Digital health promotion: possibilities and limitations

 

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On Tuesday I am giving an invited presentation at an event organised by VicHealth on the theme of ‘Harnessing the Power of Digital Technologies’. Some of the issues I’ll be focusing on include covering the different ways in which digital devices and software are used for health promotion, and what the social issues are. I’ll be drawing on my recent and current research projects looking at the social aspects of how people use digital health and self-tracking technologies (see my blog post summarising the findings of these projects here).

The critical sociological approach I’ll be advancing is discussed in a range of my publications over the past few years. The most recent of these publications include my book Digital Health: Critical and Cross-Disciplinary Perspectives, a chapter on wearable devices (available OA here), an article on what health professionals and healthcare consumers see as valuable about digital health and what its future may be (available OA here), a special journal issue I edited on self-tracking, health and medicine (the editorial for this is OA here) and an article reporting my research project on the use of social media by healthcare workers (available OA here).

Here are some of the points I’ll be making in my talk:

Among public health and health promotion professionals, social media campaigns and dedicated websites are popular forms of communicating with target groups. These approaches often take an individualistic and to-down approach, using old-style paternalistic health education and social marketing models of behaviour change and applying them to the new media contexts. They often fail to recognise that people are spontaneously and actively searching for information about health and medicine on the internet and using social media and apps to generate and share this information.

Health promotion professionals are competing for consumer engagement with a digital health ecosystem in which the commercial/corporate sector offers a far more compelling range of products. It was estimated last year that there are over 325,000 health and medical apps available on the major app stores. Social media are now a key site for the dissemination of health-related news and information. People use Facebook, Instagram, Tumblr, Twitter and Pinterest to access and share information about health, medical care and physical fitness. A large range of blogs and discussion forums have been established for people to have a say on health-related matters and respond to others. Wearable devices like Fitbit and Apple Watch provide opportunities for people to monitor and measure their health and fitness levels.

Visual media have become important in people’s engagements online, including selfies, memes, GIFs and videos. YouTube offers countless videos made by consumers about their health and fitness experiences and insights. ‘Healthy lifestyle’ influencers on platforms like Instagram and YouTube have a huge reach and impact, particularly for young people. Hashtags like #fitspo, #cleaneating, #fitnessaddict, #iquitsugar, #wellness and #weightlossjourney are used to organise content and attract like-minded audiences. Communities that challenge mainstream health promotion messages and seek to promote resistant modes of embodiment use hashtags like #badfatty, #thinspo, #proana, #selfinjury and #blithe (used for content about self-harm, eating disorders and depression), particularly on Tumblr.

My research on how public health professionals use social media found that they recognised that these communication channels were important for consumer engagement and also found them beneficial to connect with other professionals working in their fields. However, they experienced many constraints such as lack of institutional knowledge about how best to use social media, rules about not using social media in the workplace, lack of access to the internet, or peers disapproving of social media. If they were working in a contentious or sensitive area of public health, these professionals had to consider the possibility of being attacked by members of the public on social media, or inadvertently saying the wrong thing publicly.

There is a need for a social perspective on digitised health promotion. The different ways in which social groups use and respond to digitised health promotion need to be considered (for example, attributes such as gender, age, social class, education level, ethnic/racial background, health status and geographical location). My research identifies several key differences between the different groups I have included. For example, women with young children use Facebook a lot for sharing information about pregnancy and childcare and to arrange in-person meetings. Young people, on the other hand, prefer YouTube, Instagram and Snapchat to access and share health information. My project on self-tracking cyclists found that they loved to use platforms like Strava to share their data and compete with and provide support to each other. In contrast, my project on everyday self-trackers, who monitored a range of attributes about their bodies and lives, and another of my projects on women’s use of digital health technologies, found that very few were interested in sharing their data with others beyond family members or their doctors.

Personal data privacy and security are important issues when discussing how digital technologies can be used for health promotion. Across my research projects, there was very little awareness of or concern about how internet companies and app developers collect, use and share people’s often very sensitive health-related information when they engage with these technologies. This included public health professionals, who were not considering these issues in relation to their work-related activities.

Theorising mHealth and the quantified self

I have published several posts on this blog now about mHealth and the quantified self (see them here). I have also written two scholarly publications that have been published in academic journals discussing this topic in greater depth. In the first article I looked at how theories of surveillance society and the cyborg body could be applied to understanding the use of digital health technologies as they are used for health promotion, and also discussed privacy, intimacy and ethical issues (see here for details of the first article, the full version of which is open access).

