Deepika Rai
email: deepikarais.ditt@gmail.com

Sherah Kurnia
email: sherahk@unimelb.edu.au

Factors Affecting the Growth of the ICT Industry: The Case of Bhutan

Keywords: IT/ITES industry, ICT industry, Developing countries, Bhutan

The ICT industry that consists of IT and IT-Enabled Services (ITES) components has been contributing significantly to the economy of many countries globally. Due to its importance, understanding factors affecting the growth of this industry is critical for developed and developing countries. Currently, there is still a limited understanding of relevant factors and their influence on the IT/ITES industry growth in developing countries. Bhutan, in particular, is a small developing country that is striving to build this industry to diversify its economy. This study is the first study that explores factors affecting the growth of the IT/ITES industry in Bhutan. Qualitative research involving different stakeholders is employed to gain an understanding on factors facilitating and inhibiting the growth. The study findings indicate that Human Resources, Policy, Infrastructure, Foreign Direct Investment (FDI) and Culture are particularly crucial for Bhutan's context. Due to the uniqueness of Bhutan, this study helps drive the development of the industry and enhance the current understanding in this area particularly in the context of developing countries.

Introduction

Information and Communication Technology (ICT) has revolutionized the global economy by enabling cross border businesses [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF]. The ICT industry comprises of two components: Information Technology (IT) and Information Technology-Enabled Services (ITES). The IT component encompasses IT application and engineering while the ITES component includes services offered through electronic means [START_REF] Sudan | The Global Opportunity in IT-Based Services[END_REF]. The Gartner's forecast for 2016 IT spending is projected to be US$3.54 trillion, reflecting a huge market for the ICT industry [START_REF] Says | Worldwide IT Spending is Forecast to Grow 0.6 Percent in 2016[END_REF]. This industry contributes significantly to a country's economy and creates valuable employment. A study by UNCTAD in 2008 shows that in developing countries, the service sector inclusive of IT/ITES accounted for 51% of gross domestic product (GDP) and 35% of employment [START_REF]Globalization For Development : The International Trade Perspective[END_REF]. Beside increasing employment and boosting GDP, the ICT industry has a ripple effect on the development of the country through the need for efficient ICT infrastructure, transport infrastructure, educational infrastructure and enabling policy reforms. To emphasize the two important components of the ICT industry, the term IT/ITES industry is explicitly used in the remainder of the paper.

The existing literature identifies several factors affecting IT/ITES industry growth in both developed and developing countries. However, most of them are focused on developed countries such as Ireland, Israel or Singapore where the industry is well established or favorable factors exist in promoting the industry development. Although a few studies focus on developing countries (e.g. India, Philippines and Thailand) but those countries have different contextual factors. In addition, though most studies have adopted qualitative study, they differ in depth and data collection methods. The majority relied on secondary resources and only a handful of studies involved empirical data. Hence, considering the uniqueness of Bhutan as a country and the fact that the IT/ITES industry in Bhutan is still at the early stage of growth, it is necessary to understand the contextual condition of Bhutan and identify relevant key factors affecting the development of the industry. It would be impractical to assume that critical factors identified in other studies will also be applicable in Bhutan. The importance of considering contextual differences in understanding a particular phenomenon has been well recognized in the literature [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Kurnia | A qualitative study of business-to-business electronic commerce adoption within the Indonesian grocery industry: A multi-theory perspective[END_REF].

Therefore, this research aims to explore factors affecting the growth of the IT/ITES industry from the perspective of key stakeholder groups. The following questions are addressed in this study:

What are the key factors affecting the growth of the IT/ITES industry in Bhutan? How do these factors affect the growth of the IT/ITES industry in Bhutan?

A qualitative research involving interviews with major industry stakeholders is adopted as a research method to enable a detailed investigation of the industry from all perspectives. In addition, multiple secondary resources are also used to enrich the understanding obtained from the interviews. The study findings indicate that Human Resources, Policy, Infrastructure, FDI and Culture play a crucial role in the growth of Bhutan's IT/ITES industry. Currently, the first four factors in Bhutan are at a formative state and have impeded the growth of the industry. By contrast, Culture appears to be conducive for the growth of the IT/ITES industry in Bhutan. We identify a number of issues pertaining to Culture, but they appear to be relatively easy to address. Based on the findings, a number of recommendations are proposed to facilitate the growth of the IT/ITES industry in Bhutan.

The study contributes to both researchers and practitioners. For researchers, the study synthesizes useful factors affecting the growth of the IT/ITES industry. The study also enriches the existing studies by conducting an in depth qualitative study in a unique context. For practitioners, the study reflects the criticality of collaboration among stakeholders and strategic implementation and customization of each factor for successful growth of the industry. This paper is structured as follows. First, it presents the background, the opportunity of the global IT/ITES industry, the motivation for conducting this study, followed by a literature review. Then an overview of current state of the industry in Bhutan is presented. The research methodology is then briefly outlined, followed by the research findings and discussion. Finally, we conclude the paper by outlining implications, study limitations and future research work.

Literature Synthesis of Factors Affecting the IT/ITES Industry Growth

The IT/ITES industry has a tremendous potential to contribute to a country's GDP, employment generation and overall development. However, different countries face diverse challenges to grow the industry. There are also various factors that drive the development of this industry differently across countries [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Harbi | Establishing high-tech industry: The Tunisian ICT experience[END_REF]. To identify possible factors affecting the growth of the IT/ITES industry, existing studies related to development of IT/ITES industry were examined. We searched for studies using Google scholar and various online databases such as Computer and Applied Sciences Complete (EBSCO), Engineering Village and Web of Science (ISI). The keywords used for the searches include 'factors affecting IT/ITES industry development' and 'factors impacting ICT industry growth'.

There were plethora of papers related to IT/ITES industry but we only selected papers that were related to factors affecting the IT/ITES industry growth. Although the literature reviewed is not extensive, it is adequate to provide an overview of existing studies on this subject. The synthesis of factors affecting the growth of the IT/ITES industry identified from our literature analysis is presented below with brief explanations.

Human Resources. This industry is driven by human capital as a key component for production of knowledge or ideas [START_REF] Bhattacharjee | Investigating India's competitive edge in the IT-ITeS sector[END_REF][START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF]. For example, previous studies indicate that the IT/ITES industry in India advanced rapidly because of the availability of a large, well educated, high quality, English speaking workforce [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Heeks | Using Competitive Advantage Theory to Analyze IT Sectors in Developing Countries: A Software Industry Case Analysis[END_REF][START_REF] Bhattacharjee | Investigating India's competitive edge in the IT-ITeS sector[END_REF]. Similarly, the study by Carayannis & Sagi [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF] highlights that one of the key factors contributing to the success of the IT/ITES industry is the possession of a highly-skilled worked force. Furthermore, Philippine's strength is in the ITES segment which is enabled by the availability of a large pool of highly-educated English speakers [START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF][START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF]. Previous studies also indicate important role played by government in offering incentives such as education and training grants [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF] to build the human resources for this industry.

Foreign Direct Investment (FDI).

The presence of FDI in a country adds value to its IT/ITES industry growth [START_REF] Ein-Dor | IT Industry Development and the Knowledge Economy : A Four Country Study[END_REF] and offers a "demonstration effect" to the host countries [START_REF] Heeks | Using Competitive Advantage Theory to Analyze IT Sectors in Developing Countries: A Software Industry Case Analysis[END_REF][START_REF] Raja | BPO Sector Growth and Inclusive Development in the Philippines[END_REF][START_REF] Ein-Dor | Information Technology in Three Small Developed Countries[END_REF]. FDI brings in superior technologies, expertise, money, and ideas which developing countries generally lack. Hence, this is believed to be the largest type of equity flow in developing countries [START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF][START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. Thus, many developing countries depend on FDI to sustain their economic growth [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. Another benefit of FDI is that it enables local businesses to compete or take part in the global market [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF].

