Electronic Thesis and Dissertation Repository

Thesis Format



Doctor of Philosophy


Health Information Science


Nicole Haggerty

2nd Supervisor

Elysee Nouvet


3rd Supervisor

Ishola Ajiferuke



There is increasing evidence to demonstrate that current information system theoretical models meant to assess the success of the health information systems (HIS) lack the applicable theoretical underpinning suitable for developing countries. This stems partly from a theory-evidence gap where theoretical models developed in the West are applied in developing country contexts but lack tailoring to localized, contextual realities. Therefore, this study addresses this gap by enhancing the DeLeon and McLean's information system success model with six contextual factors peculiar to the infectious disease HISs in a developing country context.

This study took place in two developing countries, Liberia and Nigeria. It applied a triangulation convergence mixed-method study design, involving a quantitative descriptive, cross-sectional, and qualitative study design to collect data from participants in three decision-making levels. For the quantitative component of the study, multistage sampling guided the selection of the primary level decision makers randomly selected from 200 primary health care clinics 100 each from Liberia and Nigeria. For the qualitative component of this study, a judgemental non-probability sampling approach selected the secondary and tertiary level decision-makers involved in Liberian and Nigeria’s infectious disease response. Descriptive, structural equation modelling (quantitative) and inductive and deductive thematic analysis (qualitative) formed the core of the data analysis methods for this study.

Taken together, the data revealed that 13 of the 21 hypothesized relationships extending the DeLeon and McLean’s information system success model were supported. The difference in the number and type of hypothesized relationships supported in Nigeria and Liberia also attest to the enhanced model’s sensitivity to determine context-specific challenges in different developing countries. The results also revealed that human resources for health competency (HRHC) had the strongest predictive influence on information, system and service quality in the two countries, while external partner support negatively predicts some quality measures in the two countries.

This study demonstrates the value of applying context-specific theoretical models in HIS research in developing countries. The results from the study also demonstrate that investing in HRHC and improving donor engagement has the potentials to improve developing country's ability to make responsive evidence-based decisions during the next infectious disease pandemic.

Summary for Lay Audience

Health information system’s (HIS) research provides the evidence needed to identify gaps and priorities to improve any country’s health system readiness and performance during an infectious disease pandemic. The HIS’s role of providing information is indispensable during public health emergencies when the dearth of context specific data to guide an infectious disease pandemic response can cripple any country’s pandemic response. Several information systems theoretical models have demonstrated their applicability in supporting HIS research in several developed countries. However, these theoretical models' applicability in developing countries makes it difficult to identify context-specific HIS gaps peculiar to developing countries.

This study focused on bridging this knowledge and practice gap. It applied an in-depth review of the literature to identify contextual factors peculiar to developing countries to enhance the updated DeLone and McLean's (D&M) information system success model. Twenty-one hypotheses were identified to validate the proposed model in two developing countries: Nigeria and Liberia. A mixed-method study design was chosen for this study due to the designs' ability to provide a richer blend of insightful data to respond to the two research questions. Three levels of decision makers constituted the respondents for this research. The quantitative method applied a multistage sampling method to select and collect data from the primary decision makers working in primary health care clinics. While the qualitative method applied a judgemental sampling method to select the secondary and tertiary level decision-makers at the state and national level to participate in an in-depth interview.

The study revealed that through this proposed model, each country was able to identify differently what they determined as a priority to strengthen their HIS when preparing for a future infectious disease pandemic. This study's results demonstrated that developing countries need to improve the contextual factors presented in the proposed model to improve their HIS’s pandemic readiness and their ability to support a responsive evidence-based decision-making process in the event of a future infectious disease pandemic. Applying this study’s enhanced model in future HIS research in developing countries’ can provide the evidence decision-makers countries need to improve the performance and success of their HIS.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.