• Asia pacific journal of information systems
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• v.23 no.4
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• pp.53-84
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• 2013

With rapid development of ICT (Information and Communications Technology), new services by the convergence of mobile network and application technology began to appear. Today, smart phone with new ICT convergence network capabilities is exceedingly popular and very useful as a new tool for the development of business opportunities. Previous studies based on Technology Acceptance Model (TAM) suggested critical factors, which should be considered for acquiring new customers and maintaining existing users in smart phone market. However, they had a limitation to focus on technology acceptance, not value based approach. Prior studies on customer's adoption of electronic utilities like smart phone product showed that the antecedents such as the perceived benefit and the perceived sacrifice could explain the causality between what is perceived and what is acquired over diverse contexts. So, this research conceptualizes perceived value as a trade-off between perceived benefit and perceived sacrifice, and we need to research the perceived value to grasp user's continuous intention to use of smart phone. The purpose of this study is to investigate the structured relationship between benefit (quality, usefulness, playfulness) and sacrifice (technicality, cost, security risk) of smart phone users, perceived value, and continuous intention to use. In addition, this study intends to analyze the differences between two subgroups of smart phone users by the degree of personal innovativeness. Personal innovativeness could help us to understand the moderating effect between how perceptions are formed and continuous intention to use smart phone. This study conducted survey through e-mail, direct mail, and interview with smart phone users. Empirical analysis based on 330 respondents was conducted in order to test the hypotheses. First, the result of hypotheses testing showed that perceived usefulness among three factors of perceived benefit has the highest positive impact on perceived value, and then followed by perceived playfulness and perceived quality. Second, the result of hypotheses testing showed that perceived cost among three factors of perceived sacrifice has significantly negative impact on perceived value, however, technicality and security risk have no significant impact on perceived value. Also, the result of hypotheses testing showed that perceived value has significant direct impact on continuous intention to use of smart phone. In this regard, marketing managers of smart phone company should pay more attention to improve task efficiency and performance of smart phone, including rate systems of smart phone. Additionally, to test the moderating effect of personal innovativeness, this research conducted multi-group analysis by the degree of personal innovativeness of smart phone users. In a group with high level of innovativeness, perceived usefulness has the highest positive influence on perceived value than other factors. Instead, the analysis for a group with low level of innovativeness showed that perceived playfulness was the highest positive factor to influence perceived value than others. This result of the group with high level of innovativeness explains that innovators and early adopters are able to cope with higher level of cost and risk, and they expect to develop more positive intentions toward higher performance through the use of an innovation. Also, hedonic behavior in the case of the group with low level of innovativeness aims to provide self-fulfilling value to the users, in contrast to utilitarian perspective, which aims to provide instrumental value to the users. However, with regard to perceived sacrifice, both groups in general showed negative impact on perceived value. Also, the group with high level of innovativeness had less overall negative impact on perceived value compared to the group with low level of innovativeness across all factors. In both group with high level of innovativeness and with low level of innovativeness, perceived cost has the highest negative influence on perceived value than other factors. Instead, the analysis for a group with high level of innovativeness showed that perceived technicality was the positive factor to influence perceived value than others. However, the analysis for a group with low level of innovativeness showed that perceived security risk was the second high negative factor to influence perceived value than others. Unlike previous studies, this study focuses on influencing factors on continuous intention to use of smart phone, rather than considering initial purchase and adoption of smart phone. First, perceived value, which was used to identify user's adoption behavior, has a mediating effect among perceived benefit, perceived sacrifice, and continuous intention to use smart phone. Second, perceived usefulness has the highest positive influence on perceived value, while perceived cost has significant negative influence on perceived value. Third, perceived value, like prior studies, has high level of positive influence on continuous intention to use smart phone. Fourth, in multi-group analysis by the degree of personal innovativeness of smart phone users, perceived usefulness, in a group with high level of innovativeness, has the highest positive influence on perceived value than other factors. Instead, perceived playfulness, in a group with low level of innovativeness, has the highest positive factor to influence perceived value than others. This result shows that early adopters intend to adopt smart phone as a tool to make their job useful, instead market followers intend to adopt smart phone as a tool to make their time enjoyable. In terms of marketing strategy for smart phone company, marketing managers should pay more attention to identify their customers' lifetime value by the phase of smart phone adoption, as well as to understand their behavior intention to accept the risk and uncertainty positively. The academic contribution of this study primarily is to employ the VAM (Value-based Adoption Model) as a conceptual foundation, compared to TAM (Technology Acceptance Model) used widely by previous studies. VAM is useful for understanding continuous intention to use smart phone in comparison with TAM as a new IT utility by individual adoption. Perceived value dominantly influences continuous intention to use smart phone. The results of this study justify our research model adoption on each antecedent of perceived value as a benefit and a sacrifice component. While TAM could be widely used in user acceptance of new technology, it has a limitation to explain the new IT adoption like smart phone, because of customer behavior intention to choose the value of the object. In terms of theoretical approach, this study provides theoretical contribution to the development, design, and marketing of smart phone. The practical contribution of this study is to suggest useful decision alternatives concerned to marketing strategy formulation for acquiring and retaining long-term customers related to smart phone business. Since potential customers are interested in both benefit and sacrifice when evaluating the value of smart phone, marketing managers in smart phone company has to put more effort into creating customer's value of low sacrifice and high benefit so that customers will continuously have higher adoption on smart phone. Especially, this study shows that innovators and early adopters with high level of innovativeness have higher adoption than market followers with low level of innovativeness, in terms of perceived usefulness and perceived cost. To formulate marketing strategy for smart phone diffusion, marketing managers have to pay more attention to identify not only their customers' benefit and sacrifice components but also their customers' lifetime value to adopt smart phone.

• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.