JMIR Publications

ABSTRACT

Background:

Background:

As technology is integrated into healthcare delivery, questions related to the adoption and acceptance of health technologies leave large gaps in practice and provide limited explanation of how and why certain technologies are adopted and others are not. In these discussions, the concept of legitimacy is omnipresent but often implicit and underdeveloped. There is no cohesive agreement about what legitimacy is or how it works across social science disciplines, despite a prolific volume of literature centering legitimacy.

Objective:

Through this review, we synthesize the existing literature on legitimacy in health and technology across three disciplines and develop a novel and useful theoretical conceptualization of legitimacy as it applies to embedding technologies in healthcare.

Methods:

We conducted a Critical Interpretive Synthesis (CIS) literature review using the disciplinary constructs of Organization & Management Studies, Science & Technology Studies, and Medical Anthropology & Sociology to explore the meaning of legitimacy in health and technology, how it is produced, and how it is used. The CIS method allowed for an iterative and flexible but rigorous approach to analyzing a methodologically diverse selection of qualitative literature on an abstract concept.

Results:

Using the CIS method, we synthesized 97 articles across 30 journals within these bodies of literature. We found that across all three disciplines, legitimacy is often considered a relational quality and is tied strongly to concepts like negotiation and taken-for-grantedness. However, there is also significant divergence among disciplines and little cohesion in either theoretical or empirical approaches across the literature. Organization & Management Studies emphasized institutional norms and narratives; Science & Technology Studies emphasized relationships and co-creation of knowledge among human and non-human actors; Medical Anthropology & Sociology emphasized materialities, power, and space. We brought these different lines of thinking together in a synthesizing conceptualization of legitimacy as social infrastructure.

Conclusions:

Legitimacy as social infrastructure allows us to bring relational, material, semiotic, and network-based aspects of legitimacy into focus. Legitimacy as social infrastructure is a flexible and adaptable framework for working with legitimacy that can aid both academics and decision-makers by providing more coherent and holistic explanations for how and why embedding new technologies in healthcare practice does or does not happen.