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WORK IN PROGRESS- NOT FOR CITATION
‘Preventing obesity through self care? Ageing, technology and ‘healthy living’
Paper prepared for the Social Policy Association Conference, University of Lincoln,
July 5-7th 2010.
Flis Henwood
School of Applied Social Science
University of Brighton
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Abstract
In recent government policy on obesity (Healthy Weight, Healthy Lives (2008), we can see
the beginnings of a shift of focus from individual responsibility, Body Mass Index measures
and weight management, to a recognition of the multi-causal nature of obesity and the
concomitant need for a cross-government approach to change. It is now accepted that a
balance needs to be struck between individual behaviour change and much wider social and
environmental changes that tackle the „obesogenic society‟. But how do those who see
themselves as overweight experience this tension, what are their own personal strategies for
self care and healthy living, and what social and environmental factors do they experience
as facilitating or inhibiting these?
A parallel set of developments in policy focused on older people (see, for example, Shaping
the Future of Care Together, 2009), indicates a renewed interest in low level „prevention‟
strategies that can help promote independence and well-being, whilst reducing demand on
health and social care services. Key to the prevention agenda are access to information and
advice on exercise, diet and healthy living and on low intensity practical support services.
But what does healthy living mean in the context of ageing and older people‟s diverse and
complex bodies and lives? What kinds of intervention and prevention strategies are
employed in the everyday lived experience of growing old and trying to stay fit and healthy?
This paper will draw on a Department of Health-funded study of the potential of information
and communications technologies (ICTs) to support self care in the context of obesity
management. The study was based in one city in order to enable obesity and overweight to
be explored „in place‟, to facilitate a participatory research approach and enable a mapping
of local health and information providers and explore their relationship with the local
community. 84 per cent of study participants were women and 57 per cent were aged 45 and
over. All were engaged in some form of weight management and/or attempts at living a
healthier lifestyle.
Drawing on data collected via a survey, focus groups, participatory learning workshops, and
a set of reflective interviews, this paper explores how discourses of ageing are mobilised in
engagements with both technologies and the healthy living agenda and how understanding
the lived experience of attempts at active ageing can contribute to improved design for
interventions aimed at the prevention of obesity amongst older people.
Introduction
Recent policy focused on older people (see, for example, Shaping the Future of Care
Together, 2009), indicates a renewed interest in low level „prevention‟ strategies that can
help promote independence and well-being, whilst reducing demand on health and social
care services. Key to the prevention agenda are access to information and advice on
exercise, diet and healthy living and on low intensity practical support services. Also integral
to, if not always explicit within, this prevention agenda, is the notion that self care is a central
means by which well-being can best be promoted. But what does healthy living mean in the
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context of ageing and older people‟s diverse and complex bodies and lives? What kinds of
self care strategies are employed in the everyday lived experience of growing old and trying
to stay fit and healthy?
In recent government policy on obesity (Healthy Weight, Healthy Lives, 2008), we can see
the beginnings of a shift of focus from individual responsibility, Body Mass Index (BMI)
measures and weight management, to a recognition of the multi-causal nature of obesity and
the concomitant need for a cross-government approach to change. This emerging approach
argues that a balance needs to be struck between individual behaviour change and much
wider social and environmental changes that tackle the „obesogenic society‟. But how do
those who see themselves as overweight experience this tension, what are their own
personal strategies for self care and healthy living, and what social and environmental
factors do they experience as facilitating or inhibiting these?
The e-health agenda positions information and communication technologies (ICTs) as key
tools for the empowerment of patients and the public, providing access to information that
can help them make appropriate healthy life choices (Department of Health 2004a and b).
But how do those seeking to live healthy lifestyles engage with information and ICTs? What
role does the internet play in supporting healthy living? And how does age intersect with
internet use in the context of healthy living practices?
A recently completed study that explored self care in the context of obesity enables us to
begin to address these questions and, in so doing, to engage more critically with the concept
of „prevention‟ when used in the context of healthy living and active ageing agendas. The
Net.Weight study1 explored the potential of information and communications technologies
(ICTs) to support self care in the context of obesity management. The study was based in
one city in order to enable obesity and overweight to be explored „in place‟, to facilitate a
participatory research approach and to enable a mapping of local health and information
providers and explore their relationship with the local community. The majority of participants
were over 45 and all were engaged in some form of weight management and/or attempts at
living a healthier lifestyle. Drawing on data from this study, this paper makes the case for
understanding the lived experience of attempts at healthy living and active ageing, arguing
1 The study’s formal title is ‘Supporting the self-management of obesity: the role of information and
communication technologies’. For full report, see http://research.cmis.brighton.ac.uk/netweight/. This is an
independent report commissioned and funded by the Policy Research Programme in the Department of
Health. The views expressed are not necessarily those of the Department.