Infrastructure is broadly divided into ICT infrastructure and Technology Park infrastructure.

ICT infrastructure. An efficient ICT infrastructure is essential for facilitating and supporting IT/ITES industry growth [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF][START_REF] Heeks | Software Export Success Factors and Strategies in " Follower " Nations[END_REF]. For instance, Singapore's success in attracting multinational companies (MNC) is because of the high investment in creating efficient infrastructure [START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. Cost of ICT infrastructure including cost of internet access is another crucial element affecting the IT/ITES industry growth [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF]. Higher cost impedes adoption of ICT in a country, while reliable ICT infrastructure attracts FDI [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. India's low infrastructure cost is attractive and has also enabled the rapid growth of entrepreneurs [START_REF] Heeks | Using Competitive Advantage Theory to Analyze IT Sectors in Developing Countries: A Software Industry Case Analysis[END_REF]. Usually ICT infrastructure is either deregulated or privatized for maintaining service efficiency and low access cost as in the Philippines, Singapore and Ireland cases [START_REF] Heeks | Software Export Success Factors and Strategies in " Follower " Nations[END_REF][START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF][START_REF] Poh-Kam | Leveraging the Global Information Revolution for Economic Development: Singapore's Evolving Information Industry Strategy[END_REF].

Technology Park. The technology park can promote knowledge transfer for developing and marketing high-technology products. It also facilitates promotion and commercialization of products [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Harbi | Establishing high-tech industry: The Tunisian ICT experience[END_REF]. A study by Harbi et al. [START_REF] Harbi | Establishing high-tech industry: The Tunisian ICT experience[END_REF] indicates that such parks attract and defuse the need to have proximity/location attractiveness. India established special economic zones equivalent to technology parks to facilitate rapid growth of its IT/ITES industry, increase exports and counter the infrastructure issue [START_REF] Vaidyanathan | Technology parks in a developing country: The case of India[END_REF]. Thailand established software parks to accelerate the development of its software industry [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Heeks | Using Competitive Advantage Theory to Analyze IT Sectors in Developing Countries: A Software Industry Case Analysis[END_REF][START_REF] Trauth | The Culture Of An Infromation Economy[END_REF]. Technology parks played a crucial role for the industry growth in the Philippines by attracting manpower, FDI and local investment [START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF][START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF].

Policy. Policies such as fiscal incentives that includes tax advantage, subsidy and regulatory environment encourage the growth of the IT/ITES industry [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF]. Policy can be used to attract FDI to establish subsidiary companies, increase FDI production and encourage collaborations with local firms [START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF]. Policy should also consider the local conditions such as protection and support for local firms' growth [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF]. Countries such as the Philippines, Korea, Japan, Taiwan and India give preferential treatment to local firms' development while promoting FDI [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF]. Furthermore, policy should promote entrepreneurial culture and encourage local firms to internationalize [START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF][START_REF] Poh-Kam | Leveraging the Global Information Revolution for Economic Development: Singapore's Evolving Information Industry Strategy[END_REF]. Finally, strong coordination among various stakeholders is required to ensure policy effectiveness [START_REF] Poh-Kam | Leveraging the Global Information Revolution for Economic Development: Singapore's Evolving Information Industry Strategy[END_REF].

Culture. Culture in this study refers to bureaucracy and work ethics. Culture plays a role in ensuring "what and how things get done" [START_REF] Trauth | The Culture Of An Infromation Economy[END_REF]. High level of bureaucracy affects the efficiency, flexibility and innovativeness for the industry growth as was the case of Thailand [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF]. However, India has bureaucratic structure with a disciplined approach to work [START_REF] Heeks | Using Competitive Advantage Theory to Analyze IT Sectors in Developing Countries: A Software Industry Case Analysis[END_REF] but in addition India also possesses work culture that is similar to western culture where majority of the IT/ITES businesses emanates [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF]. The study by Trauth [START_REF] Trauth | The Culture Of An Infromation Economy[END_REF] states that global investments introduce global culture such as high standard work ethics to the workplace that enhances the development of domestic industry in a country. Geographic Location. Country location affects the direction of the trade [START_REF] Heeks | Software Export Success Factors and Strategies in " Follower " Nations[END_REF] such as Poland and Ireland are strategically located near other regions with a rapid growth in ICT and have experienced significant business benefits [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF]. However, the study by Heeks [START_REF] Chebolu | A Critical Perspective of Information Technology (IT) Industry Growth in India[END_REF] argued that location relates to export only and do not impact industry growth focused on IT products and services [START_REF] Ein-Dor | Information Technology in Three Small Developed Countries[END_REF]. Dedrick and Kraemer [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF] also indicates that countries with favorable geographic location have an advantage for a successful hardware industry as in the case of Thailand's successful hardware industry. Furthermore, in the case of India, location did not affect the industry growth, but rather the difference in time and distance offered an advantage [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Heeks | Using Competitive Advantage Theory to Analyze IT Sectors in Developing Countries: A Software Industry Case Analysis[END_REF]. This factor, however, is compensated with the advent of technology parks that facilitates access to markets and counter the infrastructure issues [START_REF] Vaidyanathan | Technology parks in a developing country: The case of India[END_REF]. Domestic IT use. An increase in domestic IT use most likely increases investment in the IT/ITES industry and promotion of the local IT industry [START_REF] Ein-Dor | Information Technology in Three Small Developed Countries[END_REF][START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. However, in Thailand, domestic IT consumption was less yet the industry was booming [START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. Thus not a significant relation seems to be there between domestic IT use and the success of the industry [START_REF] Ein-Dor | IT Industry Development and the Knowledge Economy : A Four Country Study[END_REF][START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. Therefore, this factor is not relevant if a country is focused on external market or if the local market is small [START_REF] Ein-Dor | IT Industry Development and the Knowledge Economy : A Four Country Study[END_REF][START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF][START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. For instance, despite low domestic IT use, India has a fast growing IT industry [START_REF] Heeks | Software Export Success Factors and Strategies in " Follower " Nations[END_REF][START_REF] Ein-Dor | IT Industry Development and the Knowledge Economy : A Four Country Study[END_REF] and it is the small market size and low profitability that forced entrepreneurs to focus on export activities [START_REF] Heeks | Using Competitive Advantage Theory to Analyze IT Sectors in Developing Countries: A Software Industry Case Analysis[END_REF]. Economic Development. A country's level of economic development determines the size of the local IT/ITES market and the quality of infrastructure [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. The greater the economic development, the greater the quality of infrastructure in supporting the growth and use of IT [START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. The pace of economic development and technical capabilities contributes to the success of the IT/ITES industry [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF]. However, the study by Dedrick and Kraemer [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF] states that this factor is affected by the country's policies and is thus closely related to government policies.

Research and Development (R&D).

A correlation may exist between industry attractiveness and R&D initiatives [START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF]. However, Harbi et al. [START_REF] Harbi | Establishing high-tech industry: The Tunisian ICT experience[END_REF] argue that R&D activities do not determine the success of the IT/ITES industry but it promotes innovation in the industry. However, the study by Bhattacharjee & Chakrabarti [START_REF] Bhattacharjee | Investigating India's competitive edge in the IT-ITeS sector[END_REF] noted that, recently there have been increasing investments in R&D in India that contribute to the growth of the IT/ITES industry.

Access to finance. Access to finance is important where the focus is on supporting startups, innovation, entrepreneurship and for maintaining growth of existing firms necessary for IT industry development [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Harbi | Establishing high-tech industry: The Tunisian ICT experience[END_REF][START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF][START_REF] Ein-Dor | Information Technology in Three Small Developed Countries[END_REF]. Further, this factor is linked with IT industry ranking [START_REF] Ein-Dor | Information Technology in Three Small Developed Countries[END_REF] which contributes to branding of the industry in specific countries.

