On the 5th July 2019, Jacob presented at the SAPC Annual Scientific Meeting at the University of Exeter. His presentation was entitled ‘What are primary care professionals’ views on patients’ use of self-monitoring technologies?’, and discussed the results of a focus group study with 21 primary care professionals.
The presentation explained how we designed vignettes based on data from our interviews with people who use blood pressure monitors and/or BMI scales at home. It also outlined some of the findings from the study, including how practitioners have advised their patients on what type of device to purchase and how they educate patients about how to use their monitors and how their data is used.
We are currently developing a more detailed look at the issues explored in the focus groups for a paper.
On the 19th and 20th of June 2019, the ‘Tracking Ourselves’ team hosted a two-day symposium on ‘Health Technologies in Practice: Between the home and the clinic’. The symposium marked the culmination of the Leverhulme Trust Funded Research Project on “Knowledge, Care and the Practices of Self-Monitoring”. The event brought together an interdisciplinary and international group of speakers, with interests in STS, medical sociology, anthropology, disability studies, media studies and cultural studies. Speakers were all interested in health technologies that bridge the home and the clinic, but focused on different empirical sites and employed different methods. All the papers shared a broad interest in everyday health practices and how these relate to responsibilities for health and care, as well as the people, technologies, spaces and relationships involved, including the role of health professionals and commercial actors.
On the first day, after a brief introduction to the project, Dr Kate Weiner (University of
Sheffield) presented the first paper from the ‘Tracking Ourselves’ project,
looking at everyday data practices of self-monitoring in relation to body mass
index (BMI) and blood pressure.
Considering the relationships between taking a measure, recording,
storing and reviewing data, Kate developed the idea of curation in relation to
self-monitoring records, and discussed the human work and different materials
involved in this practice.
The next presentation was by Dr Dorthe Brogård Kristensen (University of Southern Denmark) on “Optimization and the Imaginary of Metrics”. Based on an ethnography of self-tracking in a gym, the paper aimed to explore how users respond to and manage the metrics and algorithms that shape social life. Resonating with the previous talk, Dorthe drew attention to the materials involved, considering the ‘affordances’ of both digital and analogue technologies and the way people use these on their own terms.
Professor Janice McLaughlin (Newcastle University) then presented on the self-surveillance practices of young disabled people and their use of home as a site of embodied self-monitoring. Janice explored how young disabled people experience both medical advice to modify their bodies and their felt individual expectations about the capacities of their bodies.
final presentations of the first day, Dr Ros Williams (University of Sheffield)
and Dr Jacob Andrews (University of Sheffield) provided some methodological
reflections on the “Tracking Ourselves?” project. Ros presented on the
development and experiences of using long duration auto-photography and photo
elicitation interviews to explore everyday self-monitoring practices. Jake
discussed the process of creating vignettes from interviews on self-monitoring,
and the use of these as prompts for focus groups to explore clinicians’ views
and professional experiences. Ros and Jake both reflected on the nuances and
possibilities of these methods.
On the second day, Dr Btihaj Ajana (King’s College London) presented “Sharing and its discontents in the Quantified Self (QS) culture” discussing the differences between the sharing economy and commodity exchanges. By linking data philanthropy with data commercialisation, her presentation raised questions in relation to individual privacy and public interest. Dr Catherine Will (University of Sussex) and Professor Flis Henwood (University of Brighton) continued to address the communal aspects of self-monitoring with their paper from the ‘Tracking Ourselves’ project which explored the role of family and friends in the practices of self-monitoring. They argued that monitoring is a care practice, and that people tread carefully between care and surveillance. The talk illustrated the way that the work of maintaining or sustaining health is negotiated within families and monitoring has affective or emotional components in everyday life.
The last two papers of the symposium focused on the internet as a health technology, but in different ways. Dr Fiona Stevenson (University College, London) presented on raising, discussing and using the internet to seek health related information in General Practitioner (GP) consultations. Based on conversation analysis of video-recorded consultations, Fiona demonstrated that, contrary to expectations, the degree to which patients mention the internet is, in fact, relatively limited and that the way that patients invoke the internet in medical consultations is imbued with complexity.
Dr Minna Ruckenstein (University of Helsinki) presented her ongoing project
about “Tracing Medicinal Agencies: Antidepressants and Life-Effects”, talking
about everyday drug experiences and exploring the human-drug relationship. Her
project analysed health related posts from large digital open data sets, using
the computational tool Medicine Radar. This work contributes to methodological
innovation in social research and introduces the idea that side effects of
antidepressants are better understood as life effects.
Closing remarks were given by Professor Alex Faulkner (University of Sussex) and Professor Sarah Nettleton (University of York), who reflected on key themes and take away messages from the two days. They reflected on the broader politics of these technologies and their uses, and on the empirical insights gained from the different methods employed. Both commented on the ‘retro’ nature of monitoring in everyday life, in spite of innovations in technology. Sarah commented that by ‘lifting the lid’ on these practices, the presentations had been able to consider the ‘messy granularity’ of agency across cases. Finally, many of the presentations were grounded in a concern with the lived experience of engaging with these forms of technology and data, bringing to light, in particular, the emotional and relational elements of these engagements.
