Tag Archives: digital health

My publications for 2022

Authored books

  • Lupton, D. (2022) COVID Societies: Theorising the Coronavirus Crisis. Abingdon: Routledge.

Edited books

  • Lupton, D. and Leahy, D. (eds) (2022) Creative Approaches to Health Education: New Ways of Thinking, Making, Doing, Teaching and Learning. Abingdon: Routledge.
  • Pink, S., Berg, M., Lupton, D. and Ruckenstein, M. (eds) (2022) Everyday Automation: Experiencing and Anticipating Emerging Technologies. Abingdon: Routledge.

Book chapters

  • Lupton, D. (2022) The sociology of mobile apps. In Rohlinger, D. and Sobieraj, S. (eds), The Oxford Handbook of Sociology and Digital Media. New York: Oxford, pp. 197-218.
  • Lupton, D. and Leahy, D. (2022) Thinking, making, doing, teaching and learning: bringing creative methods into health education. In Lupton, D. and Leahy, D. (eds), Creative Approaches to Health Education: New Ways of Thinking, Making, Doing, Teaching and Learning. Abingdon: Routledge.
  • Lupton, D. (2022) Data: the futures of personal data. In The Routledge Handbook of Social Futures. London: Routledge, pp. 117-125.
  • Lupton, D. (2022) Digital health. In Monaghan, L. and Gabe, J. (eds), Key Concepts in Medical Sociology, 3rd edition. London: Sage, pp. 241-246.
  • Lupton, D. (2022) The sociomaterial nature of the body and medicine. In Scrimshaw, S., Lane, S., Rubenstein, R. and Fisher, J. (eds), Handbook of Social Studies in Health and Medicine, 2nd edition. Thousand Oaks, California: Sage, pp. 103-121.
  • Lupton, D. and Southerton, C. (2022) Beyond ‘wicked Facebook’: a vital materialism perspective. Emotional Landscapes, Dystopia and Future Imaginaries. In McKenzie, J. and Patulny, R. (eds). Bristol: Bristol University Press, pp. 34-51.
  • Lupton, D., Clare, M. and Southerton, C. (2022) Digitized and datafied embodiment: a more-than-human approach. In The Palgrave Handbook of Critical Posthumanism, edited by Herbrechter, S., Callus, I., Rossini, M., Grech, M., de Bruin-Molé, M. and Müller, C.J. Houndmills: Palgrave, pp. 1-23.
  • Pink, S., Ruckenstein, M., Berg, M. and Lupton, D. (2022) Everyday automation: setting a research agenda. In Pink, S., Berg, M., Lupton, D. and Ruckenstein, M. (eds), Everyday Automation: Experiencing and Anticipating Emerging Technologies. Abingdon: Routledge, pp. 1-19.
  • Lupton, D. (2022) The quantified pandemic: digitised surveillance, containment and care in response to the COVID-19 crisis. In Pink, S., Berg, M., Lupton, D. and Ruckenstein, M. (eds), Everyday Automation: Experiencing and Anticipating Emerging Technologies. Abingdon: Routledge, pp. 59-72.
  • Southerton, C., Clark, M., Watson, A. and Lupton, D. (2022) The futures of qualitative research in the COVID-19 era: experimenting with creative and digital methods. In Matthewman, S. (ed), A Research Agenda for COVID-19 and Society. Cheltenham: Edward Elgar, pp. 155-174.
  • Lupton, D. (2022) Health zines: hand-made and heart-felt. In The Routledge Handbook of Health and the Media, edited by Lester Friedman and Therese Jones. New York: Routledge.

Peer-reviewed journal articles

  • Lupton, D. and Lewis, S. (2022) ‘The day everything changed’: Australians’ COVID-19 risk narratives. Journal of Risk Research, 25(10), 1147-1160.
  • Lupton, D. (2022) ‘Next generation PE?’ A sociomaterial approach to digitised health and physical education. Sport, Education and Society, 27(5), 516-528.
  • Lupton, D. and Lewis, D. (2022) Coping with COVID-19: the sociomaterial dimensions of living with pre-existing mental health illness during the early stages of the coronavirus crisis. Emotion, Space & Society, 42. https://doi.org/10.1016/j.emospa.2021.100860
  • Lupton, D. and Lewis, S. (2022) Sociomaterialities of health, risk and care during COVID-19: experiences of Australians living with a medical condition. Social Science & Medicine, 293.  https://doi.org/10.1016/j.socscimed.2021.114669 
  • Baraitser, P. and Lupton, D. (2022) Photodiagnosis of genital herpes and warts: a sociomaterial perspective on users’ experiences of online sexual health care. Culture, Health and Sexuality, online first.
  • Watson, A. and Lupton, D. (2022) Remote fieldwork in homes during the COVID-19 pandemic: video-call ethnography and map drawing methods. International Journal of Qualitative Methods, 21. https://doi.org/10.1080/1472586X.2022.2043774
  • Watson, A., Lupton, D. and Michael, M. (2022) The presence and perceptibility of personal digital data: findings from a participant map drawing method. Visual Studies, online first.
  • Watson, A. and Lupton, D. (2022) ‘What happens next? Using the story completion method to surface the affects and materialities of digital privacy dilemmas. Sociological Research Online, 27(3), 690-706.
  • Lupton, D. and Watson, A. (2022) Research-creations for speculating about digitised automation: bringing creative writing prompts and vital materialism into the sociology of futures. Qualitative Inquiry, 28(7), 754-766.
  • Lupton, D. (2022) Understandings and practices related to risk, immunity and vaccination during the Delta variant COVID-19 outbreak in Australia: an interview study. Vaccine: X, 11. https://doi.org/10.1016/j.jvacx.2022.100183
  • Clark, M. and Lupton, D. (2022) App stories: how mobile apps come to matter in everyday life. Online Information Review, online first. 
  • Rich, E. and Lupton, D. (2022) How sociomaterial relations shape English secondary students’ digital health practices: beyond the promissory imaginaries. Social Science & Medicine, 311. https://doi.org/10.1016/j.socscimed.2022.115348
  • Lupton, D. From human-centric digital health to digital One Health: crucial new directions for planetary health. Digital Health, 8. https://doi.org/10.1177/20552076221129103
  • Lupton, D. (2022) Socio-spatialities and affective atmospheres of COVID-19: a visual essay. Thesis Eleven, 171(1), 36-65.