Political stability. In developing countries, politics influence transition to an information society [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. A country's political stability influences private sector decisions, especially whether to invest in setting up IT/ITES businesses [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF]. A study by Dedrick & Kraemer [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF] considers the IT/ITES industry to be a high risk business and political stability represents trust to investors [START_REF] Raja | BPO Sector Growth and Inclusive Development in the Philippines[END_REF].

IT Export, Sale and Production. The success of the IT/ITES industry is measured by the ability to produce and export technology related products [START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. This factor also imposes limitations to countries which enforce protectionism, competition and lack of support for exporting products [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. Furthermore, an export strategy is expensive and only viable for larger global companies [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF].

Current state of the IT/ITES industry in Bhutan

Bhutan is a small country positioned between China and India, with a population of 757,042. Government implemented numerous initiatives that enabled the development of the IT/ITES industry. For example, ICT infrastructures specifically telecommunication and internet access were promptly established. As of 2015, the mobile penetration has reached 87% and 62% internet penetration [23]. E-government services were introduced and ICT literacy and adoption programs were conducted across the country to all level of the society. Further, to enhance the entrepreneurship culture, an incubation center was established in technology park [24] beside few other agencies providing support to entrepreneurs. Several policy reforms were also made to create an enabling environment for the IT/ITES industry. In 2008, Bhutan initiated a private sector development (PSD) project funded by the World Bank which focused on a holistic approach to development of the IT/ITES industry [24]. Through the project, a technology park was built, skills development initiatives were undertaken with international and local firms and financial environment reforms were also undertaken [24]. As of 2014, approximately three FDI firms have established business in the technology park and lately there has been an increase in the establishment of service focused small domestic IT/ITES firms.

Methodology

This study aims to explore key factors affecting the IT/ITES industry growth in Bhutan from the perspective of multiple stakeholder groups. Because of the exploratory nature of the study, qualitative research method is considered to be the most appropriate for this study since it enables in depth investigation of the phenomenon of interest [28]. The unit of analysis for the study is each key stakeholder group. The stakeholder groups comprises of Government, IT/ITES Consultants, Private Sector and Telecom Operators.

Data collection involved interviews as a primary source, along with multiple secondary sources including government reports, industry reports and news clippings. The main instrument was semi-structured open-ended questions. The interview questions were developed based on the research questions for the study. Interviews were non-directive allowing freedom and flexibility to respond. Each interview took approximately one hour. For data analysis, the transcribed interviews were analyzed using qualitative techniques as suggested by a number of qualitative research method-ologists [START_REF] Neuman | Social research methods qualitative and quantitative approaches[END_REF][START_REF] Yin | Qualitative Research from Start to Finish[END_REF]. Open coding was first conducted to identify the key themes relevant for answering the research questions, followed by axial coding to establish relationships between the themes identified. Selective coding was finally conducted for additional evidence to support the key themes.

Based on Yin [START_REF] Yin | Qualitative Research from Start to Finish[END_REF] and Neuman [START_REF] Neuman | Social research methods qualitative and quantitative approaches[END_REF], construct validity in this study is addressed through the use of multiple sources of evidence, a comprehensive review of relevant literature, and the use of case study repository to establish a chain of evidence. To maximize external and internal validity, a rigorous data collection procedure and systematic data analyses were performed. Reliability is ensured through the development of appropriate interview protocol and pilot test of the questions with relevant practitioners to assess the clarity of the questions and identify errors and possible biases [START_REF] Yin | Qualitative Research from Start to Finish[END_REF].

Findings and Discussion

The analysis of the interview data indicates that Human Resources, Infrastructure, Policy, FDI and Culture are considered to be the most notable factors affecting the industry growth in Bhutan. Country's Accessibility and Cost of Operation were two additional factors identified to be important for Bhutan's IT/ITES Industry growth. The two additional factors identified are likely due to the geographical position of the country and higher dependency on import of raw materials. Therefore, as compared to the previous studies, there are added challenges for Bhutan which were not encountered by other countries studied in the past. All these factors were then further assessed to explore how they affect the IT/ITES industry growth in Bhutan. Based on the analysis, a number of recommendations are proposed to address those important factors to contribute to the industry growth. The new factors that have impeded the industry growth, however, are still challenging to address.

Culture

Focus on enhancement of work ethics

The finding related to Culture indicates that Culture is conducive for the industry growth. The reasons cited by stakeholders on their beliefs are Bhutan does not have a difficult bureaucratic system and work ethics is closely related with a reward system.. Stakeholders also felt that in comparison with the international industry standards, Bhutan still needs to improve on the work ethics as people in Bhutan are laid back and non-competitive. They rationalized that this might be due to local business not having to follow strict corporate disciplines. All participants believe that work ethics is directly related to remuneration and motivation and that additional training and orientation within the corporate culture can address the issue of work culture. In addition, the private sector also plays a crucial role in attracting people to this industry and improving work ethics. The literature suggest, financial incentives, professional development and career progression can attract people to the industry and improve works ethics [START_REF] Bhattacharjee | Investigating India's competitive edge in the IT-ITeS sector[END_REF][START_REF] Trauth | The Culture Of An Infromation Economy[END_REF].

Human Resources

Building skilled Human Resources

Based on the finding, Bhutan lacks skills in the IT segment which has impacted the industry growth. The main reason cited for skills shortage in IT segment was due to mismatch in university curriculum and market needs. As a strategy by Singapore on building its talent pool, necessary IT curriculum were embedded within the school systems itself [START_REF] Poh-Kam | Leveraging the Global Information Revolution for Economic Development: Singapore's Evolving Information Industry Strategy[END_REF]. In countries like India, Ireland, Poland and the Philippines, government collaborated with private sector and universities to address the issue of mismatch in university curriculum and market needs as well as provided grants for skills development [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF][START_REF] Raja | BPO Sector Growth and Inclusive Development in the Philippines[END_REF][START_REF] Trauth | The Culture Of An Infromation Economy[END_REF]. Therefore, Bhutan could take a similar path by introducing IT curriculum in the education system and establishing linkages among government, academia and industry to build skilled human resources that meet the industry demand.

Creating opportunities and platform for IT/ITES professionals

An interesting observation from the study is that there is lack of opportunities and platform for professionals in this area to develop their skills. One of the example cited was, generally the domestic firms subcontract their IT projects to firms outside Bhutan. This might be the result of uncertainty within the industry and inability of both government and the private sector to foresee business opportunities in this industry which may be dissuading stakeholders from creating opportunities and platform for this industry [22]. Therefore, firms consider quick gains utilizing cheaper resources from outside. Further, absence of opportunity was also referred to dearth of environment for innovation and entrepreneurship in the country. Although Bhutan has established incubation facilities as a platform to promote entrepreneurship [24], but there has been little uptake. This might be due to absence of financial support for entrepreneurs as access to capital is necessary to promote entrepreneurship, innovations and to maintain the growth of existing firms [START_REF] Harbi | Establishing high-tech industry: The Tunisian ICT experience[END_REF][START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF][START_REF] Ein-Dor | IT Industry Development and the Knowledge Economy : A Four Country Study[END_REF]. Hence, effort towards creating an enabling platform and opportunities for professionals in this industry is essential to build the skilled human resources.

FDI

Creating enabling environment for FDI

Majority of the stakeholder groups perceived that Bhutan lacks an enabling environment to attract FDI despite of having enabling polices supporting FDI. Study participants cited that it is lack of coordination in policy implementation which is impeding attractiveness. Further, consistent support and examination of FDI's health, to check if FDI is facing any issues, is missing in Bhutan. In addition, there has been limited association between FDI and local companies thereby creating an unhealthy environment. Therefore, as stated in the study by Mitra [START_REF] Raja | BPO Sector Growth and Inclusive Development in the Philippines[END_REF], strategic alliances between local and FDI companies are necessary to expand the IT/ITES industry. Furthermore, policies should be used as a tool for sharing the risk with FDI, for example fiscal incentives to make the cost of operation competitive for FDI companies. The government also has a crucial role in policy implementation to ensure the stated FDI benefits are delivered to maintain the attractive environment for FDI.

