Enabling informal digital guanxi for rural doctors in Shaanxi, China

In China, rural healthcare systems have been neglected in favor of the development of market-driven, largely urban health information systems (HIS). We investigated the effective use of information and communication technologies (ICTs) to develop a healthcare model within the rural healthcare system. We investigated information needs, existing healthcare structure, and the use of informal networks - guanxi - to acquire health information mediated by technology. Qualitative interviews (N = 74) were conducted in Shaanxi province of China. Respondents included village doctors (30), rural patients (10), urban doctors (17), and 17 other healthcare stakeholders. We found benefits of the use of ICT in informal networks for village doctors, including the facilitation of communication, greater time efficiency, and better access to medical information, particularly in mobile phone and QQ online social network usage. Guanxi relationships were established at proximate, distant, and virtual levels. Emergent communicative practices, such as Internet-driven medical research by village doctors, led to negotiations in established relationships. As suggested by the theoretical model, infrastructural, economic, socio-cultural, and technological vulnerabilities were also observed. We caution against the drawbacks of replication of the closed guanxi system in the digital ICT healthcare arena, and discuss the implications for research and policy-making.