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that this understanding is crucial not only for the design of appropriate interventions, but for a
more critical engagement with the whole notion of „prevention‟ when applied in the context of
older people.
The Net.Weight study participants
Inclusion criteria for the Net.Weight study was: „over the recommended weight for your
height‟, „trying to do something about it‟, „living in the city of Brighton and Hove‟ and „aged 16
or over‟. There were many different elements to the study, several of which are drawn upon
in this paper. The main sources of data for the analysis presented here are: survey of
people‟s self care practices which focused on overall health, weight management,
information and technology practices (385 respondents); 4 focus groups (average of 7
participants each); 3 sets of participatory learning workshop groups (39 participants in all);
and a set of reflective interviews for those who attended workshops (18 participants).
57% of the user survey respondents were aged 45 or over, although the workshop
participants were an older group, with 85% in this age group2. Women made up 84% of the
survey sample and 79% of the workshop participants.
In policy discourse, „healthy lives‟ are strongly associated with „healthy weights‟ (Department
of Health, 2008) and „healthy weights‟ are measured, most commonly, using the Body Mass
Indicator (BMI) scores, where a BMI in the range between 18.5 and 24.9 is considered as
normal, between 25 and 29.9 is overweight, and 30 or above is obese (Department of Health
2006). Using the BMI, 95% of the Net.Weight user survey sample was either overweight
(45%) or obese (50%)3. The average BMI in this sample was 30.7. The workshop
participants were a slightly heavier group, with average BMI of 31.8. Many survey
respondents lived with one or more chronic health condition associated with being
overweight, including high blood pressure (23%), breathlessness (19%), high cholesterol
(13%), osteoarthritis (11%), type 2 diabetes (7%) and „other‟ conditions (22%). 30% lived
with more than one chronic condition. Workshops participants had a similar health profile.
2 This difference may well reflect the fact that older respondents to the survey were less confident in the use
of computers and the internet and were keen to learn new skills and assess the relevance of these technologies for their everyday healthy living practices. It may also reflect the fact that older people have more time to attend such workshops. Of the 3 workshop groups, the group with the highest average age (67, Group B) met in the day time; Group A (average age 58) also met in the day time; Group C, with the youngest average age (46) met in the evening.
3 This reflects the sampling approach which sought to recruit participants who were overweight or obese, as
measured by the BMI. A few ‘normal weight’ people did respond to the survey and were included because they were deemed to be engaged in self care related to the prevention of weight gain.
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High blood pressure, high cholesterol and osteoarthritis were significantly more prevalent in
the older age groups. These conditions, and the „lived experiences‟ of managing them,
provides important context for understanding participants‟ self care and healthy living
strategies, and may point to the redundancy of the more generic „preventative‟ healthy living
messages for many older people and people with complex health problems.
Several participants drew on their experiences of age-related health problems to resist a
simple conflation of health and weight and emphasise a broader definition of „keeping well‟:
Lianne was concerned about her weight but had a more pressing health issue to address:
Yes, and I mean I am overweight, but with kidney failure, I do have to follow a special diet, so it‟s not that easy to lose weight (Lianne, aged 64).
She continued:
being on dialysis now I have to be careful that I‟m not missing things, before I was on dialysis I had a very strict diet, now I have to make sure I eat enough because I could be missing protein or vitamins… the doctor is, you know, says I‟ve got to be careful to eat enough, and eat enough protein, so that‟s why I don‟t worry too much about my weight (Lianne).
Amanda, recently diagnosed with diabetes, stated that her priorities had had to change:
when I dieted before, I would actually cut down on the carbohydrates, but as a diabetic, I can‟t do that. So I‟ve actually had to change and learn different, different ways… (Amanda, aged 60)
With complex co-morbidities, there is, of course, also the problem of not knowing for sure
what is causing what. As Esther expressed:
... I‟d got to the heaviest I‟d ever been, and I was having more and more twinges of backache and knees and thinking „is this old age and arthritis, or is this overweight and could I ease it…? (Esther, age not given).