Infrastructure

Improving ICT infrastructure to meet the industry standards Majority of stakeholder groups raised reliability, redundancy and cost of ICT infrastructure as the foremost issues that was also highlighted in several government reports [22,24]. By contrast, Singapore's attractiveness stems from having an efficient ICT infrastructure [START_REF] Poh-Kam | Leveraging the Global Information Revolution for Economic Development: Singapore's Evolving Information Industry Strategy[END_REF]. Most of the literature considers the efficiency and cost of ICT infrastructure to be crucial for attractiveness [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. Study participants suggest that introduction of a third international gateway, coming via a completely different international route, will resolve the issue of reliability and redundancy. Alternatively, in order to provide uninterrupted services, Indian companies set up multiple business sites within and outside India [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF]. So until the third gateway is installed, Bhutan could perhaps be positioned as business continuity planning (BCP) location for FDI or to address the redundancy issue within, the Bhutan's industry could consider other countries as a BCP for their business.

The prohibitive cost of bandwidth (internet) has been another challenge for Bhutan. Study participants proposed introducing a third telecom operator or subsidy from government to make access affordable. However, subsidy is not a sustainable strategy and as previous studies have reflected deregulation and privatization of the stateowned telecom operator as a successful strategy in reducing cost and improving the quality of service [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Poh-Kam | Leveraging the Global Information Revolution for Economic Development: Singapore's Evolving Information Industry Strategy[END_REF][START_REF] Trauth | The Culture Of An Infromation Economy[END_REF]. Thus, deregulating and privatizing Bhutan's stated-owned telecom operator might provide competition, increase quality and reduce cost.

Leveraging Technology Park to foster the industry growth

The technology park is increasingly valued in creating an overall ecosystem and replaces unreliable public infrastructure [START_REF] Sudan | The Global Opportunity in IT-Based Services[END_REF][START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Harbi | Establishing high-tech industry: The Tunisian ICT experience[END_REF]. However, the study participant's contend that technology park in Bhutan has little to no impact on the industry growth as well as slow in creating a fully operational park. This is perhaps due to absence of collaboration between the FDI and domestic firms because the technology park is more focused towards attracting FDI. On the contrary, countries such as India, Singapore and Taiwan established technology parks with an export-oriented focus [START_REF] Vaidyanathan | Technology parks in a developing country: The case of India[END_REF] irrespective of domestic or FDI firms. In both India and Thailand, technology parks were also established to promote rapid growth in the IT/ITES industry [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF]. Similarly, Bhutan could take a balance approach by encouraging both FDI and domestic firms to leverage the technology park. This can be possible through offering a tailored economically suitable package for domestic firms to locate at technology park.

Policy

Policies need to facilitate growth of domestic firms

The finding of this study indicates policies are more focused on attracting FDI and neglected the growth of local IT/ITES firms. This is in contrast with the literature, which suggests that any nations striving to build this industry had policies and strategies that always balanced the development of both local and FDI companies because local companies are considered a long term investment for sustainability [START_REF] Abara | Resilience and recovery: The Philippine IT-BPO industry during the global crisis[END_REF][START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF][START_REF] Trauth | The Culture Of An Infromation Economy[END_REF]. For example, Japanese government ensured protection and support for the domestic market to compete globally and Korean government's policy gave preferential treatment to local companies [START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. Furthermore, literature claims that policy should be developed based on the country's environment [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF] .This is clearly lacking in Bhu-tan's case. Therefore, Bhutan needs to realign the policies to balance the growth of the industry through creation of enabling business environment for both FDI and domestic firms. The collaboration between private sector and government also needs to be strengthened. This can be achieved through strengthening the national IT association as identified in previous studies [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Sudan | The Global Opportunity in IT-Based Services[END_REF]22].

Encouraging stakeholder collaboration for effective policy implementation

The government has introduced various policies to enable the development of the IT/ITES industry. Such policies create attractiveness for the IT/ITES industry as supported by previous studies. Such policies can also address the cost of operation factor [START_REF] Joshi | An analysis of India's future attractiveness as an offshore destination for IT and IT-enabled services[END_REF][START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Carayannis | Exploiting opportunities of the new economy: developing nations in support of the ICT industry[END_REF][START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF]. However, despite creating such an enabling environment, the industry growth has still not been impressive as expected. This indicates the need for ensuring the successful implementation of such policies. The literature claims that the efficiency of government in administration and coordination of policy is one of the reasons for Singapore's success in growing its industry. Singapore has also established a special agency to overcome compartmentalization of government effort [START_REF] Poh-Kam | Leveraging the Global Information Revolution for Economic Development: Singapore's Evolving Information Industry Strategy[END_REF]. Similarly Bhutan needs to consider eliminating coordination issues through taking Singapore's path or through development of application systems to integrate all the stakeholders for policy implementation thus ensuring collaboration.

Accessibility to the country This has been identified as a factor that can impact the growth of the industry in Bhutan. It is a new factor that has not been mentioned in previous studies. The reason could likely be due to the geographical position of the country since Bhutan is a landlocked and mountainous country with limited accessibility. The national airlines are only allowed to fly in and out of the country, which are also limited in numbers and frequency. Bhutan has only one international airport providing air connectivity to five countries. The airport allows only the country's airline to operate and thus have two airline companies. By surface transport there is exit to India only. The challenge faced by this industry is travel time taken to and from Bhutan. The stakeholder group cited that for this industry, travelling to the business locations has to be easy with minimal turnaround time to reach the destination. This is by far a challenge that stakeholder groups felt is difficult to address and to an extent a factor that is deterring FDI investment into the country.

Cost of Operation

The participants cited cost of general operation to be a factor that can impact the growth of the industry. This factor again was not mentioned in previous studies likely due to the kind of countries that were studied. Bhutan is different with added challenges like the cost of operation which is high as compared to the region with similar or better facilities and service than Bhutan. Bhutan mostly imports raw materials and products for consumption therefore, the high cost can also be due to import of raw materials for all the facilities and services offered. The cost of operation excludes cost of internet access and cost of operation at the technology park. The cost of operation is related with cost of living, cost of hiring, cost of travel and real estate cost. Generally, the cost of operation in Bhutan is extremely high comparable with metropolitan cities in India and region but with less facilities and choices. Thus, the cost of opera-tion was identified by stakeholder groups as a factor that is positioning Bhutan as an unattractive business location for this industry and is still challenging to address.

Conclusion and implications

This study provides a useful synthesis of factors affecting the growth of the IT/ITES industry. It is also a first study conducted in the context of Bhutan, employing a qualitative approach. Two additional factors, Country's Accessibility and Cost of Operation have been identified for Bhutan's context, which are likely to be important factors for countries similar to Bhutan. As indicated in this study, all the factors identified as key influential factors, though have been consistent with previous studies, the state and effect of each factor differs slightly across contexts. For example, for Thailand, Policy did not have impact on the success of the IT industry [START_REF] Tan | Factors contributing to IT industry success in developing countries: The case of Thailand[END_REF], whereas for Bhutan, Policy seems to play a crucial role in the growth of the industry.

For researchers, the study synthesizes useful factors affecting the growth of the IT/ITES industry. The study also enriches the existing studies by conducting an in depth qualitative study in a unique context that was not explored in earlier studies. This study also reaffirms previous studies' recommendation that one size fit all is not possible for understanding factors affecting the development of IT/ITES industry in different countries [START_REF] Techatassanasoontorn | Analyzing ICT and Development[END_REF][START_REF] Dedrick | National technology policy and computer production in Asia pacific countries[END_REF]. The applicability and influence of each factor varies from country to country. For practitioners, the study reflects the criticality of strategic implementation of each factor for successful growth of the industry. The study also presents the need for strategic collaboration and customization of the factors according to the environment of the country. This study is also an eye-opener in showcasing the need for strategic alliance among the government, private sector and academia.

