcare technologies to support the health sector. As a result, this study is
among the few studies to empirically investigate the configural paths to support healthcare
improvement with emerging technologies. As such, fsQCA is a novel contribution that offers
holistic perspectives to the existing literature for emerging technology usage.
Despite this study’s novel contributions, limitations include the fsQCA methodology,
perceptual data and the context of the study. The fsQCA methodology is still evolving with
different interpretations, although it reveals new insights and as such further studies are
required to explain the configural paths of social phenomena. Additionally, future research
should consider other constructs beyond the UTAUT and digital literacy to illustrate
configural paths to healthcare technology acceptance and usage. Again, the views of
healthcare professionals are perceptual data. Hence future research on operational data will
support significant contributions towards pathways to accept and use emerging technologies
for healthcare improvement. Lastly, this study is from a developing country perspective
where emerging digital healthcare technology is still rising to support healthcare
management. Hence, more investigation from other cross-country analyses of configural
paths for digital technology deployment in healthcare will enhance the conversation with
IoTs and BDA for healthcare management.

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Appendix IoTs and BDA
technologies

1. Demography
Gender: Male
Female
Age: 20 – 30
31- 40
41 – 50
Above 50
Professional Qualification: Certificate
Diploma
First Degree
Master’s Degree
PhD
Job Title/Position: Doctor
Pharmacist
Nurse
Medical Lab. Technician
Paramedic
Others
Length of Service: 1-10
11-20
21-30
31-40
41 and Above

2. Smart Devices for Healthcare Management

i. Which of the following devices are you familiar with for Healthcare Services?
ii. Medical data transfer device
iii. Remote patient monitoring devices
iv. Vital signs data capturing device. Table A1.
v. Drug tracking device Questionnaire – IoTs
vi. Mobile (Connected contact lenses, Watches, Ingestible sensors) tracking device and BDA technologies
vii. Medical refill reminder technology for healthcare
management
(continued )
AJIM
3. IoTs and BDA Usage and Acceptance
Please tick your level of agreement – Strongly Agree (7), Agree (6), Somewhat Agree (5), Neutral
(4), Somewhat Disagree (3), Disagree (2), Strongly Agree (1)
Digital and Data Literacy 1 2 3 4 5 6 7
I find it hard to decide what the best keywords are to use to search patient
data/information
I get tired when looking for information from computer or mobile device

Sometimes my skills are limited to using new technologies

I find it hard to find a website and platforms I visited before

I have competencies to use mobile devises to collect patients’ data

Promoting IoTs and BDA application (Outcome) 1 2 3 4 5 6 7

Using smart devices and data capabilities improve health analytics
Using smart applications promote data sourcing quickly
Big data analytics tools simplify patients’ data daily
Emerging medical technologies will support decision-making faster
IoTs and BDA support monitoring patients remotely and providing
diagnostics
I like to work with emerging technologies to improve medical management

Using smart devices, analytical and storage applications will

improve caregivers and patient’s relationship
Performance Expectancy 1 2 3 4 5 6 7
Using IoTs & BDA in my job would enable me to accomplish task more
quickly
IoTs & BDA applications would improve my job performance
Using the IoTs & BDA systems would enhance medical professionals’
effectiveness on the job
Using IoTs & BDA systems would increase medical professionals’
productivity
Using IoTs & BDA systems make it easier to my job
I would find IoTs & BDA systems useful for medical management
Facilitating Conditions 1 2 3 4 5 6 7
I have control over using emerging medical applications
I have the necessary knowledge to use emerging technologies
Given the resources, opportunities, and knowledge it takes touse the system, it
would be easy to use the system
The IoTs & BDA are not compatible with other systems
Guidance was available to me in the selection of emergingmedical
technologies
Specialized instruction concerning the use of emerging medical technologies
were made available to me

Table A1. A specific person or group is available for assistance

(continued )
 IoTs and BDA
Effort Expectancy 1 2 3 4 5 6 7 technologies
Learning to operate the IoTs & BDA systems would be easy
My interactions with emerging medical applications would be clear and
understandable
I would find medical application systems to be flexible to interact with
It would be easy for me to become skilful at using the IoTs &
BDA systems
Using IoTs & BDA systems takes too much time from normal duties
Working with IoTs & BDA systems are so complicated and difficult to
understand what is going on
It will take too long to learn how to IoTs & BDA systems to make it worth the
effort
Using the system involves too much time doing mechanical operations
Social Influence 1 2 3 4 5 6 7
I use emerging medical application because proportion of my co-workers use
the system
The senior management within health institutions are helpful inthe use of new
medical technologies
My supervisor is very supportive of the use of new medicalapplication such as
IoTs & BDA applications
In general, the health institutions have supported the use of emerging medical
technologies
Having IoTs & BDA systems is a status symbol for health institutions
People in my healthcare institution who use IoTs & BDA systems have more
prestige than those who do not
People in my healthcare institutions who use the IoTs & BDA system have a
high profile
Behavioural Intentions 1 2 3 4 5 6 7
I plan to use emerging technologies soon
As soon I understand the IoTs and BDA application, I use them
My healthcare institution requires I use IoTs devices
I will use smart devices to support daily progress of patient
I intend to use emerging technologies in the coming years
Table A1.
Source(s): Table by author
AJIM Variable Levels Frequency (f) Percentage (%)

Gender Female 331 74.4

Male 114 25.6
Age 20–30 202 45.4
31–40 218 49.0
41–50 24 5.4
Above 51 1 0.2
Educational Level Certificate 80 18.0
Diploma 182 40.9
First Degree 137 30.8
Master’s Degree 34 7.6
Doctorate Degree 12 2.6
Professional Qualification Doctor 104 23.4
Health Administrator 46 10.3
Pharmacist 26 5.8
Nurse 190 42.7
Laboratory Scientist 28 6.3
Paramedics 12 2.7
Physiotherapist 39 8.8
Years of Service 1–10 324 72.8
11–20 110 24.7
21–30 5 1.1
31–40 4 0.9
Above 41 2 0.4
Smart Devices for Healthcare Mobile wearable device 108 24.3
Management Remote Patient monitoring 50 11.2
device
Medical data transfer device 123 27.6
Medical refill reminder 29 6.5
technology
Cloud connectivity 88 19.8
Vital signs data capturing 47 10.6
Table A2. device
Sample profiling Source(s): Table by author

Corresponding author
Abeeku Sam Edu can be contacted at: asedu@ug.edu.gh

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