Our project symposium, ‘Health Technologies in Practice’, took place on the 19th and 20th June 2019 and was a great success, with 49 attendees from 24 institutions from across Europe. We’d like to say a big thank you to all our delegates and speakers.
Two early career researchers
reflect on their experience of attending the symposium:
Xiufeng Jia (Department of Sociological Studies, University of Sheffield): “I am a first year PhD researcher, studying how ordinary self-trackers feel about their self-tracking data in order to understand datafied agency. For me, this two-day symposium was like an academic holiday that took me away from my current busy work and brought me into an exciting and relaxing research exploration in a very friendly environment. All of projects that the researchers presented from different perspectives were creative and meaningful for academics and the society. Besides, after a walking tour of Sheffield, this symposium provided a great opportunity for me to communicate with the researchers (such as Dr Btihaj Ajana, Dr Minna Ruckenstein and Dr Rachael Kent) from beyond the University of Sheffield who are working on self-tracking studies, when we were having a lovely dinner with other participants together. The whole event actually helped me improve my literature review and interview questions, and deal with some confusions in the methods in my research project. It also really encouraged me to be more enthusiastic to research, after experiencing how those researchers investigated new and interesting projects through their talks.”
Lauren White (Department of Sociological Studies, University of Sheffield): “As a third year PhD researcher exploring the daily practices of people living with Irritable Bowel Syndrome (IBS), the conference reminded me of important features of managing health present in my own research, alongside important methodological considerations. In particular, I was drawn to the relational practices of monitoring health, and how managing health or symptoms of broader illness can be situated in relational networks both in public and private lives. Moreover, I recognised the careful tightrope of negotiating surveillance and care, as both an individual and collective practice. Methodologically, I found familiarity in the materiality, and again attached my own research experiences of using paper diaries and object elicitations to those of the presenters. Reaching the end of the conference, I left with new connections, alongside insights and striking lines into the possibilities of monitoring health, as an affective, material and important lived experience in a fast and changing social landscape.“
They talked about ‘engaging material methods to explore everyday health practices’, reflecting on their experiences of using objects like monitoring devices, apps, and records as prompts in interviews. They also gave some initial reflections on the use of long-duration photo elicitation, including the practicalities of setting up and managing this, and some of the new insights gained as a result of using it.
The latest output from the Tracking Ourselves? project is now available online as an article in the journal Critical Public Health, a publication that invites research critically exploring new ways of thinking about public health. The paper is entitled Constituting practices, shaping markets: remaking healthy living through commercial promotion of blood pressure monitors and scales.
The article comes out of the first phase of our research, and looks specifically at commercial material produced around a sample of digital blood pressure monitors and weighing scales. We look at the promotional material developed for the sale of these devices, alongside the devices themselves, their packaging and design. The paper argues that companies operating in this space can be seen to re-work well-establishing practices like weighing and blood pressure monitoring to maintain connections to health whilst moving away from more explicit clinical associations.
A number of free e-prints of this journal article are available here. For those whose institutions cannot access the article directly, please do get in touch with any of us for a pre-print version of the article.
Below, you can read an abstract for the paper.
Commercial actors play a key role in promoting public health agendas as they move into space previously occupied by the state-sponsored health sector and welfare state. This paper examines how marketing of digital self-monitoring devices promotes public health. Existing self-monitoring research often separates or compares positions of commercial actors and users, using a discourse lens to examine commercial actors’ ‘expectations’ and ‘promises’, and user research focusing on ‘practices’. The research on which this paper is based moves beyond this divide, examining commercial and user worlds through a practice lens. We draw on the research’s first stage which examined self-monitoring device marketing, arguing that marketing can be understood as constituting self-monitoring practices. Much literature on self-monitoring focuses on novel networked devices, resulting in potential over-emphasis on change and innovation. Taking cases of well-established bodily monitoring (weighing and blood pressure), we set self-monitoring within a longer history. We draw on Shove’s practice theory which attends to histories of practices and evolutions in practices required elements materials, meanings and competences. Commercial companies are shown to rework well-embedded practices as they constitute the practice elements of self-monitoring. They thus keep in play continuities and novelty, maintaining connections to health while moving away from clinical associations. We argue that, in constituting self-monitoring practices as ‘aesthetic’, ‘enjoyable’, and ‘shared’, commercial actors address implicit resistances to negative connotations of ‘individualised’, ‘responsibilised’ consumer citizens implied in neo-liberal health-promotion agendas, widening the self-monitoring market and promoting public health by creating more desirable ‘lifestyle’ practices.