However, there are limitations to this study due to time and resource constraints. This study is only a preliminary study with limitation in total number of participants and the number of stakeholder groups. For instance, the study could also include consumer stakeholder group. Nevertheless, the preliminary understanding obtained from this study is valuable to recognize the IT/ITES industry in Bhutan and its development. Further, the two new factors identified in this study have set context for further study to analyze if the identified factors are important for the industry growth as these factors has not been explicitly studied in detail for other countries. For Bhutan, this study has also laid a path for future in depth study in this area.

  Bhutan connected to the global information and communication technology (ICT) only in 1999 and thereafter prioritized ICT. The prioritization of ICT is also to diversify and create a sustainable economic development which is currently dependent largely on hydropower and tourism. Furthermore, Bhutan's late entry is believed to give the advantage of being able to learn from other countries, and leapfrog to enter into global IT/ITES business within a short period of time. However, according to the study by Infocomm Development Authority (IDA), Bhutan's IT/ITES industry ecosystem is "loosely defined" with lack of clarity about what comprises this industry which has resulted slow growth of this industry[22]. The industry is dominated with retail in computer products with minimal usage of domestic skills. Significant amounts of work are also outsourced to companies outside the country and local companies leverage overseas skills with very limited usage of local resources and competency[22].


Marva Mirabolghasemi
email: d.m.mirabolghasemi@gmail.com

Noorminshah A Iahad

Cancer Patients on Facebook: A Theoretical Framework

Keywords: Cancer, E-Patients, Health 2.0, Social Cognitive Theory, Social Network Sites

établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.

Introduction

One of the main health dilemmas afflicting Malaysia is cancer [START_REF]Malaysia Cancer Statistics -Data &Figure[END_REF]. The incidence of cancer is 30000 yearly and Breast Cancer (BC) is the most common cancer [START_REF]Malaysia Cancer Statistics -Data &Figure[END_REF]. Nowadays, patients and their families often cite difficulties such as lack of information, insufficient psychosocial support, and uncoordinated care [START_REF] Clauser | Improving modern cancer care through information technology[END_REF]. There are some studies that described improvements that Social Network Sites (SNS) could offer to health care such as openness, communication, greater transparency, improved patient support and knowledge translation [START_REF] Bacigalupe | Is There a Role for Social Technologies in Collaborative Healthcare? Families, Systems[END_REF]. It can serve as key health communication channels to provide a location for online dialogue and encourage communities and individuals to interact by providing information related to disease treatment, and survivorship [START_REF] Mirabolghasemi | Malaysian Breast Cancer Patients' Performance in using Social Network Sites: A Task Person Technology Fit Model[END_REF]. SNS have attracted general population in middle-income and high-income countries. Hospitals and cancer support groups should embrace SNS that they may contribute to quality improvements in healthcare. Active use of SNS by healthcare institutions could also speed up information and communication provision to patients and their families, thus increasing quality even more [START_REF] Van De Belt | Definition of Health 2.0 and Medicine 2.0: a systematic review[END_REF][START_REF] Van De Belt | Use of social media by Western European hospitals: longitudinal study[END_REF]. Applying theories are useful because they provide a framework to help identify the determinants of successful intervention. Koskan et al. [START_REF] Koskan | Use and Taxonomy of Social Media in Cancer-Related Research: A Systematic Review[END_REF] have done a systematic literature review on SNS in cancer related research and the results show that the usage of theories is still lacking. However, Social Cognitive Theory (SCT) is the most comprehensive theory that could explain the effect of individual and environmental constructs on certain behavioral patterns in the context of Health Information Systems (HIS).

Since using SNS seems to be significant for individuals with cancer; there is a need for conducting more research to understand factors that can potentially affect cancer patients' performance in using SNS. Early research (1996-2007) was mainly descriptive studies of online discussion forums. Later, researchers began analyzing SNS; therefore, future research should determine how SNS can influence cancer patients' behavior [START_REF] Koskan | Use and Taxonomy of Social Media in Cancer-Related Research: A Systematic Review[END_REF]. Impact of SNS on users can be estimated through their performance [START_REF] Cao | A Systematic Review of Social Networks Research in Information Systems: Building a Foundation for Exciting Future Research[END_REF]. There is still the lack of studies consider the impact of participating in BC Facebook groups [START_REF] Bender | Seeking Ssupport on Facebook: AaCcontentAanalysis of BbreastCcancerGgroups[END_REF]. Therefore, the main objective of this study is to determine the factors that affect the performance of cancer patients in SNS.

Literature Review

The research study's literature review is divided into two main sections. Firstly, a brief description of SNS in healthcare is provided. Secondly, the theoretical perspective is considered.

Social Network Sites in Healthcare

The increase in SNS membership has been followed by an increase in SNS user research [START_REF] Wells | Facebook User Research Using a Probability-Based Sample and Behavioral Data[END_REF]. Previous studies have identified improvements that social networks could offer to health care such as openness, communication, greater transparency, improved patient support and knowledge translation [START_REF] Bacigalupe | Is There a Role for Social Technologies in Collaborative Healthcare? Families, Systems[END_REF]. Hospitals and cancer support groups should embrace social network as they may contribute to quality improvements in health care. Active use of SNS in health care institutions could also speed up information and communication provision to patients and their families, thus increasing quality even more [START_REF] Van De Belt | Definition of Health 2.0 and Medicine 2.0: a systematic review[END_REF][START_REF] Van De Belt | Use of social media by Western European hospitals: longitudinal study[END_REF].

There is very little literature is known about the advantages of support services for cancer patients. Loader et al., [START_REF] Loader | Medicine on the line?Computer-mediated social support and advice for people with diabetes[END_REF] distinguished that informational support can be provided in online communities by virtual relationships. These kinds of support can be received through online interactive services as the helpful real-world contact persons' support [START_REF] Turner | Developing an optimal match within online communities: An exploration of CMC support communities and traditional support[END_REF]. SNS provide the ability for patients to exchange information on subjects such as clinical diagnosis sources of medical evidence, treatment options, adverse treatment effects, the experience of bodily symptoms and experiences with health care providers [START_REF] Griffiths | Social networks-The future for health care delivery[END_REF].

Social Cognitive Theory

SCT is found to be the most comprehensive theory that could explain the performance of cancer patients in SNS because it considers the individual performance and identifies how people acquire and maintain certain behavioral patterns. In addition, SCT describes that there is a dynamic and continuous interaction among the behavior, individual and environment.

The behavioral factors can be the performance, use or adoption. It is important to note that, according to SCT, the environmental factors are twofold which are social support and situational factors [START_REF] Carillo | Social Cognitive Theory in IS Research-Literature Review, Criticism, and Research Agenda[END_REF]. The situational factors are system and task characteristics and the TTF theory can explain them properly [START_REF] Mirabolghasemi | Exploring Factors that Affect on Cancer Patients Performance in Social Networks for Informational Support[END_REF]. Among individual factors, the literature revealed the important role of cognitive factors. Figure1 shows there is not any Information Systems (IS) model which considers the effect of both environmental and individual factors on behavior and there is still the lack of comprehensive model which consider the effect of those factors on behavior. The developed conceptual model must allow the testing and hypothesizing of certain relationships to consider whether or not the formulated theory is valid [START_REF] Sekaran | Research Methods for Business: A Skill Building Approach[END_REF]. Our contention is that integrating both personal and environmental factors can enhance our understanding of individuals' performance in the context of Health Information Systems (HIS).

Methodology

This research applied a survey method. To increase the reliability and validity of the research instrument, three experts with HIS research experience in quantitative meth-ods and scale development evaluated the survey's content validity. Based on purposive sampling, 178 breast cancer patients who had experience of using cancer support groups answered the questionnaire. Smart PLS 3 was used to conduct analysis in two main stages: (1) the assessment of the measurement model, including items reliability, convergent and discriminate validities, and (2) the assessment of the structural model.