Arguing on Facebook about COVID: a case study of key beliefs, rationales and strategies

Throughout the COVID-19 crisis, social media platforms have become well-known for both disseminating misinformation and conspiracy theories as well as acting as valuable information sources concerning the novel coronavirus and governments’ efforts to manage and contain COVID. Facebook in particular – the world’s most popular social media site – has been singled out as a key platform for naysayers such as anti-vaccination exponents and ‘sovereign citizens’ to express their resentment at containment measures such as lockdowns, quarantine and self-isolation regulations, vaccination mandates and face-covering rules.

What rationales and beliefs underpin these arguments? How and to what extent are they contested or debated on Facebook? What rhetorical strategies are employed by commentators to attempt to persuade others that their views/facts are correct?

To explore these questions, I chose a case study of a short video (2 minutes 5 seconds long) shared by the World Health Organization (WHO) on Facebook on 19 February 2022. I came across the video three days after it was published on the platform as part of my routine Facebook use. It turned up in my feed because a Facebook friend of mine had shared it (which it how the average Facebook user is presented with content from organisations like WHO if they don’t follow these accounts themselves.) I noticed how much engagement this post had received in those three days. There were 6,000 reactions: including 5k likes but also 551 laughing face emojis (suggesting viewers found the video content risible), 1.2k comments, 2.2k shares and 244k views. I decided to delve into the comments thread to see what people were saying in response to the video.

WHO’s official Facebook page has a huge follower base: at the time that I viewed this video, their page listed over 14 million likes and over 38 million followers. It is clearly a highly trusted Facebook presence. Many of its posts have thousands of reactions (the use of emojis to respond to posts), likes, comments and shares. WHO shares content at least once a day and often more frequently: most of this content is made by WHO itself in its role to communicate preventive health messages globally. In reviewing their latest content, it is evident that WHO has a very busy and accomplished team making their social media content.

The video featured two WHO experts: Dr Mike Ryan (pictured above from the opening section of the video) and Dr Maria Van Kerkhove, both of whom feature regularly in WHO’s social media content. Ryan was introduced in a caption as ‘ED, WHO Health Emergencies Programme’ and Van Kerkhove as ‘COVID-19 technical lead, WHO Health Emergencies Programme’.

In this video, both people spoke to camera as if to an unseen interviewer, explaining why they were concerned about governments beginning to loosen COVID restrictions too quickly.

The written introduction to the video stated:

Some countries are lifting all public health and social measures despite high numbers of COVID-19 cases/deaths. Dr Mike Ryan and Dr Maria Van Kerkhove explain why a slow approach is better.

Ryan and Van Kerkhove went on to use simple English to acknowledge that there is a strong desire on the part of governments and citizens to ‘open up’ and remove all COVID restrictions and ‘go back to normal’. They warn, however, that such actions could lead to the pandemic continuing ‘much longer than it needs to be’ due to ‘the political pressure to open up’ in ‘some situations’, and that replacing abandoned control measures would be difficult if a new variant emerged. Ryan and Van Kerkhove emphasise the importance of ‘a slow, step-wise approach’ to lifting COVID restrictions rather than an ‘all-or-nothing approach’ that ‘many countries’ are adopting at this point in the COVID crisis.

Both speakers are careful not to single out individual leaders or governments for criticism in these quite vague statements, leaving it up to the viewer to make a judgement about exactly to which ‘situation’ they are referring. These experts also ‘acknowledge uncertainty’ and that their concerns may be unfounded but emphasise the need for caution. They note that they do not ‘blame anyone’ for feeling confused, given the continual flux in governments’ COVID measures. Van Kerkhove ends by stating firmly that ‘you [the video viewers] have control over this’ regardless of government actions and then Ryan chimes in by asking ‘every individual just to look at your situation’ and ‘be smart, protect yourself, protect others, get vaccinated and just be safe and careful’.

There’s a lot that could be said about the statements made by these two WHO experts in this video: the veiled critique of ‘many countries” government actions and health communication efforts, the focus on individual responsibility in the face of government inaction and lack of responsibility. But I wanted to direct my attention to the more than 1,000 comments Facebook users wrote in response to this video.

I noticed first that comments came from all over the world – evidence again of the global reach and popularity of Facebook. When commentors were responding to each other, therefore, there were many examples of someone in Asia, South America or Africa engaging with Facebook users located in the USA, Australia, Canada, Europe or the UK.

Another observation was that a vigorous debate was occurring in the comments section, with supporters of the video’s messages seeking to argue with those who decried what they saw as an overly cautious or even unscientific argument from the WHO experts. Those who did not support the WHO’s points made such arguments as (my paraphrasing):

  • opening up will help the economy – people need jobs
  • people’s lives need to get back to ‘normal’
  • most populations are now adequately vaccinated, so there is no need for further restrictions
  • governments are lying to their citizens and spreading false information as a way of exerting greater control over them
  • the novel coronavirus does not exist and nor does COVID
  • it is risk to one’s health to wear masks for prolonged periods of time
  • other health conditions kill more people than COVID
  • COVID mass testing and mass vaccination have been conducted as a profit-making enterprise serving Big Pharma and governments
  • WHO’s facts are wrong and they are spreading lies and fear, trying to promote their own interests for political purposes
  • WHO has shown little leadership during the pandemic and is ineffectual
  • face masks give a false sense of security and are useless as a preventive measure
  • people who follow government restrictions are being controlled and can’t think for themselves
  • the pandemic has been going on for two years and governments and health agencies like WHO are still not controlling it adequately
  • the person commenting does not like to feel forced to do anything by government authorities, especially if restrictions/mandates do not help the situation (in their view) – ‘my body, my choice’
  • even vaccinated people can still become infected with or transmit the coronavirus, fall ill or die of COVID – they are therefore pointless
  • COVID is ‘real’ but controllable like influenza or no worse than the common cold
  • governments who continue to impose restrictions/mandates are ‘Socialist’
  • people’s immune systems can be strengthened without vaccines due to basic health promoting strategies
  • people are dying from being given too many COVID vaccines (including children), not from the disease itself
  • vaccines are ‘bioweapons’
  • the medical establishment and the government are forcing COVID vaccines on people and hiding evidence of their serious side-effects
  • there is a difference between ‘dying with COVID’ and ‘dying from COVID’ – governments and health agencies are deliberately obscuring this
  • people need to be freed from living in fear
  • scientists and medical experts are controlled by governments to serve political agendas
  • ‘commonsense’ practices such as eating a healthy diet, taking Vitamin D and washing hands regularly will adequately protect against COVID

