Table 4.

Additional factors to consider when using a modified ANT approach

Methodological issue	How this may be addressed	Implications for our study
ANT does not a priori divide the world into micro and macro contexts or attribute agency to either individuals or social structures	Broader contextual factors should be taken into account and may be viewed as other parts of the network	Political, cultural and economic environments are important to consider when examining the introduction of the software
The number of actors in the network is potentially infinite	Researchers need to make rigorous and pragmatic decisions of where (and from whom) to start and where to stop data collection. The primary focus should be on answering the research question.	Although the focus may be on exploring changes to work processes, views from other relevant stakeholders such as implementation team members, developers and governmental stakeholders may also be sought
Different actors can play multiple roles in multiple networks at multiple time points	May be useful to view networks as consisting of several sub-networks and as changing over time	Can examine how different networks align or fail to align (e.g. use of systems across different wards), how they are positioned in relation to larger networks (e.g. the hospital, the historical, cultural, political environment) and how networks change over time (e.g. comparing early and later implementation stages)
ANT is too descriptive and fails to come up with any definitive explanations or approaches of how exactly actors should be viewed and analysed	Important not to lose sight of the wider study aims as purist ANT can be prone to getting lost in detail	The focus of the study is on examining the changes in work processes as a result of the introduction of the software and all other activity should centre around this primary research question
A truly detached observer does not exist as he/she always comes from a particular position in time and space and plays an active role in eliciting and constructing accounts	Researchers need to be pragmatic and acknowledge their involvement through reflexive accounts	It is important to keep a field journal and reflexive notes throughout data collection and analysis
Human accounts and often those of the most powerful are privileged offering little insight into the material world	Need to recognise individual differences between humans and acknowledge that artefacts have attributes and a history	Take into account differences arising from different actors by being explicit about their positioning and the attributes of the technology arising from different historical constellations