Based on the research model and hypotheses, we included the following variables in this study: outcome expectation, self-efficacy, social support, task characteristics, technology characteristics, task technology fit, and performance. A 5-point Likert scale was adopted for the evaluation. Outcome expectation was taken from [START_REF] Khalifa | Determinants of Satisfaction at Different Adoption Stages of Internet-Based Services[END_REF][START_REF] Koo | Expectation, Confirmation, and End User Satisfaction: The Knowledge-Intensive Website of the Korean National Cancer Information Center[END_REF] and self -efficacy was adopted from [START_REF] Wu | The Influences of Social Self-Efficacy on Social Trust and Social Capital-A Case Study of Facebook[END_REF][START_REF] Sherer | The Self-Efficacy Scale: Construction and Validation[END_REF]. Social support adopted from [START_REF] Gustafson | Effect of computer support on younger women with breast cancer[END_REF][START_REF] Gustafson | Use and impact of eHealth system by low-income women with breast cancer[END_REF][START_REF] Shaw | Antecedent characteristics of online cancer information seeking among rural breast cancer patients: an application of the Cognitive-Social Health Information Processing (C-SHIP) model[END_REF][START_REF] Han | Factors associated with use of interactive cancer communication system: an application of the comprehensive model of information seeking[END_REF][START_REF] Kim | Predictors of Online Health Information Seeking Among Women with Breast Cancer: The Role of Social Support Perception and Emotional Well-Being[END_REF]. Task characteristics, technology characteristics, task technology fit and performance were based on the variables used by Mirabolghasemi and Iahad [START_REF] Mirabolghasemi | Malaysian Breast Cancer Patients' Performance in using Social Network Sites: A Task Person Technology Fit Model[END_REF].

RESULTS

The Demographic Information of Respondents

This study collected data from 178 respondents in cancer support groups in Peninsular Malaysia. Table 1 shows the demographic details of the respondents.

The Reliability and Convergent Validity of Survey

The of the survey was assessed through the use of Cronbach's Alpha and Composite reliability tests. Table 2 shows that the Cronbach's Alpha for this study ranges from 0.718 to 0.896, and the Composite Reliability ranges from 0.842 to 0.918. The above results consequently have the recommended value of 0.70, indicating that the items used represent the constructs are reliable. Convergent validity was then tested using Average Variance Extracted (AVE) that should be a value greater than 0.5 to be confirmed [START_REF] Fornell | Evaluating structural equation models with unobservable and measurement error[END_REF]. AVE is greater than 0.5 for all of the constructs so the value was considered to indicate good convergent validity. Therefore, sufficient reliability and convergent validity are demonstrated in Table 2.

Discriminant Validity

The discriminate validity of these measures was also tested by evaluating AVE, and comparing the square root of its value to the latent variable's inter-correlations with other latent variables [START_REF] Hair | A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM)[END_REF]. As presented in Table 3, the square root of AVE is greater than the latent variable inter-correlations with other latent variables. The HTMT value was also below 0.90. Therefore, discriminant validity was established between the reflective constructs.

Assessment of Structural Model

Once the construct measures are reliable and valid the structural model is assessed. This consists testing the relationships between the constructs and the model's predictive capabilities [START_REF] Hair | A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM)[END_REF]. Structural model results are summarized in Table 4. As can be seen in Table 4, outcome expectation (β=0.182, t value=2.373), selfefficacy (β=0.332, t value=3.508), social support (β=0.297, t value=3.772), all showed a significant positive relationship with performance. On the other hand, task characteristics and technology characteristics should fit to have (β=0.198, t val-ue=3.972) a significant positive relationship with performance.

The model as presented in Figure 2, demonstrated 77% variance in cancer patients performance in using SNS. The results of the hypotheses testing showed that outcome expectation, self-efficacy, social support had a significant positive relationship with performance. Meanwhile, cancer patients' performance in using SNS was determined directly by the fit between task and technology characteristics. The last criterion for assessing the structural model is the evaluation of effect size f 2 in the structural model [START_REF] Hair | A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM)[END_REF]. If 0.02 <f 2 ≤ 0.15 the effect is small, 0.15 <f 2 ≤ 0.35 the effect is medium, and if f 2 > 0.35 the effect is large. The results of this study showed that the independent constructs had small effect size on performance.

Discussion

SNS provide an interactive environment to deliver health information to cancer patients. Growing presence of the technology cause of an essential need to explore performance in the context of IS [START_REF] Bravo | Information systems and performance: the role of technology, the task and the individual[END_REF]. Most of the studies on SNS for cancer patients are more descriptive rather than theory building. Therefore, this study explores factors that can affect on the performance of cancer patients in using SNS.

The hypotheses of this study consider whether combinations of outcome expectation, self-efficacy, social support and task technology fit lead to increased performance in using SNS. Moreover, this study's findings provide evidence supporting hypotheses stating that task characteristics and technology characteristics have significant and positive impact on TTF, and that TTF has a significant and positive impact on cancer patients' performance in using SNS. The major contribution of this study is the formation of a theory-based model which integrates SCT and the theory of TTF.

The findings have resulted in practical and theoretical contributions, which may help online cancer support groups to obtain a more comprehensive perspective of the way SNS affect the performance of cancer patients when using SNS. In particular, researchers in the field of HIS would get an opportunity to explore how this integrated model helps to predict cancer patients' performance in using SNS.

Conclusion

SNS have attracted millions of users and many of them have integrated these sites into their daily practices. The factors that affect the performance of cancer patients in SNS is investigated using 178 respondents in two hospitals and four cancer support groups in peninsular Malaysia. The results show that outcome expectation, selfefficacy, social support had significant positive relationship with performance. Moreover, cancer patients' performance in using SNS was determined directly by fit between task and technology characteristics.

Finding factors that are related to performance of cancer patients in the SNS will enable health care providers to generate ideas on how an effective social network intervention for cancer patients can be conducted and it can help health care providers to design intervention more clearly. In addition, meeting patients' needs may result in cost savings, patient empowerment and activation and these are ways for achieving patient cantered care.

While contributing to both theoretical and practical contributions, the study had some limitations that should be dealt with future studies. First, gathering data from the whole population of cancer patients using Facebook were not possible and the data collection had done using 178 respondents. The reason was that some of the cancer patients were not keen to answer the questionnaire. Therefore, the broader sample size and the cross-cultural research in the broader geographical sample distribution may provide the new contributions in the future research. This study considered breast cancer patients' performance in using Facebook which is the most popular SNS among cancer support groups. Future research should validate and test the findings using other types of SNS.

Figure 1 .

 1 Figure 1. Investigated SCT Interactions in Previous Research Adapted from Carillo[START_REF] Carillo | Social Cognitive Theory in IS Research-Literature Review, Criticism, and Research Agenda[END_REF]

Figure 2 .

 2 Figure 2. Results of the PLS Analysis

Table 1 .

 1 The Demographic Details of Respondents

	Frequency	Percentage
	(N=178)	(%)

Table 2 .

 2 Results of Reliability and Convergent Validity Tests

			Reliability	Converg
	Constructs	Cronbach's	Composite	ent Validity AVE
		Alpha	Reliability
	Outcome expectation	0.718	0.842	0.640
	Self-efficacy	0.863	0.902	0.648
	Social support	0.881	0.913	0.678
	Task characteristics	0.849	0.888	0.571
	Technology characteristics	0.787	0.858	0.525
	Task-technology fit	0.857	0.913	0.778
	Performance as a behavior	0.844	0.906	0.763
	Performance as an outcome	0.868	0.910	0.717
	Performance	0.896	0.918	0.616

Table 3 .

