This article, titled “Digital health: A sociomaterial approach” by Benjamin Marent and Flis Henwood, published in Sociology of Health & Illness in 2023, addresses the often vague and strategically used notion of “digital health”. The authors aim to develop an analytical understanding of digital health to better comprehend the ongoing transformations in healthcare.
The article’s core contributions include:
- A Sociomaterial Approach to Digital Health: The paper advocates for a sociomaterial approach to digital health, which refuses to see matter as an innate property of technologies. Instead, it explores how technologies “come to matter and generate possibilities through their enactment in practices”. This approach is deeply informed by Karen Barad’s agential realism, which recognizes the entanglement of non-human and human elements in the constitution of phenomena like digital health. From this perspective, identities and properties of entities like health apps and patients are not pre-existing but materialize through dynamic “intra-actions”.
- Three Key Foci for Understanding Digital Transformation: The authors detail how digitalization impacts health and medicine by presenting three interrelated challenges and their corresponding reconfigurations:
- Quantification: Reconfigurations of knowledge: This refers to the processes of translating analogue materiality into digital data, often seen in data-intensive medicine. The article highlights how data are not neutral but are contingent and brought into being through situated practices, affecting how knowledge is created and understood. An example is the emergence of “in silico vision” in reproductive medicine, where algorithms predict embryo viability, creating an alternative mode of authorized seeing and impacting the conceptualization of prenatal life. This shift also leads to new “digital health citizenship” responsibilities for individuals, including data input, sharing experiential knowledge, and even donating data for research.
- Connectivity: Reconfigurations of relationships: This focuses on how digital materialities entangle in practices of connectivity, such as telemedicine and eHealth. Digital connectivity, especially amplified during the COVID-19 pandemic, reconfigures traditional notions of copresence in healthcare. Studies, like those on HIV care platforms, show that digitized connectivity can evoke ambivalent feelings, blurring closeness and privacy, and creating new forms of “distance-presence”. It also involves new forms of invisible work for both providers and users, redefining roles and responsibilities.
- Instantaneity: Reconfigurations of control: This explores how digital materialities are entangled in the temporality of practice and new forms of control, driven by advances in microchips and algorithms. The article discusses how instantaneous calculation leads to distributed and ambiguous forms of control, as seen in self-tracking for chronic diseases. An ethnographic study in physical rehabilitation shows how algorithmic authority is negotiated and sometimes “broken down in use,” demonstrating that agency arises from associations between social and material actants rather than the algorithm alone. This necessitates new modes of accountability, moving beyond mere transparency or bias identification.
- Three Innovative Strategies for Digital Health Innovation: The authors propose three interconnected strategies to guide digital health research and innovation, embedding Karen Barad’s concept of agential cuts:
- Participation: Recognizing that ontologies are heterogeneous and contingent, this strategy emphasizes deliberative and collaborative processes in developing digital health interventions and policies. It calls for engaging with multiple publics to continually review imaginaries, aims, and consequences, embracing ambivalences and uncertainties inherent in participatory processes.
- Affordances: This strategy challenges technology-centric views by focusing on the relational structure between technological features, embedding environments, and participants. It allows for understanding how technologies materialize differently in various use contexts, leading to diverse outcomes and shedding light on societal implications like empowerment and equity.
- Generativity: This concept highlights that digital health boundaries are not fixed but are enacted in practices. Digital technologies are seen as “epistemic things” that are continuously unfolding, acquiring new properties, and combining presence and absence. This strategy requires ongoing engagement with design and use practices, recognizing that technologies constantly require fixes and updates alongside sociocultural developments.
Ultimately, the article aims to lay the foundation to reorient and sensitize innovation and care processes to create new possibilities and value-centric approaches for promoting health in digital societies, rather than simply promoting digital health for its own sake.
Reference: Marent, B., & Henwood, F. (2023). Digital health: A sociomaterial approach. Sociology of Health & Illness, 45(1), 37–53. https://doi.org/10.1111/1467-9566.13538.