People who supported the points made by the WHO experts in the video tended to be reactive in their comments, responding to the naysayers using such rationales as:

  • COVID is a real threat and has killed many people – we still need to be cautious to protect ourselves and others
  • even though the situation seems to be improving in many countries, new variants could emerge that could pose major challenges
  • scientific and medical knowledge and expertise should be trusted over other information sources
  • many people are still dying
  • opening up too quickly will lead to many more deaths globally
  • vaccines do protect against serious disease and death and everyone should accept them: the benefits outweigh any risk
  • face masks are important protective agents against infection (just as shoes, for example, protect against foot injuries)
  • people who don’t want to conform to COVID restrictions/mandates are being selfish and don’t understand the importance of self-sacrifice to protect others
  • wearing face masks and getting vaccinated are small sacrifices to make for the greater good and saving others’ lives as well as self-protection
  • economies are damaged if too many workers become ill from COVID and can’t go to work
  • the person commenting still feels at high risk from COVID and is happy to continue to engage in preventive measures such as wearing masks and accepting vaccination
  • young children have not yet been protected by COVID vaccination in many countries and therefore are vulnerable to infection
  • mass vaccination programs have worked well globally to protect people against other serious diseases, such as polio
  • people who support dropping all restrictions are engaging in magical thinking or do not want to face reality
  • low income countries do not have enough medical support to help people who become ill with COVID
  • countries should work together in a global response to COVID rather than simply pursing nationalistic interests

Rhetorical strategies on the part of both ‘sides’ of the argument included:

  • giving examples from their own lives/health (e.g. they had avoided COVID because of wearing face masks and getting vaccinated or they avoided COVID because their immune systems were naturally strong and not weakened by vaccines)
  • describing the situations of people they knew personally (e.g. those who died from COVID vaccines or those who died because they refused COVID vaccines)
  • urging people to ‘do their research’ or ‘due diligence’ and not just rely on television, social media or what their friends tell them
  • accusing those who are disagreeing with them of ‘lying’, ‘making up facts to suit their agenda’, as ‘stupid’ or simply gullible (to either misinformation or in believing the science)
  • providing hyperlinks to articles or blog posts outside of Facebook to support their claims and urging others to read them as part of educating themselves about the ‘facts’
  • claiming ‘truth’ in response to ‘non-truths’, ‘lies’ or ‘fake news’
  • contrasting the value of all human lives versus the value of individual freedom
  • the use of large numbers to support the validity of the arguments

As just one example of a pithy exchange between two commentators:

Commentator 1: We can’t stop living.

Commentator 2: 900,000 Americans have.

These findings demonstrate the kinds of beliefs and rationales underpinning Facebook users’ concepts of COVID risk and their attitudes towards COVID restrictions. Both sides received ardent support from others. Comments sometime descended into ad hominem attacks but most of the content was focused on presenting opinions or ‘facts’ and responding to these arguments with counter-claims. Most of the commentators attempted to act as educators, challenging the misinformation or extreme views put forward by the naysayers. Emotions ran high as people defended their position or accused others of stupidity, blindness to the truth or making up facts. Some extreme misinformation positions and conspiracy theories were advanced (e.g. ‘the holy blood of Jesus Christ is our only protection’) but many arguments concerned topics such as whether vaccines were necessary or effective (and how many there should be) or raised issues around the politics of COVID control.

The main insight from this single case study of COVID commentary in response to a peak health agency’s video posted to Facebook is that there was little evidence of an echo-chamber or filter bubble where only one main viewpoint was put foward. Instead, vigorous debate and contestation about ‘the truth’ went on in the comments section, suggesting an open forum for many opinions to be aired. However, it was also clear that people’s opinions or beliefs were not challenged in and through the debates or comments. Despite all the argumentation and presenting of examples from personal experience or hyperlinks to other material, no consensus or acceptance of other people’s opposing views was evident in these comment threads.

My 2021 publications

Books

Lupton, D., Southerton, C., Clark, M. and Watson, A. (2021) The Face Mask in COVID Times: A Sociocultural Analysis. Berlin: De Gruyter.

Edited books and special issues

Lupton, D. and Willis, K. (eds) (2021) The COVID-19 Crisis: Social Perspectives. Abingdon: Routledge.

‘In and beyond the smart home’ special issue. Convergence (volume 27, issue 5), 2021.

Journal articles

Lupton, D. (2021) Young people’s use of digital health in the Global North: narrative review. Journal of Medical Internet Research, available online at https://www.jmir.org/2021/1/e18286/

Lupton, D. and Southerton, C. (2021) The thing-power of the Facebook assemblage: why do users stay on the platform? Journal of Sociology, 57(4), 969-985.

Lupton, D. (2021) ‘Not the real me’: social imaginaries of personal data profiling. Cultural Sociology, 15(1), 3-21.

Watson, A. and Lupton, D. (2021) Tactics, affects and agencies in digital privacy narratives: a story completion study. Online Information Review, 45(1), 138-156.

Watson, A., Lupton, D. and Michael, M. (2021) Enacting intimacy and sociality at a distance in the COVID-19 crisis: the sociomaterialities of home-based communication technologies. Media International Australia, 178(1), 136-150.

Lupton, D. (2021) ‘Things that matter’: poetic inquiry and more-than-human health literacy. Qualitative Research in Sport, Exercise and Health, 13(2), 267-282.

Lupton, D. (2021) ‘The internet both reassures and terrifies’: exploring the more-than-human worlds of health information using the story completion method. Medical Humanities, 47(1), 68-77.

Lupton, D. (2021) ‘Next generation PE?’ A sociomaterial approach to digitised health and physical education. Sport, Education and Society, online first doi.org/10.1080/13573322.2021.1890570

Lupton, D. (2021) ‘Sharing is caring’: Australian self-trackers’ concepts and practices of personal data sharing and privacy. Frontiers in Digital Health, 3(15). Available online at https://www.frontiersin.org/articles/10.3389/fdgth.2021.649275/full

Lupton, D. and Lewis, S. (2021) Learning about COVID-19: a qualitative interview study of Australians’ use of information sources. BMC Public Health, available online at https://doi.org/10.1186/s12889-021-10743-7

Lupton, D. (2021) ‘Honestly no, I’ve never looked at it’: teachers’ understandings and practices related to students’ personal data in digitised health and physical education. Learning, Media and Technology, 46(3), 281-293Hjorth, L. and Lupton, D. (2021) Digitised caring intimacies: more-than-human intergenerational care in Japan. International Journal of Cultural Studies, 24(4), 584-602.