 3 Structural Model Results

		OE	Performance	SE	SS	TAC	TTF	TEC
	OE	0.800
	Performance	0.667	0.784
	SE	0.661	0.772	0.805
	SS	0.561	0.726	0.681	0.823
	TAC	0.449	0.619	0.674	0.617	0.756
	TTF	0.508	0.641	0.603	0.522	0.647	0.882
	TEC	0.400	0.497	0.517	0.363	0.546	0.716	0.725

*Note: OE= Outcome Expectation, PA= Positive Affect, SE= Self-Efficacy, SS= Social Support, TAC= Task Characteristics, TTF= Task-Technology Fit, TEC= Technology Characteristics

Table 4 .

 4 Structural Model Results

	Hypothesis	Path coefficient	t-value	Result
	Outcome expectation-> Performance	0.182	2.373	Supported
	Self-efficacy-> Performance	0.332	3.508	Supported
	Social support-> Performance	0.297	3.772	Supported
	Task characteristics-> Task-technology fit	0.365	5.985	Supported
	Technology characteristics -> Task-technology fit	0.517	2.738	Supported
	Task-technology fit->Performance	0.198	3.972	Supported

Acknowledgement

A special thank you goes to Cancer Support Groups in Peninsular Malaysia who contributed to the survey and Universiti Teknologi Malaysia (UTM) for hosting the research.


Irya Wisnubhadra

Stephanie Pamela Adithama

Design and Build OLAP Business Intelligence for Village Sustainable Development Planning

Keywords: OLAP Business Intelligence, Sustainable Development Planning, Village Information System and Rural Areas (SIDeKa)

The Indonesian government-year period 2014-2019, endorsed the National Medium Term Development Plan (RPJMN) with the concept of building Indonesia from the rural area. One of the RPJMN focus is the development of rural and border areas brings a new paradigm for the village development. This village development paradigm change requires the support of village information system. Village Information System and Rural Areas (SIDeKa) has developed and implemented in dozens of villages in the some district as a

Introduction

The Indonesian government year period 2014-2019, endorsed the National Medium Term Development Plan (RPJMN) with the concept of building Indonesia from the rural area. The government develops all sectors in order to get a better Indonesia, with the several objectives focus: (a) improve competitiveness, (b) improve the quality of human being, including mental development, (c) utilize and restore the lost potential in maritime and marine sectors, (d) improve the quality of economic growth, (e) reduce the inequality between regions, (f) restore environmental damage, and (g) advance social life. In the fifth focus that is the reduction of inequality between regions, government provides a large focus on the development of rural and border areas [START_REF] Perencanaan | Rencana OpenPembangunan Jangka Menengah Nasional[END_REF].

Village authority in the philosophy of "Village Builds" in the government of President Joko Widodo, change the village development paradigm from object becomes the subject of development. The development initially overlapping as an institution, financial and planning is now becoming more consolidated.

Changes in the development paradigm and village authority is the authority on village government administration, the implementation of rural development, rural community development, and community empowerment requires support from village information system. Village information system explicitly has appeared in the Village Law, in article 86 concerning Rural Development and Development of Rural Areas Information System, which contain [START_REF] Perencanaan | Rencana OpenPembangunan Jangka Menengah Nasional[END_REF] Village has right to access information through the village information system developed by the local district/city government, (2) The government and regional governments must develop a rural development and development of rural areas information system, (3) Village information system referred in paragraph 2 includes hardware and software facilities, network, and human resources, (4) Village information system referred in paragraph 2 includes the villages data, rural development data, rural areas data, and other information related to rural development and the development of rural areas, (5) village information system referred in paragraph 2 managed by village government and can be accessed by village communities and all stakeholders, (6) The local district/city government provide district/city information planning for the village. Village information system then becomes very important.

Rural development should also be aligned with the level of development in the above village level (Supra Desa), ie district/city and sub-district. Development plans at village level should be aligned with the policy and strategy of the district/city, Regional Development Plan (RPJMD), Strategic Plan Working Unit (SKPD), Spatial Planning and Regional Plan (RTRW) District/City, and the planned development of rural areas [START_REF] Bina | Peraturan Menteri Dalam Negeri Nomor 54 Tahun[END_REF].

In the previous research, the authors have designed and build integrated Village Information System and Region (SIDeKa). The information system developed through strategic planning based on Enterprise Architecture, and priority-based information system development planning [START_REF] Ward | Strategic Planning for Information Systems[END_REF]. SIDeKa has implemented in several villages in districts in Indonesia, ie in Meranti, East Belitung, Boalemo Gorontalo, Pangkajene Islands, Raja Ampat, Gianyar, Pemalang, Tasikmalaya, and Kulon Progo. The transaction data and information in the village have captured accurately using SIDeKa. These data and information becoming crucial sources for development planning in the next phase.

The volume of data generated by the SIDeKa for daily operations of the different kinds of businesses has experienced an explosive growth. Data warehouses play an important role in helping decision makers obtain the maximum benefits of these large amounts of data. Data are extracted from several sources, cleansed, customized and inserted into the data warehouse. A data warehouse is defined as a subject oriented, integrated, time-variant and non-volatile collection of data in support of management decision making process. [START_REF] Al-Aboud | Strategic Information Systems Planning : A Brief Review[END_REF]. The most popular analysis mean is the Online Analytical Processing (OLAP) which enables users to examine, retrieve and summarize data within a multidimensional model. This paper describe a design and implementation of OLAP Business Intelligence for development planning at village and supra village (district) that integrates SIDeKa's data from all villages and aligns the development planning with the vision, mission, and objectives of rural development in the Village Law No. 6 of 2014. OLAP Business Intelligence will be useful for Village Sustainable Development Planning for support the strategic and tactical decisions [START_REF] Ranjan | Business Intelligence: Concepts, Components, Techniques And Benefits[END_REF] as well as being a tool to monitor development progress in every villages which are connected as human neural network. In the end OLAP Business Intelligence is expected to improve organizational performance in sustainable development [START_REF] Nazier | Business Intelligence And Its Role To Enhance Corporate Performance Management[END_REF].

Related Work

Nowadays we are witnessing of explosion of transactional data transferred in the internet. 2 billion people from developing countries using the internet. The huge data need to be efficiently gathered, stored and analyze to support decision making not only for business institution but also for the government. One of the solution is Data warehouse and Online Analytical Processing (OLAP) Business Intelligence. Data warehouse is a collection of data that is subject oriented, integrated, time variant, and non-volatile designed for complex queries [START_REF] Inmon | Building the Data Warehouse, Fourth Edition[END_REF] [START_REF] Ponniah | Data Warehousing Fundamentals[END_REF].

Data warehouse is used to strengthen action ability of Health Information System, in Tajikistan [START_REF] Latifov | Data Warehouse Approach to Strengthen Actionability of Health Information Systems:Experience from Tajikistan[END_REF]. This research proposed process of standardization using meta-data dictionary that would support data for action. Business Intelligence also useful for developing countries. Purkayastha et.al proposed Big Data Analytics for developing countries, using cloud computing for operational Business Intelligence in health [START_REF] Purkayastha | Big Data Analytics for Developing Countries -Using the Cloud for Operational BI in Health[END_REF]. This big data is resulting from integration of health data from multiple sources. Mohamed et.al show that KM is critical for innovation, prioritization and efficient use of resources. A significant linear association between IICTs and KM across time and geography is detected. IICTs improve the quality of shared decision making in inter-and intra-organizational settings [START_REF] Mohamed | An empirical assessment of knowledge management criticality for sustainable development[END_REF].

Inspired by the usefulness of data warehouse and business intelligence as a tool for decision making in the government or in organization, authors design and build an OLAP Business Intelligence for sustainable development.