The latest article is entitled ‘Quantifying the body: monitoring, performing and measuring health in the age of mHealth technologies’, published in Critical Public Health (see here for details). It builds upon the previous article by bringing in discussion of the quantified self movement. Here is the abstract:

Mobile and wearable digital devices and related Web 2.0 apps and social media tools offer new ways of monitoring, measuring and representing the human body. They are capable of producing detailed biometric data that may be collected by individuals and then shared with others. Health promoters, like many medical and public health professionals, have been eager to seize the opportunities they perceive for using what have been dubbed ‘mHealth’ (‘mobile health’) technologies to promote the public’s health. These technologies are also increasingly used by lay people outside the professional sphere of health promotion as part of voluntary self-tracking strategies (referred to by some as ‘the quantified self’). In response to the overwhelmingly positive approach evident in the health promotion and self-tracking literature, this article adopts a critical sociological perspective to identify some of the social and cultural meanings of self-tracking practices via digital devices. Following an overview of the technologies currently available for such purposes I move on to discuss how they may contribute to concepts of health, embodiment and identity. The discussion focuses particularly on how these technologies promote techno-utopian, enhancement and healthist discourses and the privileging of the visual and the metric in representing the body via these devices.

My current research is moving from a focus on health promotion to the construction of patienthood in digital health discourses. I’m looking at how patients are being encouraged to engage in self-monitoring and self-care activities to reduce healthcare costs, and the commodification of patients’ accounts of their experiences of illness and healthcare on social media platforms designed to elicit patient opinion.

The new mobile digital technologies, health and the body

I’ve just had an article accepted in the journal Social Theory & Health (see link below). It looks at the phenomenon of ‘m-health’, or the use of mobile digital devices such as smartphones and tablet computers to promote health. There are now a plethora of apps available for downloading onto these devices that measure and monitor aspects of the user’s health: blood pressure and heart rate, ovulation, hearing function, body mass index (BMI), adherence to a medication regime, alcohol and cigarette intake, diet, sleep quality and length, exercise frequency and level and other bodily functions and activities can all be monitored using such apps. Apple has produced technologies and apps that allow users to hook up a blood pressure monitor or a set of scales to their mobile devices to record blood pressure and weight, produce tables and readouts of these and compare daily (or hourly) fluctuations. These data can then be shared with other people via social media, so that friends or followers may keep a close eye on how many kilometres a user has run that week, what her or his heart rate was for each run, how the user’s weight has changed (or not), what kind of diet they have consumed, whether they have stuck to their medication and so on.

Many of these apps are produced by commercial developers. However health promoters are beginning to see their potential and to consider and adopt the capabilities of mobile digital devices to individualise and target health promotion messages so as to change people’s behaviour. As one writer argued in a recent blog post on the use of messaging for public health objectives, such apps can be used to ‘become a “personal health coach”‘ to remind people to takeup health-related behaviours.

The use of mobile digital devices in health promotion endeavours represents a significant shift in the methods of health promotion. Health promotion has traditionally been a low tech area of public health in comparison with the vast array of medical technologies used in the clinical setting. The primary use of technology in health promotion has tended to be in employing communication media to disseminate illness-prevention messages to a wide audience. Health promotion has borrowed extensively from commercially-oriented social marketing, advertising and public relations approaches and methods to do so. These industries are now embracing social media and mobile devices as part of their publicising efforts. Here again, therefore, health promotion can be seen to be taking the lead from commercial enterprises which are directed at marking and selling commodities.

Writers from medical and health promotion backgrounds about the new social media and mobile devices tend to confine themselves in their discussions to describing how these technologies could be most effectively used as tools in their efforts to help people deal with medical conditions or improve their general health and wellbeing. From a sociological perspective, a more critical analysis may be undertaken of how these technologies may operate to construct various forms of identities and ways of experiencing and viewing one’s body. This analysis includes identifying the kinds of assumptions that are made about the target of these technologies and what the moral and ethical ramifications of using them may be. Moral implications include the kinds of meanings and the representation of the ideal subject that are related to the use of these technologies in the interests of promoting health. Ethical issues include questioning the extent to which health promotion practice should intrude into their targeted populations’ private lives and what kinds of messages and practices they employ when using digital surveillance devices. The article addresses these and other issues, drawing upon a range of social and cultural theory to do so.

I argue that m-health technologies produce a digital cyborg body. They are able to act not only as prostheses but also as interpreters of the body. The subject produced through the use of m-health technologies is constructed as both an object of surveillance and persuasion and as a responsible citizen who is willing and able to act on the health imperatives issuing forth from the technologies and to present their body/self as open to continual measurement and assessment. The implications of this new way of monitoring and regulating health have yet to be fully explored. These include privacy issues, questions about the intrusion of health promotion even more insistently into everyday lives and the possible ways in which concepts of ‘health’ might be reconfigured via the use of these new technologies.

References

Lupton, D. (in press) M-health and health promotion: the digital cyborg and surveillance society. Social Theory & Health. Advance online pre-publication details are here.

See my pinterest board on ‘M-health and the Digital Cyborg‘ for images related to this topic.