Lupton, D. and Watson, A. (2021) Towards more-than-human digital data studies: developing research-creation methods. Qualitative Research, 21(4), 463-480.

Watson, A., Lupton, D. and Michael, M. (2021) The COVID digital home assemblage: transforming the home into a work space during the crisis. Convergence, 27(5), 1207-1221.

Downing, L., Marriott, H. and Lupton, D. (2021) ‘Ninja levels of focus’: therapeutic holding environments and the affective atmospheres of telepsychology during the COVID-19 pandemic. Emotion, Space & Society, 40. Available online at https://doi.org/10.1016/j.emospa.2021.100824

Lupton, D. and Lewis, S. (2021) ‘The day everything changed’: Australians’ COVID-19 risk narratives. Journal of Risk Research, online first, doi.org/10.1080/13669877.2021.1958045

Clark, M. and Lupton, D. (2021) Pandemic fitness assemblages: the sociomaterialities and affective dimensions of exercising at home during the COVID-19 crisis. Convergence, 27(5), 1222-1237.

The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world. Kickbusch, I., Piselli, D., Agrawal, A., Balicer, R., Banner, O., Adelhardt, M., Capobianco, E., Fabian, C., Singh Gill, A., Lupton, D., Medhora, R. P., Ndili, N., Ryś, A., Sambuli, N., Settle, D., Swaminathan, S., Morales, J. V., Wolpert, M., Wyckoff, A. W., Xue, L., Bytyqi, A., Franz, C., Gray, W., Holly, L., Neumann, M., Panda, L., Smith, R. D., Georges Stevens, E. A., & Wong, B. L. H. (2021) The Lancet and Financial Times Commission on governing health futures 2030: growing up in a digital world. The Lancet. Available online at https://www.sciencedirect.com/science/article/pii/S0140673621018249

Lupton, D. (2021) ‘All at the tap of a button’: mapping the food app landscape. European Journal of Cultural Studies, 24(6), 1360-1381.

Petrie, K., Deady, M., Lupton, D., Crawford, J., Boydell, K. and Harvey. S. (2021) ‘The hardest job I’ve ever done’: a qualitative exploration of the factors affecting junior doctors’ mental health and wellbeing during medical training in Australia. BMC Health Services. Available online at https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-07381-5

Book chapters

Lupton, D. (2021) Self-tracking. In Kennerly, M., Frederick, S. and Abel, J.E. (eds), Information: Keywords. Columbia University Press, pp, 187-198.

Lupton, D. (2021) Afterword: future methods for digital food studies. In Leer, J. and Krogager, S.G.S. (eds), Research Methods in Digital Food Studies. Abingdon: Routledge, pp. 222-227.

Lupton, D. and Willis, K. (2021) COVID Society: introduction to the book. In Lupton, D. and Willis, K. (eds), The COVID-19 Crisis: Social Perspectives. Abingdon: Routledge, pp. 3-13.

Lupton, D. (2021) Contextualising COVID-19. In Lupton, D. and Willis, K. (eds), The COVID-19 Crisis: Social Perspectives. Abingdon: Routledge, pp. 14-24.

Other publications

Lupton, D., Pink, S. and Horst, H. (2021) Living in, with and beyond the ‘smart home’: introduction to the special issue. Convergence, 27(5), 1147-1154.

Watson, A., Clark, M., Southerton, C. and Lupton, D. (2021) Fieldwork at your fingertips: creative methods for social research under lockdown. Nature Career Column, 3 March 2021. Available at https://www.nature.com/articles/d41586-021-00566-2

Lupton, D., Pink, S. and Horst, H. (2021) Living in, with and beyond the ‘smart home’: introduction to the special issue. Convergence, 27(5), 1147-1154.

Digitised quarantine: a new form of health dataveillance

isolation

Most social analyses of the use of personal health data for dataveillance (watching and monitoring people using information gathered about them) have largely focused on people who engage in voluntary self-tracking to promote or manage their health and fitness. With the outbreak of COVID-19 (novel coronavirus), a new form of health dataveillance has emerged. I call it ‘digitised quarantine’.

Traditional quarantine measures, involving the physical isolation of people deemed to be infected with a contagious illness or those who have had close contact with infected people, have been employed for centuries as a disease control measure. Histories of medicine and public health outline that quarantine (from the Italian for ’40 days’ – often the length of the isolation period) was practised as early as the 14th century as a way of protecting people living in European coastal cities from the plague brought by visiting ships.

With the advent of COVID-19, quarantine has been actively used in many of the locations that have experienced large numbers of cases. Millions of people have already been placed in isolation. Quarantine measures have included self-isolation, involving people keeping themselves at home for the required 14-day period, as well as imposed isolation, such as requiring people to stay in dedicated quarantine stations, and large-scale travel bans and lock-downs of whole large cities. Quarantine began with lock-downs of Wuhan and nearby cities in the Chinese province of Hubei. At the time of writing, cases have been discovered in many other countries, often with identified hot-spots of contagion around identifiable places and regions, including a South Korean church, a north Italian region and a cruise ship docked in Japan.

Side-by-side with these centuries-old measures, in some locations, digital technologies and digital data analytics have been taken up as ways of monitoring people, identifying those who are infected and tracking their movements to ensure that they adhere to self-isolation restrictions for the length of the quarantine period. In China, people were prevented from leaving their homes if they had been identified as infected with COVID-19 by a digitised rating system on a phone app that coded them ‘red’. Chinese government agencies also released a ‘close contact detector’ app that alerted people if they had been in close proximity to someone infected with the virus. In some Chinese cities, local government authorities have brought in monitoring measures using facial recognition data and smartphone data tracking combined with information derived by requesting people to enter details about their health and travel history into online forms when visiting public places.

