Abstract
This thesis examines the practices of antibiotic use and develops a process-oriented approach to establishing a digitally mediated institution for Antimicrobial Resistance (AMR) data management in resource-constrained public health settings in India. The research focuses on the problem of inappropriate antibiotic prescription practices and explores through an institutional work lens how digital tools can make the challenges visible to address AMR. However, in resource-constrained contexts overcoming multiple interconnected challenges like high patient loads, inadequate infrastructure, infectious diseases prevalence, limited diagnostics, and limited experience with digital technology is crucial. To address these challenges, this study identifies new forms of creating, maintaining and disrupting institutional work that needs to be enacted through three interconnected stages: stabilising data entry (the input stage), building relevant reports (the outputs stage) and putting the generated data into action for patient care and policy making (outcomes stage). The research describes the journey from input to outcome involving several temporal rhythms spanning material, symbolic and relational dimensions and how digital technologies help build novel interconnections among these dimensions. This research offers practical insights on enabling hospital ownership and enhancing their capabilities in using open-source digital AMR systems, fostering growth through collaborative learning by doing and kickstarting discussions about data to fuel local actions at practice and policy levels.
List of papers
Paper I: Thakral, Y. (2022, August). Digital Monitoring of Antibiotic Resistance (ABR) in Low-and Middle-Income Countries: A Narrative Literature Review. In Scandinavian Conference on Health Informatics (pp. 33-40). DOI: 10.3384/ecp187006. The article is included in the thesis. Also available at: https://doi.org/10.3384/ecp187006 |
Paper II: Thakral, Y., Sahay, S., & Mukherjee, A. (2022). Designing an Antibiotics Resistance (ABR) monitoring system to strengthen the evidence base for facilitating responsible antibiotics prescription by physicians. In International Conference on Information Systems, ICIS 2022. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://aisel.aisnet.org/icis2022/is_design/is_design/3 |
Paper III: Thakral, Y., Sahay, S., & Mukherjee, A. (2022). Closing the “antibiotics usage” awareness gap: An Action Design Research study from India. Communications of the Association for Information Systems, (under review). The paper is not available in DUO awaiting publishing |
Paper IV: Thakral, Y., Sahay, S., & Mukherjee, A. (2022). Routinizing practices and stabilizing institutional work: A case of digital monitoring of Antibiotic Resistance (ABR) in India. Communications of the Association for Information Systems, 51(1), 24. DOI: 10.17705/1CAIS.05130. The paper is not available in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.17705/1CAIS.05130 |
Paper V: Thakral, Y., Sahay, S., & Mukherjee, A. (2022). Strengthening digital monitoring of antibiotic resistance in low-resource settings. Journal of Global Health, 12. DOI: 10.7189/jogh.12.03061. The article is included in the thesis. Also available at: https://doi.org/10.7189/jogh.12.03061 |