Esther‟s predicament neatly encapsulates the complex relationship between health, weight
and age in older people‟s lives where bodily constraints imposed by co-morbidities interact
with discourses of self care to raise questions about the responsibility for „prevention‟ of
unhealthy bodies and lives.
Self care as ‘prevention’?
The prevention discourse encompasses concerns about an ageing population and ever
increasing demands on the health service caused by people living longer, often with long
term and chronic illnesses and associated disabilities. For example, the 2009 Green Paper
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Shaping the Future of Care Together, which set out a vision for a new National Care
Service, focuses on how to meet the care needs of the ageing population in the context of
rising demand and limited resources. In this context, „prevention‟ becomes a powerful and
seemingly rational concept to employ:
Money could often be better invested in prevention, rehabilitation and keeping people active and healthy (HM Government, 2009, p.9, emphasis added)
However, insofar as self care is seen as key to „prevention‟, we need to start thinking more
critically about self care. The self care agenda is seen as a key component of the model for
Supporting People with Long Term Conditions (Department of Health, 2005a), linked to both
improved health outcomes and the empowerment of patients (Department of Health, 2005b)
The Department of Health states that self care is about putting people in control of their
health, and that:
[T]he NHS cannot do self care to people, but what it can do is create an environment
where people feel supported to self care. 4
A number of innovative national initiatives have been introduced to showcase this self-care
agenda, including the Expert Patient Programme (EPP) and the „patient trainers‟ initiative,
where patients and the public are trained in self care skills to improve health (Department of
Health, 2004a).
As I have argued elsewhere (Henwood et al, forthcoming), the UK government‟s self care
agenda can been understood as part of the neo-liberal agenda encompassing the new
public health (NPH) and the new „healthism‟ (Peterson and Lupton, 1996). As such, „self
care‟ might be differentiated from „self –help‟. As Bella (forthcoming) argues, early self-help
movements worked with a „collective‟ model of empowerment that was overtly „political‟, and
„intended to achieve broadly based social change‟ (p.**), an agenda that has arguably been
subverted by formal self-management programmes and health promotion approaches which
promote „state-sanctioned‟ objectives‟ (p**). However, the situation may not be as clear-cut
as this. For example, recent research on self-management programmes in the UK, whilst
remaining critical of the policy emphasis on the individual and on efficacy, and whilst
claiming that self-management programmes may represent an abdication of state
responsibility for health (Kendall and Rogers, 2007), also acknowledge that such
programmes do, at times, seem to trigger a new consumer health movement built not on the
medical paradigm but on the subjective experience of living with a chronic condition (Wilson
et al, 2007; Kennedy et al, 2004). Thus, it may be more useful to think not of the state
4 (http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_4128529
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approach to self care subverting self-help approaches but as the two approaches existing in
tension with one another. Veinot, in her study of the UK‟s Expert Patient Programme (EPP),
describes this in terms of two „co-existing discourses‟- „self help‟ and „managerial
effectiveness‟ (Veinot, forthcoming).
Obesity is challenging from a self care point of view and illustrates these tensions well.
Despite the beginnings of a shift in government policy from a focus on individual
responsibility to a recognition of the wider, environmental causes of obesity (Department of
Health, 2008), Webb‟s argument - that obesity policy tends to position the individual as
„normatively responsible for the onset of obesity and, in part, its management‟ (Webb, 2009,
p855) - still has relevance. Despite the fact that both the causes and consequences of the
condition are complex and beyond the scope of individual self management alone, NHS
weight management and healthy living programmes are typically aimed at individuals and
may, therefore, be understood as representing just the type of abdication of state
responsibility for health that Kendall and Rogers speak of. This focus on individuals may
also, of course, lead to attributions of blame that undermine the very practices of self care
such programmes aim to promote.
What is the lived experience of self care in the context of overweight and obesity for older
people? How do older people, many of whom have struggled with their weight all their lives,
understand and manage the tension between individual responsibility and wider, social
determinants of unhealthy lifestyles? Is there evidence of the co-existing discourses of self
help and self care?