It is not only Chinese authorities who are experimenting with digitised forms of identifying infection risk and enforcing isolation. In the Australian city of Adelaide, two people identified as having COVID-19 were placed under voluntary home isolation, their movements monitored by the police using their smartphone metadata. It is notable that the police emphasised that this is the same dataveillance system used for tracking offenders in criminal investigations. As is the case with traditional quarantine measures, the freedoms and autonomy of those deemed to be infected or at risk of infection are in tension with public health goals to control epidemics.  The types of digitised monitoring of people’s movements using their smartphones or enforced notifications to complete online questionnaires are redolent of the measures that are used in the criminal justice system, where employing electronic monitoring technologies such as digital tracking bands has been a feature of controlling offenders’ movements once released from a custodial sentence.

These resonances with law enforcement should perhaps not be surprising, given that public health acts in many countries allow for the enforced isolation or even imposing significant fines or incarceration of people deemed to pose a risk to others because they are infectious or identified as being in a high-risk category of transmitting disease. There is a recent history of countries such as Singapore using technologies such as surveillance cameras and electronic tags for controlling the spread of SARS in 2003. These practices have been called into question by scholars interested in investigating the implications for human rights.

Since then, the opportunities to conduct close monitoring of people using their smartphones and online interactions have vastly expanded. The use of detailed data sets generated from diverse sources in these novel digitised quarantine measures leads to a range of new human rights challenges. Such monitoring may be viewed as a ‘soft’ form of policing infection, in which physical isolation measures are combined with dataveillance. However, underlying the apparent convenience offered by digitised quarantine are significant failures. One difficulty is the potential for the data sets and algorithmic processing used to calculate COVID-19 infection risk to be inaccurate, unfairly confining people to isolation and allowing them no opportunity to challenge the decision made by the app. Examples of such inaccuracies have already been reported by Chinese citizens subjected to these measures.  As one man claimed: “I felt I was at the mercy of big data,” … “I couldn’t go anywhere. There’s no one I could turn to for help, except answer bots.”

At a broader level, another problem raised by digitised quarantine measures is the ever-expanding reach into people’s private lives and movements by health authorities and other government agencies that they portend. This function creep requires sustained examination for its implications for human rights. The data-utopian visions promoted by those seeking to impose digitised quarantine may well lead to data hubris when their inaccuracies, biases and injustices are exposed.

Acknowledgement: Thanks to Trent Yarby for alerting me to two of the news stories upon which I drew for this post.

My 2019 publications

Books

Reports

Lupton, D. (2019) The Australian Woman and Digital Health Project: Comprehensive Report of Findings. Canberra: News & Media Research Centre.

Book chapters

  • Lupton, D. (2019) Vitalities and visceralities: alternative body/food politics in digital media. In Phillipov, M. and Kirkwood, K. (eds), Alternative Food Politics: From the Margins to the Mainstream. Routledge: London, pp. 151-168.
  • Lupton, D. (2019) Digital sociology. In Germov, J. and Poole, M. (eds), Public Sociology: An Introduction to Australian Society, 4th St Leonards: Allen & Unwin., pp. 475-492.

Journal articles

In-conversation about digital health and Data Selves

In June 2019, I took part in an ‘in conversation’ event at King’s College London, organised by the Social Science & Urban Public Health Institute. The conversation was transcribed and published on the Institute’s website. They have kindly given permission for me to repost the content here. Thank you to Benjamin Henckel and Shayda Kashef for their work on this event and the post.

On 13th June 2019 the Social Science & Urban Public Health Institute (SUPHI) at King’s College London hosted a special in-conversation event with Professor Deborah Lupton. During the event Professor Lupton discussed her forthcoming book Data Selves, and reflected on the role that digital technologies are playing in the urban public health landscape.

Below is an edited version of the transcript from the event. Special thanks to sponsor, PLuS Alliance.

By Benjamin Hanckel and Shayda Kashef

What is digital health and where do you see the field at now?

Digital health is  a  short, snappy title to refer to the huge range of digital technologies that are used to apply to health, right through from older technologies such as websites, search engines, online discussion forums, through to things like 3D printing of body parts and apps and all those kinds of digital technologies that are quite new on the scene. So I think digital health for me encompasses that diverse range of ways that certain forms of healthcare and health communication can be digitised. And given that there are more and more of these technologies emerging, there’s never something I have to wonder writing about because there’s always something new on the horizon and it’s really interesting to  trace their trajectory and find how older technologies are often forgotten about. Google search is probably the number one most highly used digital health technology because people use it as a form of self-triage, and it’s interesting to me how those older technologies are often forgotten about in the rush and the excitement of the social imaginaries that represent newer technologies, such as apps and wearable devices, which is the brave new world of healthcare. People are often still getting much more value from websites and online discussion forums, for example, than they are getting from health apps.

Putting this in the context of your current work, can you tell us about the Vitalities Lab you set up at the University of New South Wales and how it relates to digital health?

I’ve been building on my previous interest in Foucauldian theory now to incorporate some perspectives from new materialisms and particularly feminist new materialisms and vital materialisms, as there’s an overlap between those two materialisms but they aren’t the same thing. I’ve only been at the University of New South Wales for four months but as part of my appointment I was encouraged to set up a research team. The name Vitalities is meant to denote the kinds of directions and interests that I have at the moment. So to begin with I’ve been writing a lot about ‘lively data’ over the past few years and that means people’s personal data and about the digital data economy and how digital data about people take on value. They are lively because people engage with data about their bodies and themselves in ways that synergistically change their own lives, they may respond to their own data and change aspects of their lives based on what their data are telling them. So that’s the notion of lively data.

Vital materialism gets back to that idea of vitalities as well. So, some of the feminist new materialism scholarship that I’ve been engaging with, particularly the work of  Karen Barad, Jane Bennett, Donna Haraway and Rosi Braidotti, talk a lot about capacities and affective forces, and how they are generated through interactions that people have with other humans and with non-human actors. It’s very much this idea that there are capacities that are generated when people come together with other people, with non-humans, which I’m trying to explore in my recent research, of course within particular digital technologies, how people engage with their digital devices but also their data to generate new capacities. So that gets back to that vitality as well, there are these capacities constantly being generated and reformed and reconfigured with and through devices and data.

Can you expand on how ‘vitalities’ might contribute to new ways of thinking about methods and methodological enquiry?

