Continuance of mHealth services at the bottom of the pyramid: the roles of service quality and trust

Continued usage of information systems (or, IS continuance) has proven to be a critical success parameter for ICT implementation at the top of the global economic pyramid. However, there are few studies which have explored continued IS usage at the bottom of the economic pyramid (BOP) though it represents the majority of the world's population. To fill this knowledge gap, this study develops an mHealth continuance model at the BOP framing the impact of two post adoption expectation beliefs (i.e., perceived service quality and perceived trust). This study extends ECM (expectation confirmation model) perspective synthesizing the extant literature on continued IS usage, service quality and consumer trust. The proposed model was empirically tested within the context of mHealth (mobile health) services at the BOP, applying PLS (partial least squares) under a cross sectional study. The findings confirm that both perceived service quality and perceived trust have significant explanatory power under an integrated ECM providing superior prediction of continuance intentions. The study concludes by discussing conceptual contributions, practical implications, limitations and future research directions.