The user survey asked specifically about what people did to manage their weight. Physical
exercise and dieting were the most common ways in which people has sought or were
seeking to manage their weight, with more than 95% of respondents having tried one or both
means to manage their weight. More than 60% of the sample said that weight management
was important to them (particularly true for women) but 60% had not been successful in over
the preceding year and, whilst more than 60% wanted to lose 1, 2 or more stone in the next
year, almost 50% were not confident about their ability to do so. Responses to the survey
open question „what do you find hardest about managing your weight?‟ suggest a number of
reasons why weight management is difficult for our sample with „temptations‟ of food,
„comfort eating‟ and a „lack of will power‟, related to both food and exercise, being key.
However, unsurprisingly, given the health conditions with which many of our participants
lived, ill-health and bodily constraints (for example, knee pain, making exercise difficult;
prescribed drugs (steroids, HRT); kidney failure; multiple sclerosis; heart condition; slipped
disc) were also mentioned frequently as either causing weight gain and/or mobility problems.
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Asked „what would help you most with managing your weight?‟, support was paramount
(„help from doctor and more support from family‟, „someone overseeing me‟, „support from
other dieters‟, „greater motivational support‟ etc.). However, again, there were responses that
suggested a wider context for weight management and attempts at living healthier lifestyles.
Many talked about the need to reduce stress which often led to over-eating and under-
exercising, creating a negative cycle („finding work that is no stressful‟; ‟less stress‟; „finding
another way with dealing with emotions‟; „a balanced lifestyle‟; „having a job that was less
stressful‟). Women, in particular, mentioned their role in food provision within the family in
this context: („not having to cook for children‟; „not having to cook for the rest of my family‟;
„to be able to concentrate entirely on myself- difficult with a family to cook for‟).
Others key suggestions for support for lifestyle change were affordable food and exercise
options and accessible local services: („finding a diet that lets me eat the food I can afford to
buy‟; „cheaper forms of exercise‟; „free gym membership‟; „better access to leisure centres‟;
„accessible exercise at reasonable cost…and being able to find it locally‟; „nicer
swimming/gym facilities‟; „to keep going to slimming club (but expensive)‟; „finding a sport or
activity that I enjoy and is fun, without being expensive‟; „affordable healthy food at work‟ ;
„safe bicycle lane in Brighton‟).
Age was articulated strongly in responses to the question „what would help you most with
managing your weight?‟ with many expressing a need for the support of a group of older
people („a group exercise with people my own age would be good‟; „a class or group of
people that are the same age/weight‟).
Others resisted an individualised approach more explicitly and expressed a clear desire for
the need for wider social changes – again, expressed in relation to age:
resources that cater for my age group that acknowledge many of us over 60 are neither elderly/olds loaded with money and would like to continue to be interested in how we look, what we wear; encouraging incentive to remain lively and feel good about ourselves (survey response)
One response neatly encapsulates the range of exclusions (based on cost, age and size)
from existing resources felt by many of our participants:
I have only ever been successful in weight loss when I have been able to attend a gym and had help. I can‟t afford this anymore and I think I am too old and too big now anyway (survey response)
Interviews also revealed a tension between individual responsibility and the wider, social
determinants of unhealthy weights and/or lifestyles. By participating in the Net.Weight study,
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all participants can be understood at some level as taking individual responsibility for their
weight and health and their responses demonstrate this clearly, often relating the need for
action directly to age:
… being over 50 and reading the information that‟s out there it‟s vitally important that I get some of this weight down for cardiac reasons really, to get rid of it, because I am at high risk (Alexander, aged 63).
What am I? I‟m 72 and I‟m fairly...well, quite overweight. And I‟m diabetic, so I really do need to get my weight down (Claire).
However, there were also very clear resistances to the self care agenda that prioritises
individual responsibility and often blame. Many of these resistances involve the mobilisation
of ideas about age and the ageing body. For women, menopause was a time of significant
change in relation to their bodies, their weight and, for some, their approach to weight
management. Two responses to the open question „what do you find hardest about
managing your weight?‟ illustrate this point well:
My metabolism seems to have changed since going on HRT. I put on a stone and have not been able to shift it (survey response)
I have struggled to lose weight since menopause - feel my problem exacerbated by hormones (survey response)
In interview, Isabelle, aged 67, who had had a hysterectomy, related her weight and body
size directly to this mid life event:
... the annoying thing was I wasn‟t always like this but people only know me as I am now, you know, and I mean, until I was 47 and I had my hysterectomy, I was only a size 10 or 12 and then, you know, now I‟m nearly 11 stone and I‟m only five foot and you know people only see me as I am now, you know, that annoys me that they judge you by what you are now, not what I can do or what I‟ve done, but what I look like and I find that very, very upsetting (Isabelle)
Asked if she started to put weight on gradually after her hysterectomy, she replied:
Yeah, it sort of came on very quickly, I suppose, with my age as well but, yes, I did find that I‟d put a lot of weight on after I had that (Isabelle)
Here, participants can be understood a resisting the idea that individuals can always
„manage‟ their way out of poor health and related weight gain, implicitly taking issue with
notions of „prevention‟ as found within self care discourse. Their accounts also point to the
inappropriateness of generic healthy living messages in the context of the mid-life to older
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women and their ageing bodies. In the next section, we explore, more critically, the role of
information in self care.