In terms of theoretical methods, there’s a sort of emerging approach to qualitative empirical research, post-qualitative inquiry, that I’ve also found really interesting to work with lately. And there’s a very strong overlap of post-qualitative inquiry with more than human theory, because post-qualitative inquiry sees research as always being a research assemblage, as always being partially emergent and sort of going away from the very positivist approach to qualitative approaches which have dominated a lot of health related qualitative enquiry of late. Every type of research is always a research assemblage: the researcher is always part of the data that they generate. So that’s where post-qualitative research departs from the more positivist approach to qualitative research. It’s interesting how the more than human theory is now being brought into research methods: and that’s what I’m trying to do with the kind of work that I’m doing recently, when I’m writing up my own empirical research and analysing it to bring in post-qualitative perspectives as well as the more than human theory that I’m trying to think with when I’m generating concepts that I’m using to analyse my empirical data. So the empirical data might include traditional forms of data such as interview transcripts, or focus group transcripts, but with post-qualitative methods they often now include arts-based materials, drawings, storyboards that people might have made in workshops. I’ve been experimenting with a method called story completion recently, which involves people finishing stories that we start for them and then inviting them to create the narrative, which is another form of research material that I think can be quite interesting to use as a way of understanding people’s experiences. So that’s been a really new method that I’ve been experimenting with as another way of accessing people’s feelings and experiences in ways that they themselves might find hard to articulate if we’re just asking them in an interview to articulate. Because often they’re such mundane experiences for people that coming at it from a more oblique way or a more sort of creative way can be an interesting way to access those kinds of experiences and fears.

Can you expand on how you have engaged with some of these themes in your most recent work, and in particular in your forthcoming book Data Selves? 

Data Selves covers what I call ‘living data’ and it gets back to the lively data I was talking about earlier, but also how people live with and through and alongside their personal data. In Data SelvesI’m really trying to expand on feminist new materialism, human data assemblages ideas, and I argue that people’s personal data are often represented in dematerialised and depersonalised ways, such as when we talk about the big data phenomenon, the data tsunami and being overwhelmed by data. And we often forget that not all data that are generated by, for example smart cities or by any other form of data generation, are about non-humans. But a lot of those data are about actual humans, about their lives, about their bodily practices and habits and routines.

With Data Selves, as the title suggests, I wanted to bring in that more than human, non-human aspect and to understand data human assemblages as all human assemblages, and bring in that humanity and re-humanise this core data. And for me that raises a different form of ethics around those data. I’m arguing that we should think of personal data in similar ways, as sort of embodied, human, not fleshy but they’re kind of about our flesh, that sort of ambiguous ontology. So I would argue that we need to think of them in certain ways like we think of other body parts and other body attributes that people donate or give or sell in some situations as very much human remains, and I’m arguing that that’s how we should treat people’s personal data, and that raises questions about the ethics of how other people might use those data and seek to profit from those data.

In the book I draw on a few of my empirical research projects, which do talk about people, about how they engage with and make sense of their data, and I’m arguing that we need to understand people’s engagements with their data as very often infused with affect, vulnerabilities, multi-sensory engagement. So there’s actually a chapter on what I call materialisations of data, when I talk about social imaginaries of data, the very utopian ideas of data as being very productive and generative, and how people themselves can benefit from their own data. So there’s that very positive representation. Then what’s interesting that over the past few years though, when talking about people’s personal data there’s this very dystopian representation of data that privacy no longer exists. So you’ve got really interesting polar representations of how people’s data can be used in both positive and negative ways.

I did a project which I called the Data Personas Project and that built on the design methods approach, personas. I called it their data persona, or a profile of you that’s made about details about you from your online and app related encounters and engagements. And then I asked people to imagine the futures of their data persona, because I think there’s a lot of interesting and intriguing ways we can think about inviting people to imagine futures, rather than having futures imagined for them, on behalf of them by others. I also asked them how similar or different is your data persona from you? Some people did imagine a dystopian idea whereby nothing is private, you know, the internet knows everything about me, but most people said the internet doesn’t know everything about me, it doesn’t know my internal beliefs and feelings, and so on. So I thought that was really interesting because we also get this discourse in media studies in particular and surveillance studies which is very critical of the idea that people think privacy is dead and they’re not concerned about their privacy, you know, the privacy paradox, so yes, people say “I’m worried about my privacy” but they don’t do anything to actually protect their privacy. But that research that I did using the data persona concept kind of shows that people don’t think that their privacy has been completely taken over by the internet.

There is an ongoing debate about data capture for the common good, versus data capture that is perceived as morally questionable. How might we think about these boundaries?

I try to avoid a really normative approach to these kinds of ethical discussions. The context is everything. And people’s contexts are so variable and unique to them, that’s what really comes out when you look at the ways that people engage with digital technologies and digital data. If you look at the Association of Internet Researchers document on ethics around doing research with online materials, it’s really interesting because they argue that you have to look at the context for each research project. There shouldn’t be hard and fast guidelines about how social research is used when we’re talking about using people’s personal data. More recently, human ethics committees have become far more aware of that, as people might be putting their information out there when they go online, so it’s become a more complicated situation now. It’s not as easy to get ethics approval and you do actually have to argue for why and how you’ll get those people’s consent or if you don’t, why not and so on, so it’s become far more complicated. All I would say is that there needs to be these very detailed, lengthy considerations about the context.

But all those issues around whether people know that you’re accessing their data, to what extent, now there’s the issue now with de-anonymisation too, Because if you know what you’re doing, data harvesters can be really good at de-anonymising data to generate detailed profiles about people.

But even when a decision is made about if it is appropriate to generate these data and what to use people’s data for, because it might improve public health or improve treatment for medical conditions, really strong data privacies and security measures can be leaked or breached or hacked. So you don’t know what the future of those lively data might be, so that’s very difficult.

The event concluded with a brief Q&A session with the audience which covered a range of issues, including:

  • An expansion of the debate about data collection, and how we manage data capture within the context of emerging technologies, and
  • A discussion about the possibilities for technologies to benefit certain people who are marginalised, such as people with disabilities, with Professor Lupton acknowledging that there is more to do in this area.

My publications in 2018

Books

  • Lupton, D. (2018) Fat (revised 2nd edition). London: Routledge.

Book chapters

  • Lupton, D. (2018) Lively data, social fitness and biovalue: the intersections of health self-tracking and social media. In Burgess, J., Marwick, A. and Poell, T. (eds), The Sage Handbook of Social Media. London: Sage, pp. 562-578.
  • Lupton, D. (2018) Digital health and health care. In Scambler, G. (ed), Sociology as Applied to Health and Medicine, 2nd Houndmills: Palgrave, pp. 277-290.
  • Lupton, D. and Smith, GJD. (2018) ‘A much better person’: the agential capacities of self-tracking practices. In Ajana, B. (ed), Metric Culture: Ontologies of Self-Tracking Practices. London: Emerald Publishing, pp. 57-75.
  • Lupton, D. (2018) 3D printing technologies: a third wave perspective. In Michael Filimowicz, M. and Tzankova, V. (eds), New Directions in Third Wave HCI (Volume 1, Technologies). Springer: London, pp. 89-104.