A new paper, using data from the pilot interviews from our project, has been published in Sociology of Health and Illness. The journal article was written by Kate Weiner and Catherine Will. In it, they argue that the use of self-monitoring devices may be understood as a shared practice that expresses care for self and for others. The abstract is reproduced below, and the entire paper is available to read Open Access here.
Abstract The growing consumer market in health monitoring devices means that technologies that were once the preserve of the clinic are moving into spaces such as homes and workplaces. We consider how one such device, blood pressure monitors, comes to be integrated into everyday life. We pursue the concept of ‘care infrastructure’, drawing on recent scholarship in STS and medical sociology, to illuminate the work and range of people, things and spaces involved in self-monitoring. Drawing on a UK study involving observations and interviews with 31 people who have used a consumer blood pressure monitor, we apply the concept beyond chronic illness, to practices involving consumer devices – and develop a critical account of its value. We conclude that the care infrastructure concept is useful to highlight the socio-material arrangements involved in self-monitoring, showing that even for ostensibly personal devices, monitoring may be a shared practice that expresses care for self and for others. The concept also helps draw attention to links between different objects and spaces that are integral to the practice, beyond the device alone. Care infrastructure draws attention to the material, but ensures that analytic attention engages with both material and social elements of practice and their connections.
We have uploaded a working paper that draws together existing scholarship from digital sociology and media & communication studies with work from Science and Technology Studies and the Sociology of Health and Illness.
The scholarship and questions we consider in this paper are informing our thinking and plans as the project progresses. We’d welcome your comments.
You can download the paper here and read the abstract below.
This paper aims to contribute to critical studies of self-monitoring by drawing together existing scholarship, emerging predominantly in digital sociology and media and communication studies journals, with scholarship from Science and Technology Studies (STS) and Sociology of Health and Illness (SHI) on other health technologies used away from the clinic. We take stock of existing work and suggest potential avenues for further exploration. We start by offering a critical summary of scholarship on self-monitoring, arguing that an important theme has concerned the meaning and value of data. An initial focus on media and commercial discourses, providing political economy and Foucauldian analyses, has been complemented and complicated by emerging ethnographic work, particularly on the Quantified Self movement, which suggest plural understandings and valuations of self-monitoring data, and limits to data flows. A key contribution of our argument is that there may be more to self-monitoring than data and data flows. We suggest that a technology-in-practice perspective might help to explore the diversity of monitoring practices, bringing into relief issues that are already central in SHI and STS. We draw on evidence from comparison cases of other health technologies used in domestic spaces (telecare and pharmaceuticals) to highlight three conceptual areas that have resonance for self-monitoring: (i) non-use, resistance and unexpected uses of technologies, (ii) the distributed work of self-monitoring within existing care infrastructures, and (iii) the emotional meaning of self-monitoring. We end with a series of questions that we propose could help orientate and further enrich future scholarship into self-monitoring.
This was an innovative series of events designed to bring together cutting edge thinking in social science, drawing on theories of social practice, with the experiences of civil society organisations, especially those in the community and voluntary sector. The series explored what these organisations ‘do’ – attending to the complexities of everyday work in fields including health, education, social care, housing and other community action.
The book sprint was aimed at condensing some of the themes and work which emerged from the seminar series, and acted as a collective and collaborative approach to book writing, where everyone writes, edits and redrafts what emerges during a week period.
The final product of the book sprint – New Practices for New Publics? Theories of social practice and the voluntary and community sector – is available for download here.
You can follow tweets from the book sprint on twitter or learn more about the writing concept at book sprint’s website.
Participation in the seminar series and book sprint has helped to shape and develop our thinking about theories of social practice, providing ideas about everyday practice that will inform the tracking project.
Catherine from the Tracking Ourselves? project is also involved in the Cost of Living website, which published short pieces that focus broadly on the politics, economics and sociology of health and health care. Below is some of a piece she and Kate Weiner, also in the team, wrote for Cost of Living on technology for self-monitoring. You can read the whole piece here.
Health and fitness tracking is all the rage. You want to keep track of your weight or count calories? There are apps for that. The NHS even offers an app ‘to track the whole family’s BMI over time.’ Through using these personal digital devices we can all learn to monitor our behavior. This in turn can motivate us to make and maintain changes to prevent disease, and improving our health by sharing data with friends (see the recent BBC documentary, Monitor Me).
In some ways this narrative is persuasive. Personal computing has changed the way we live and work, and the spread of smart phones has been rapid. People now hold enormous analytic power in their hands many times a day. But we have some doubts about the extent to which people are happy to monitor themselves in this way.
We’ve been researching consumers of the cholesterol lowering drugs, statins, and of so-called functional foods that contain plant sterols, like Benecol and Flora proactiv, for a few years now. Respondents in our research were from a wide range of ages and backgrounds. Their views suggest a strong reluctance to engage in the kinds of activity that are involved in digital health tracking.