Research Methodology

This research comprehensively done by doing some related activities, can be viewed on a fishbone diagram in Figure 1 A literature study by gathering information from books, articles, and scientific journals that discuss information system/information technology strategic planning related to Village Information System and Rural Areas. (2) Data Collection. Data collection related to information system strategic planning is done for several techniques, including: (a) direct observation, surveying the location, (b) interview, interviewing stakeholders related to village government organization, and business processes related to information system strategic planning, (c) survey, if interview with stakeholders not enough yield important information. (d) Business processes analysis in organization. The business processes are analyzed with analysis tools, i.e.: Porter's Value Chain [START_REF] Porter | Competitive Advantage Creating and Sustaining Superior Performance[END_REF] and Business Process Analysis [START_REF] Al-Aboud | Strategic Information Systems Planning : A Brief Review[END_REF]. (e) Enterprise Architecture modeling, using phases in TOGAF ADM methodology [11]. This approach is a complete and comprehensive approach that is suitable for strategic information system planning [START_REF] Alonso | The IT Implicated Within The Enterprise Architecture Model: Analysis of Architecture Models and Focus IT Architecture Domain[END_REF].

Business process identified for village government services shown in Figure 2 below:

OLAP Business Intelligence for Village and Rural Areas for Sustainable Development Planning

Indonesia is a big country that have at least 70 thousand villages. The new development paradigm turn village into new role as become the subject of the development instead of as an object. The new role implies the need for management information system of village development. Right now villages already have an open source information system that could support for village development planning, actuate, and monitoring that called SIDeKa.

The information system has been developed in the early stages (SIDeKa) is an application which is still in transactional scale and handle daily operations. The information needs in aggregation and reporting form are important for sustainable development planning at the village and supra village (district) level. The application is then called OLAP Business Intelligence. OLAP Business Intelligence is a decision making support applications that could satisfy organization needs to meet the efficiency of decision making using technology to rapidly extract useful information from very large data so that accelerate the decision-making [START_REF] Farrokhi | The Necessities for Building a Model to Evaluate Business Intelligence Projects[END_REF].

The development of OLAP Business Intelligence Application develop in the following steps: (1) Identify the sustainable development planning regulation and procedures. This step is an OLAP Business Intelligence Requirements Analysis. Requirements analysis was conducted through Focus Group Discussion (FGD) with stakeholders at the district level such as Bappeda and SKPD and business processes analysis related to development planning. 4 below. The first block from the block diagram shows that the data processing and information is the first main issue. This first block is then filled by the Online Analytical Reporting (OLAP) application, which is one of the basic functionality of business intelligence application. Some important questions related to OLAP, which need to be answered for sustainable development planning such as: (a) How large and which land area, and the potential revenues that can be achieved for the entire area in the district, including all of the potential of agricultural, livestock, tourism? (b) How is the development of agricultural, livestock, tourism, etc. during the period of last five years? (c) How large the disaster-prone district area? (d) How many people that was born, died, migration in a certain district? (2) OLAP Business Intelligence Design. This design phase comprises of: (a) presenting a star schema based on dimensional model that captures information needs for sustainable development planning. Create dimensionality model in information package and star schema design is conducted in this design phase. Information package explain the facts/measure, and dimension along with the attributes and hierarchies that will compose data warehouse. Data warehouse is a collection of data that is subject oriented, integrated, time variant, and non-volatile designed for complex queries [

The Result

The result of the development of OLAP Business Intelligence application shown in Figure 9 below: This screenshot depicts the dashboard of the OLAP Business Intelligence that could display the previously defined report. Report is based on OLAP Business Intelligence standard capabilities that could choose measures and dimension for reporting and display it in variety of reports like map, graph, and table. The OLAP Business Intelligence is an open source tool that embed with the SIDeKa (Village Information System and Rural Areas).

Conclusion and Future Works

The OLAP Business Intelligence Application and Information System at district / supra village have been built by integrating transactional data from SIDeKa that have been developed previously. This system be able to answer the important questions used for development planning at the district / supra village includes the district condition, economic and financial potency, and the timely development performance by district.

The application is open source in nature and could be used as tool for gathered, stored, and presented information of aggregate data to integrated district development planning. Reports are created custom and could be presented on map, table, or graph.

In the future, the challenge is how to extend OLAP Business Intelligence in the province and national level. There is so many data integration issues because of the variability of Village Information System that has already deployed. Analytical Reporting presented in this study is only limited to development planning, which is very important for developing country like Indonesia. The research have opportunity to extend to covers the food fulfillment decision making for the community.

Figure 1 .

 1 Figure 1. SIDeKa research activity Activity 1, Villages and Rural Areas information system strategic planning implemented in phases: (1) Literature Study.A literature study by gathering information from books, articles, and scientific journals that discuss information system/information technology strategic planning related to Village Information System and Rural Areas. (2) Data Collection. Data collection related to information system strategic planning is done for several techniques, including: (a) direct observation, surveying the location, (b) interview, interviewing stakeholders related to village government organization, and business processes related to information system strategic planning, (c) survey, if interview with stakeholders not enough yield important information. (d) Business processes analysis in organization. The business processes are analyzed with analysis tools, i.e.: Porter's Value Chain[START_REF] Porter | Competitive Advantage Creating and Sustaining Superior Performance[END_REF] and Business Process Analysis[START_REF] Al-Aboud | Strategic Information Systems Planning : A Brief Review[END_REF]. (e) Enterprise Architecture modeling, using phases in TOGAF ADM methodology[11]. This approach is a complete and comprehensive approach that is suitable for strategic information system planning[START_REF] Alonso | The IT Implicated Within The Enterprise Architecture Model: Analysis of Architecture Models and Focus IT Architecture Domain[END_REF].Business process identified for village government services shown in Figure2below:

Figure 2 .

 2 Figure 2. Village Value Chain

Figure 3 .

 3 Figure 3. Front End Side Screenshot SIDeKa Activity 4 is Design and Build OLAP Business Intelligence for sustainable development planning conducted in this study. The design process of OLAP Business Intelligence performed with the following steps: 1) Identify the sustainable development planning regulation and procedures, 2) Presenting a star schema based on dimensional model that captures information needs for sustainable development planning, 3) Introduction new measures that captures both the temporal and spatial dimensions, 4) Design model/architecture for Extract, Transform and Loading, and 5) Implementing the OLAP Business Intelligence System.

  Several government regulations related to development planning are: (a) Law No. 25 of 2004 concerning National Development Planning, (b) Law No. 32 of 2004 concerning Regional Government, (c) PP 08 of 2008 concerning Stages, Preparation Procedures, Control and Implementation Evaluation, Regional Planning, (d) Regulation 54/2010 concerning the implementation of PP 08/2008, and (e) Law No. 11 of 2008 on Information and Electronic Transactions. One of the main business processes related to development planning is shown in block diagram in Figure

Figure 4 .

 4 Figure 4. Preliminary Drafting RKPD Regency/City Diagram[START_REF] Bina | Peraturan Menteri Dalam Negeri Nomor 54 Tahun[END_REF]

Figure 9 .

 9 Figure 9. Data Warehouse Design Screenshot for Demography Fact

  14] [15]. (b) Introduction new measures that captures both the temporal and spatial dimensions, and (c) Design model/architecture for Extract, Transform and Loading OLAP Business Intelligence application architecture is shown in Figure 5 below:

		1. District Condition
		and General	District Preliminary RKPD Design:
	Data and Information Processing	Profile Analysis 2. District Economic and Finance Analysis	1. Introduction 2. Last year RKPD evaluation 3. Development priority and objectives 4. District Work Plan
		3. Last year
		performance
		evaluation
	District	District RKPD	District RKPD
	RPJMD	Document Evaluation	Document this year

pilot project.

This star schema represents district condition fact, and dimensions that could be analyze from our OLAP Business Intelligence application. The continuous dimension also include in this design to accommodate continuous query. Besides district condition, this fact could be answered economics and finance condition.

Economics and finance condition fact also could be derived from Fact Demography in figure 7 This District Indicator fact could answer how success the district development performance in term of planning and realization. This information could be drill down to detail villages / sub villages, time, activity planned, and development account.