Journal articles

Encyclopedia entry

Findings from the Young Australians and Digital Health Project

Digital technologies for health-related topics and practices such as websites, online discussion forums, social media, content-sharing platforms, mobile apps and wearable devices are now available as a means for young people to learn about and promote their health, physical fitness and wellbeing. Young people are often assumed to be ardent users of digital health technologies by virtue of having been born into the age of new digital media. Thus far, however, few social research studies have directed attention to the details of how and why young people use digital technologies for health-related purposes and how other, non-digital sources also contribute to the ways in which they learn about their bodies and health and engage in practices to support their health and wellbeing.

The Young Australians and Digital Health Project, a qualitative interview-based study of 30 young Australians (aged 16 to 25 years) was designed to address these issues. The participants were recruited to ensure equal numbers of female and male participants and a spread of ages, ethnic backgrounds and geographical locations across Australia. The interviews took place in April-May 2018. Participants were asked a series of questions relating to how and why they sourced health and medical information and support, and which of these they found most and least useful and helpful. They were asked if anyone had recommended that they use digital health technologies and whether they had any concerns about their personal health data privacy and security. The final question had a future-oriented perspective, asking participants to imagine and describe an ideal digital health technology for their everyday needs.

The interview questions and analysis of transcripts of participants’ responses were designed to draw attention to the affordances of the actors involved (human and nonhuman), relational connections between these actors, affective forces and agential capacities. The affordances of fleshly human bodies include their sensory perceptions, emotional responsiveness, embodied expertise, memory and the ability to learn and to move in certain ways. The affordances of nonhuman objects such as digital technologies relate to the design features of these technologies and what they potentially allow people to do with them. Relational connections include the ways in which humans interact with and respond to other humans, as well as with nonhumans, and how these relationships contribute to or generate bonds and affects.

As the table below shows, all participants said that they sought information from doctors and other healthcare providers, and most also turned to advice from friends and family members. Very few young people used books for health information, but pamphlets were still read by around a third of participants (usually picked up in doctors’ surgeries while waiting for a consultation). In terms of digital tools and resources, search engines were used by everyone, with health websites a close second. All the participants said that they were routinely online throughout the day and were accustomed to searching the internet as a habitual practice for various purposes. They generally searched between once or twice a week or once a month for health-related topics.

Youtube, online discussion groups and social media groups were fairly well-used, but by less than half of the participants. Participants noted that these sources were often found from an initial search using Google Search. Only five of the 30 participants said that they had signed up to My Health Record (Australia’s nationwide patient electronic medical record), with the remainder noting that they had not heard of it.

Sources of health and medical information used currently

SOURCES

 

 Number of respondents (n=30)
Non-digital sources  
doctors and other health care providers 30
friends and family 21
pamphlets 11
books   5
Digital sources  
search engines 30
health websites 26
YouTube 13
online discussion forums 12
wearable devices 12
social media groups 10
apps   9
digital exercise games (e.g. Wii Fit)   8
electronic medical record (My Health Record)   5
physical activity platforms (e.g. Strava)   6

 

The convenience, accessibility and detail and diversity of information offered by digital media and devices were valued by the participants.

So I would initially just google my query and do a little bit of research on my own but then I would take my problems to a doctor and they would have more detail and more answers for me. I would usually just look up, kind of, symptoms and triggers for certain things. I would mainly just look up information, possibly finding a solution on my own. I like going online for the ease of use, ease of access, variety of information available, all that kind of stuff. (male, 24 years)

The young people also appreciated being able to source others’ personal experiences online by using online discussion forums, social media groups and viewing people’s stories on YouTube. They felt connected to the physically distant others they encountered online through their sharing of experiences and affective responses on these platforms.

Well, probably I just read forums to find information on the forums, the one thing I find useful is that they have allowed people to express their own feelings with different kinds of diseases. And I find that if it relates to me, then I guess it doesn’t make me feel so alone – knowing that what I’m going through, someone else is going through it with it. (male, 24 years)

Apps and wearable devices (mostly Fitbits) were used for mental health and wellbeing and booking medical appointments, as well as for self-tracking sleep, heart rate, steps and other physical activities, and menstrual cycles. Digital exercise games such as Wii Fit and physical activity platforms like Strava were the least used of all the technologies listed. Few participants who did use them did so regularly, with several participants noting that exercise games were too time-consuming to set up.

Doctors were highly valued as the pre-eminent source of health information authority because of their training and expertise. Young people noted that it could be difficult to distinguish between different opinions and details about health and illness expressed online, requiring them to assess which sources were most valid and reliable. By comparison, a doctor’s expertise was individualised to patients’ specific needs and they could offer knowledgeable interpretations based on their training. Young people could then defer to this expertise.

I guess online there’s a lot of different opinions on what something – like, if you think you’ve got a cold or something like that then you go online and I guess you’re not really qualified yourself to go, this is actually what symptoms I’m experiencing and this is what it actually is. Whereas I feel like if you go to a doctor they’re able to pinpoint it quite well. (female, 22 years)

The participants highly valued the capacity of digital technologies to generate detailed information about their bodies and health states and imagined new technologies that would be able to achieve even more detailed personalisation and customisation. However, they expressed little knowledge or concern about how their personal health data may be exploited by other actors or agencies, despite the fact that the interviews took place a matter of weeks after the Facebook/Cambridge Analytics personal data scandal. Several participants said that they had noticed that companies like Facebook and Google were monitoring their online searches and content for advertising purposes, but these practices were accepted as the norm for online engagement.

Obviously, Google, because they’re finding ways to link to merchandise, or that’s what I believe, personally.  If I look up fitness they’ll say, “Oh look at this fitness gear; why don’t you buy it?” I think it’s just society today – I can’t really stop it. (female, 18 years)

The participants’ accounts highlight the importance to this demographic group of the relational and affective dimensions of seeking health-related advice and information. While all the participants went online routinely and regularly to find advice and information, particularly because the internet affords convenience, ready access and a wealth of diverse opinions, it was evident that their connections and relationships with other people, both face-to-face and digitally mediated, were very important. Other key affordances offered by digital technologies included offering material that could be viewed anonymously and unobtrusively.

