Academic journal article Health Sociology Review

Clinical Self-Tracking and Monitoring Technologies: Negotiations in the ICT-Mediated Patient-Provider Relationship

Academic journal article Health Sociology Review

Clinical Self-Tracking and Monitoring Technologies: Negotiations in the ICT-Mediated Patient-Provider Relationship

Article excerpt

Introduction

Health self-tracking has become a popular research issue in recent years. This interest is due to a number of partially related causes, such as the increase in people with long-term health conditions, the growing importance of self-care, the spread of miniaturised and easy-to-use measuring devices and smartphone applications and the availability of social networking platforms. With some basic computer skills and some low-cost gadgets, it is relatively easy to produce and share an amount of personal health information unimaginable only a few years ago.

The new technologies have been hailed by healthcare managers and policy-makers as offering opportunities to reshape the healthcare system. Groups of tech-enthusiasts have played a significant role in raising awareness about the potential of self-tracking modalities. The Quantified Self movement (http://quantifiedself.com) has established itself as a new approach in which the ability of laypeople to collect and interpret data enables them to find patterns and improve their quality of life (Li, Dey, & Forlizzi, 2010). While there is still little evidence of health benefits associated with Quantified Self practices (Ledger & McCaffrey, 2014), some studies have focused on the surveillance and control aspects of self-tracking (Allen, 2008; Bossewitch & Sinnreich, 2013) and resistance practices enacted by users (Fox, 2015). Moreover, the demographic categories that could benefit most from Quantified Self practices - such as elderly people with chronic conditions - are not a target market for the companies producing these technologies (Doyle, Walsh, Sassu, & McDonagh, 2014). These results leave open the question of whether self-tracking practices contribute to exacerbating the differences among social groups in their access to new health services.

Most of the debate on health self-tracking seems to be modelled on a script in which two irreconcilable positions can be easily discerned. On the one hand, there are the techno-enthusiasts who consider self-tracking technologies and practices to be a turning point in health management (Rivera-Pelayo, Zacharias, Müller, & Braun, 2012; Swan, 2012); on the other, there are those who see them as embodiments of a corporate and public health agenda that will eventually lead to the medicalisation of society (Conrad, 2007) and which must be resisted through subversive practices (Fox, 2015).

This polarisation does not do justice to the rich phenomenology of health self-tracking, instead reducing it to a confrontation between 'nightmare' scenarios and those full of 'promise' (Pols, 2012). This contrast is a recurrent trope in debates on new technologically propelled changes. The techno-utopian scenarios presented by both academia and policymakers need to be challenged (see Lupton, 2014a, 2016), and there is a need for critical analysis of self-tracking practices and how they relate to the ongoing transformation of health care.

For these purposes, it is necessary to shift the focus from the future to the present, considering the social practices of self-tracking and the place that they occupy in people's everyday lives. Interesting in this regard is the classification by Lupton (2014b) of the different ways in which trackers organize, analyse and interpret data. Lupton identifies five categories of self-tracking: private, communal, pushed, imposed and exploited (Lupton, 2014b). Thus, how one keeps track of one's diet differs according to whether the data are collected for oneself (private self-tracking), shared with an online community of people who want to lose weight (communal self-tracking), collected on a doctor's advice (pushed self-tracking), required by an employer (imposed self-tracking) or given to a company that wants to profile its customers (exploited self-tracking). This classification has, among other things, the merit of showing how the Quantified Self movement - which has, in some ways, 'cannibalised' the debate on self-tracking - constitutes only two of the components of the phenomenon (i. …

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