A Socialized Affordance Perspective of a Mobile Application for Patients’ Assessment and Referrals at the Community Level in Malawi

The implementation of mobile technology plays a crucial role in enhancing healthcare delivery in developing countries, leading to both anticipated and unforeseen consequences. This study investigates the social practices involved in deploying a mobile application designed to aid Community Health Workers (CHWs) in patient assessment and referral processes, facilitating their connection to higher-level healthcare facilities. Utilizing the concept of socialized affordance, we examine how social structures influence the interactions between human actors and technology. We identified three key socialized affordances: streamlining CHWs’ work processes in village clinics, strengthening monitoring and accountability, and enhancing CHWs’ digital knowledge and skills development. These affordances led to several intended outcomes, including improved CHWs adherence to protocol, improved patient referrals, enhanced time management, improved CHWs performance, and improved digital capacity building. However, unintended outcomes also emerged, such as the exclusion of volunteers, heightened respect from community members, increased workload for CHWs, and heightened anxiety among CHWs. Consequently, this study contributes to the understanding of socialized affordance by illustrating how the interplay between human actors and technology is shaped by the institutional, cultural, and social dimensions of the environment where affordances are perceived and actualized.