Information as prevention?
Information is considered an essential component of self care, a point that can be illustrated
well in the case of obesity. In December 2004, a year or so before the Net.Weight study was
devised, the then Public Health Minister, Melanie Johnson, spoke about the obesity problem
in the UK:
Obesity has rapidly become a serious problem, with over half of the population recorded as either overweight or obese. It is essential that people eat healthily and stay active if they are to stave off the threat of killer diseases like cardiovascular disease, type II diabetes and cancer. But we can‟t force people to be healthy nor tell them how to lead their lives. What we can do is provide them with the information, advice and support to make their own choices (Department of Health, 2004c) (emphasis added).
This message encapsulates, neatly, the policy context within which the Net.Weight study
was undertaken. Heavy emphasis is placed here on the importance of information, advice
and support for „self management‟ or „self care‟ in relation to obesity and a seemingly
unproblematic link between information, empowerment and choice. The Net.Weight study
took a more critical approach to the concept of „information‟ and its relationship to
empowerment and choice in the context of self care.
In contrast to policy discourse and much of the practice-based literature, where information
is understood as a neutral resource to be collected, organised, communicated and used, a
more critical social science approach might understand information as „situated knowledge‟,
a distinction that, following Haraway, can be characterised as a „view from nowhere‟, versus
a „view from somewhere‟ (Haraway,1991). Suchman makes a similar distinction between a
view of objective knowledge as „a single, asituated, master perspective that bases its claims
to objectivity in the closure of controversy‟, and „multiple, located, partial perspectives that
find their objective character through ongoing processes of debate‟ (Suchman, 2002, p. 92).
As I have argued elsewhere (Henwood et al, forthcoming), information is often „black-boxed‟
but this does not mean it is neutral; it simply means that its knowledge roots and the type of
expertise it represents are obscured from view. Medical knowledge is particularly susceptible
to this form of black boxing when it is re-packaged as „health information‟. In e-health
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discourse, information is associated with empowerment but, as has been suggested
elsewhere (Henwood et al 2008), information cannot be empowering if its knowledge roots
are obscured, if the „user‟ is unable to assess its provenance and its overall accuracy and
validity, as well as its relevance for the particular local and social circumstances of use.
Access only to such „informational knowledge‟ (Lash, 2002) restricts opportunities for critical
engagement with that information and, arguably, positions people as agents of „self-care‟
rather than „self-help‟.
How do older people seeking to live healthier lifestyles engage with healthy living
information? What normative assumptions about bodies and health are being communicated
in healthy living information and how relevant is generic healthy living advice in the context
of ageing and older people‟s diverse and complex bodies and lives?
Responses to an open question in the user survey about information and support needs
generated an interesting set of responses, many of which suggested that information was
not the main issue or inhibiting factor („Information? Sure, but losing weight is hard
work!!!!!!!!!!!!!!!!!!‟; „Information is not the problem, will power is!‟; „I already feel confident
about finding information but I fail to use the information correctly‟; „I'm confident enough
about this - it's putting all the information and my knowledge into practice, that's the
crunch‟). Thus, participants do not give primacy to information in the way that self care
discourse does but they are still positioning themselves firmly within this discourse when
they emphasise their own inadequacies in „using‟ the information correctly to make
behaviour changes- the „healthy choices‟.
