Academic journal article Health Sociology Review

Mobile, Wearable and Ingestible Health Technologies: Towards a Critical Research Agenda

Academic journal article Health Sociology Review

Mobile, Wearable and Ingestible Health Technologies: Towards a Critical Research Agenda

Article excerpt

Introduction

In present times, the growth of mobile and wearable technologies is radically reconfiguring health care, as they allow people to self-monitor and regulate their health practices, often without the involvement of any healthcare professional. For example, wristbands fitted with motions sensors use algorithms to track everyday activities, such as walking or hours slept. The global significance of these transformations is vast, as mHealth activity is capable of functioning in environments where there is a limited technological infrastructure. Thus, exploring the potential of mHealth is fast becoming a global priority, especially where resources are limited and where more people have access to a mobile device than a hospital or clinic. While there is much to celebrate about the transformative capacity of mHealth, there is also a more critical discourse emerging in response to what Lupton (2014a, p. 706) describes as the 'prevailing solutionist and instrumental approaches to the application of digital technologies to medicine and public health'.

Extending the critical analysis of mHealth, we examine consumer-oriented technologies that are pertinent to promoting healthy lifestyle behaviours, such as physical activity, body weight management, and food consumption. Wider concerns about the absence of regulation around such lifestyle apps underpin our interest in these categories of mHealth technologies (Powell, Landman, & Bates, 2014). Over 70% of all health apps fit into this category (Research2Guidance, 2014), but the expansion of health-related data reveals a much bigger picture of unregulated health apps. Our intention for this paper is to present an overview of critical digital health studies focused on these technologies and to signpost future research agendas. Our analysis begins with a review of the term mHealth, so as to establish the parameters of this field. We then focus on some of the recent notable contributions to the critical analysis of mHealth, examining the theoretical developments informing these analyses and exploring some of the challenges and emerging issues. Many of these wearable technologies and apps deserve individual empirical exploration - perhaps even the development of what might be termed device ethnography - though we focus on broad characteristics of these apps and the kinds of practices that occur within them. These insights indicate how the sociology of digital health, as a distinct research field, is in need of new methodological approaches, and cannot rely simply on established techniques.

Mhealth as a public health solution

Striving for technological efficiencies has long since been part of health care's internal logic. As such, the recent trend towards adopting mobile health tracking technology must be understood within the wider economics of care, which tend towards streamlining structures, systems, and resources. Increasingly, governments and health agencies treat mHealth as a way to deliver a more efficient and effective healthcare system. For example, in 2014, the British Government's vision statement for transforming health care in the face of a growing budget deficit announces that it will develop an 'expanding set of NHS accredited health apps that patients will be able to use to organise and manage their own health and care' (NHS England, 2014, p. 32). For the UK, it is perhaps the clearest indication of how the mobile device ecosystem will become a bigger part of how health care is managed. The rising appeal of digital health solutions to influence individual behaviours is therefore rationalized 'against the backdrop of contemporary public health challenges that include increasing costs, worsening outcomes, "diabesity" epidemics, and anticipated physician shortages' (Swan, 2012, p. 93). Policy investments in digital health care are justified based on their ability to deliver greater efficiency of overburdened healthcare systems. In terms of how health care is practiced, it therefore reflects a 'logic of choice' (Mol, 2008) whereby the concept of the patient as a customer or citizen emerges, along with the instrumental aspirations of digital interventions that transfer responsibility away from the state and onto the individual, an approach which, as many of the studies below indicate, aligns with neoliberal health perspectives. …

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