Feeling understood by and connected to other people was an agential capacity generated through various combinations of humans with each other and with technologies. The ideal digital health technologies that were imagined by the participants also evoked the affordances of convenience and accessibility. These imaginaries also suggested the importance to young people of technologies that could ‘know’ and ‘understand’ them better than those they had already tried.

In summary, these findings highlight that gaining a better knowledge of bodies, illness and healthcare and feeling more in control of health and wellbeing states were important to the young people. They valued face-to-face as well as online relationships and personal connections with other people for providing information and support, including family members and friends as well as medical professionals.

These were the vibrancies that animated the participants’ enactments of seeking and finding health information and support, that kept them googling, reading the content of websites, social media platforms and online forums, watching videos and using apps and wearable devices. While the young people’s consumption of this content may overtly appear to be passive, given that they tended to view rather than create online content, the young people were actively making sense of the material they were accessing and gathering, deciding how relevant or valid it was for their needs, how they would respond to it and whether they needed to seek further advice from doctors or others.

 

 

 

Using graphic narratives for research translation and engagement

Today I attended a workshop to learn how to draw graphic narratives — in effect, comic strips. I was interested in learning this technique as research translation and engagement tool. I thought that it could be a fun way to visually represent findings from a research project. The method can also be used to plan research projects, as an alternative to tools such as mind-mapping or concept-mapping. The idea is that using a comic-strip format helps to simplify issues and present them in narrative formats.

We focused in the workshop on the best way to represent emotional states using simple drawing techniques. We started with drawing Donald Trump’s grumpy face using several different methods. Here’s the last Trump drawing I produced. We only had a minute to draw this one.

img_0772.jpg

 

Then we moved on to practising drawing different facial expressions to convey emotion. Here I am working hard on this task.

IMG_0775 (2)

 

We finished the workshop with a big task, which involved drawing a comic strip on a topic we had chosen. I decided to try and represent some research findings from a current project I have been analysing interview data from: on young people’s use of digital health. The project’s findings showed that young people constantly google health information and appreciate learning about the experiences of other young people, so that they feel less alone. YouTube is one source where they can find other young people talking about their health and illness experiences. But young people are also willing to seek medical advice if they feel this is needed. I tried to convey these key findings in my comic strip.

IMG_0778

Ideas for participatory arts/design activities with a digital health focus

I’m currently interested in innovative and creative ways of conducting research on people’s use of digital health technologies. (See my posts on design sociology here, here, here and here, and a report using these methods for a stakeholder workshop here.)

Here’s some ideas I’ve put together, some of which I have tried and others of which I plan to try soon.

Mapping the service ecology

What works?

  • Each participant writes on a card, answering the question …. Think about a time you used a digital device (smartphone, tablet, desktop, laptop, health monitoring device, wearable device etc) for health or fitness-related purposes? What was it? What did it do? What did you like/dislike/find useful/useless about it?

Then share their experience with the group.

Future digital health? ‘What if? scenario …’

  • Each participant writes on a card, answering the question …. Think about an object or service you would like to see designed that would help people prevent or manage illness and disease. It can be digital or not digital. It can be anything you can imagine – something that is purely science fiction, or something that perhaps could realistically be invented. What is it? What does it do? What does it look like? Who would use it? Who wouldn’t use it?
  • Write a brief scenario outlining an example of someone using this technology to promote their health.

Then share this idea with the group.

This will develop two catalogues of devices: what works, and future directions. This could involve presenting this information in a number of formats: sketches or cartoons, film scripts, personas, written scenarios etc.

Inspiration cards

These are a set of cards that can be used to inspire conversation and ideas in workshop.

E.g. I’ve created ‘Blood, Sweat, Tears … Digital’ cards for a digital health workshop. They can be found here: Blood, Sweat, Tears … Digital inspiration cards.

Collages

Give participants materials (pens, paper, glue, images) to make collages on a theme, expressing their thoughts and feelings. They can write words or draw images on the collage as well. They then present their collage to the group, explaining the choices they have made.

E.g. Make a collage showing how using digital technologies make you feel.

Story completion

Provide an opening to a story and ask the participants to complete it.

E.g.

“X decided they wanted to try an app to improve their health. They went to the Apple App Store and searched the health and fitness section …. [What happened next?]

“X decided to buy a fitness tracker to improve their health and physical fitness. They took it home and tried it on …. [What happened next?]

 Body mapping, more-than-human mapping, time-lines, sensory mapping (smell, sound, taste etc).

E.g. large sheets of paper with a blank outline of human figure in the centre. Participants asked to draw on the figure and around the figure, showing sensations, feelings, emotions concerning their health and fitness. Make links to other people, other living things (e.g. pets) and to non-living things (built environment, bikes, cars, digital technologies). Then explain their maps to other participants.

E.g. Draw a map of their life (or a typical person’s life) with a time-line showing how that person would use digital technologies/be tracked by digital technologies that can monitor/measure/reveal aspects of their bodies and health – how would this person access or use this information? How would other people access or use this information?

Memory elicitation

E.g. Think about the last time you went online to find information about a health or wellbeing topic. Write about what you looked for, what information you found, and how you acted (or disregarded) the information. Do you remember any emotions or physical sensations that were part of this experience?

Photo elicitation

E.g. ask people to use their smartphones to take photos of them using digital devices in the usual places. These can be added to timelines, maps etc. Or just record them talking about the photos and their practices.

Personas

The participants are asked to generate profiles about archetypal users of technologies. They give them names, describe their sociodemographic characteristics, sketch them and generate a short narrative describing their life, goals and behaviours related to the topic in question (e.g. use of a specific digital technology).

Make your own health app

Ask people to create an app store page for an app they have invented for health purposes. Ask them to give the app a name, write a promotional blurb for it (What will it do? What is so great and new about this app? Why should people download it onto theirphones?). Include some sketches of screenshots for the app, just like on the app stores.

Digital storytelling

Participants make short films using smartphones or other mini digital cameras to tell a narrative – could be autobiographical. Uses music and voice-overs as well as images, including art-work, photos or video footage. Stories can be created as a group exercise and shared with the group.

E.g. Participants make a film about their use of health apps or wearables and share with the group.