Utilising symbolic interactionism to explore users’ interpretations of technologies designed to support health and social care

European Society for the Study of Symbolic Interaction (ESSSI) Conference

Mark Hawker

My perspective

• I am not (entirely) a sociologist• I am not (entirely) a health services

researcher• I am not (entirely) a gerontologist• I am not (entirely) a symbolic interactionist• However, I do see potential in drawing

together various concepts from these disciplines to construct a theory of healthcare technology use

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Problem statement• We are living in an ageing

population, which continues to increase year-on-year

• Health and social care budgets are diminishing as part of austerity cuts so less money is available to spend on the ageing population

• Increasingly, technology is seen as a ‘solution’ to the problem but this tends to neglect the perspectives of those who use the technology

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http://www.parliament.uk/business/publications/research/key-issues-for-the-new-parliament/value-for-

money-in-public-services/the-ageing-population/

One example, telecare systems

• Worn on the wrist or around the neck

• When activated, connects to a call monitoring centre

• Call is then triaged by the call monitoring centre operator

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Six dimensions underpinning my approach

1. Individuals act in ways that express an identity, which relates to commitments and the salience of that identity

2. Ageing and chronic illness can have a significant influence on an individual’s sense of identity

3. Individuals act towards technologies based upon the meanings that the objects have for them, which is negotiated through social interactions with others

4. The meaning of a technology is derived through social interaction and is most fully understood with reference to the relationships between the technology, individuals and society

…

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Six dimensions underpinning my approach, cont.

5. Meanings are constructed, managed and transformed through an interpretive process through which individuals make sense of technologies with respect to their roles, and structural constraints and opportunities

6. Healthcare technologies may be used in ways that go beyond satisfying needs, a common interpretation, by facilitating role performance and enabling impression management

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My (theoretical) approach to healthcare technology usage

A note on domestication

• “Technologies should [not] be seen as innocent and completely malleable. Rather, the domestication argument is that technologies should be seen as under-determined and not undetermined. Designers inscribe visions and actions into artefacts, and they are probably successful in shaping users’ actions quite often. However, this may only be clarified through empirical analysis of actual use.” (Sørensen, 2006: 57)

• Can be analysed across the dimensions of appropriation, incorporation, objectification and conversion

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Research design

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A local telecare system SCRIPT telerehabilitation system

19 older people

Recruited via local organisations working with older people

4 stroke survivors

Recruited via the SCRIPT project

• Document review• Qualitative interviews

• Document review• Qualitative interviews• Observations of user

engagement over a period of six weeks

Theoretical reading of data Theoretical reading of data

What have I found?• Common experiences of older people that shaped their identities

and the ways in which they negotiated everyday life (e.g. ‘active’ agers)

• Appropriation of telecare systems embedded within the wider challenges and dynamics of everyday life (e.g. help and support networks)

• Multiple interpretations (or metaphors) of telecare systems• As ‘prescriptions’• As ‘safety nets’• As ‘load balancers’• As ‘currency’

• The work of maintenance activities ensured the technology remained ‘active’ and ‘visible’ within users’ everyday lives (i.e. a focus on interaction)

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Uncertainty, change and identity“Well, I’m 85. And when you get to be an octogenarian you’re a candidate. You’re also … strokes, heart attacks, you name it. When you get to be in your 80s, anything can happen. And a’ve no family, a’ve no siblings, so I’m on ma own. So a’m determined, like many other people, to keep that, to keep it that way, and keep independent as long as a can. And this is all part of it, a’ll do what a can in order to be prepared.”15/04/2023© The University of Sheffield

‘Real world’ interpretations‟ A’ve had it about … two year. I was ill, I was in hospital for

about eight months. And when a came out they gave me this pendant and … I ‘ave tried it out. If I press this [button] I’ve got immediate help.

‟ Well, I got one in the first place because I live alone. And it gave me a sense of security if anything went wrong.

‟ But I weighed it up and I thought: ‘well, I need help, and I need somebody to get in’. [My neighbour] has a key. But, and if I rang [my neighbour] she would come, but, [my neighbour’s] getting older, too. I don’t feel that I ought to put that responsibility on her shoulders.

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A creative use of a telecare system‟ [I got this telecare system] as a gesture to

me son and daughter I thought I’d rather have a [telecare system] than go and stay anywhere, y’know. And, er, at least that satisfied them.

‟ I would’ve been in trouble if, er, [my daughter] had come and I wasn’t wearing it! [Laughs.] I would be in trouble.

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Discussion• Telecare systems are not just functional objects

but are also interpreted as symbolic objects; the ‘use’ of these objects goes beyond cost and clinical effectiveness

• The meaning of a telecare system is negotiated within the context of everyday life

• Users’ agency and identities as older people influence the extent to which they are able to construct and negotiate the meaning of telecare systems

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An Interactive Healthcare Technology Usage Model (IHTUM)

Bibliography• Berker, T., Hartmann, M., Punie, Y. and Ward, K. J., eds. (2006). Domestication of

media and technology. Maidenhead: Open University Press.• Haddon, L. (2011). Domestication analysis, objects of study, and the centrality of

technologies in everyday life. Canadian Journal of Communication, 36(2): 311–323.• Oudshoorn, N. and Pinch, T., eds. (2003). How users matter: the co-construction of

users and technology. Cambridge, MA, USA: The MIT Press.• Serpe, R. T. (1987). Stability and change in self: a structural symbolic interactionist

explanation. Social Psychology Quarterly, 50(1): 44–55.• Snow, D. A. (2001). Extending and broadening Blumer’s conceptualization of symbolic

interactionism. Symbolic Interaction, 24(3): 367–377.• Sørensen, K. H. (2006). Domestication: the enactment of technology. In: T. Berker, M.

Hartmann, Y. Punie and K. J. Ward, eds. Domestication of media and technology. Maidenhead: Open University Press, pp.40–61.

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QUESTIONS?

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Utilising symbolic interactionism to explore users’ interpretations of technologies designed to support health and social care

European Society for the Study of Symbolic Interaction (ESSSI) Conference

Mark Hawker