In interview, Olga (77) expressed frustration at the generic level of much of the health
information which she experienced as having been „pushed‟ at her throughout her life. Asked
if and where she looks for health information now, she replied:
Well I really and truly haven‟t looked at that much. I just feel now having got to the age I have I know what I should do, which is near starve, and then it would work…but I'm constantly bombarded by Tesco diets on the email (Olga)
There was a strong feeling amongst participants that, insofar as information was deemed
important, it needed to be age-appropriate. Amanda (60) had lived with a weight goal of 65
kilos for many years. Asked if this was still her goal, she replied:
It still is my goal. Actually, it might be, it might, it might be, aghh.. I don‟t know, 65, I mean that‟s 63, 65 was my weight when I was 25 and working at the Folies Bergère (she was a dancer), so may not be. Maybe I can put it up to 68. I‟m not really sure
Later, she drew on the idea of an aging body to argue for resistance to cultural norms and
for being more „realistic‟ about one‟s goals:
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I think, you know, there‟s, there are realities that we have to sort of think about and, you know, being in, in reality… I am 60, I‟m not going to have a 25 year old body…and so forth. Once you get that kind of information, sort of self assessment, I think it makes it easier.
Interestingly, Amanda had ideas about how the internet might open up access to a wider
range of knowledges about body weight:
What would help would be, would be a site that was real, and not trying to make you into a 60 kilo stick insect! I think internet could help with that if we, you know, if we weren‟t fed this sort of „You should be such and such a weight‟ etcetera and so forth, and, and fed the healthy aspect, as opposed to, you know, sort of the idealistic „Let‟s all conform‟ (Amanda)
Age- and health-appropriate, local information was also a major theme when participants
were generating ideas for the content of workshops:
More information for people with health problems- I have osteoarthritis, sciatica and
don‟t know what exercises to do
Where can people in wheelchairs take exercise?
Participants‟ accounts of engaging with information about weight management show that
there are resistances to the „view from nowhere‟ and that lived experiences have produced
alternative „views from somewhere‟. These „somewhere‟ experiences include the embodied
experience of ageing and the desire for local, accessible and age-appropriate activities and
services also suggest the importance of the design and planning of services for „active
ageing in place’.
Technologies of prevention?
As in the case of self care, policy agendas have tended to link the implementation of ICTs
with the development of a patient-centred health service and the empowerment of patients,
without the mechanisms by which this link works being fully explicated. For example, the
development of health information services offered via NHS Direct and digital interactive
television (DiTV) in the late 1990s were said to widen access to information in ways that
support the development of self care and patient empowerment (Nicholas et al 2002 and
2003). More recent research has looked at the potential of Web 2.0 as an enabling
technology in healthcare (Boulos and Wheeler, 2007; Deshpande & Jadad, 2006;
Eysenbach, 2008; Hardey, 2008) and at how it is currently being used in self care through
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blogging (Sundar et al, 2007) and online communities (Blank & Adams-Blodnieks, 2007;
Leimeister et al, 2006) . However, there is no necessary or straightforward correlation
between the implementation and use of ICTs and improved services, health care
experiences or health outcomes because social outcomes are not determined by technology
alone. We have already seen that information, as understood within the discourse of self
care, is experienced by older people as too generic, too imbued with inappropriate cultural
values and norms, and as being „pushed‟ at them in ways that imply individual responsibility
and induce feelings of blame. With Web 2.0 offering more interactivity and the potential for
patient and citizen feedback on health services, interesting new questions arise about the
extent to which such technologies can be used to support new forms of governance, as well
as individual choice. The Net.Weight study sought to contribute to a better understanding of
these important socio-technical factors.
„Users‟ have become an important focus for researchers working in the socio-technical
tradition in recent years (see, for example, the collection Users Matter by Oudshoorn and
Pinch, 2003). Following Latour, who argued that „the fate of…. machines is in later users‟
hands‟ (Latour, 1987, p259), and Bijker, who argued that neither technology nor society
determines the other but rather they both „emerge as two sides of the same coin, during the
construction processes of artifacts, facts and relevant social groups‟ (Bijker, 1995, p.274),
much emphasis has been placed on how users shape technologies through the process of
„design-in-use‟. This socio-technical approach recognizes that technologies are not simply
„adopted‟ and „used‟ in an unproblematic sense. As Suchman argues, there are many
activities, and often much hard work, currently „glossed under the notion of technology
adoption‟ and that these involve „appropriating the technology so as to incorporate it into an
existing material environment and set of practices‟ (Suchman, 2002, p 93). Strauss (1985)
referred to this work as „articulation work‟.
It is this idea of technology being embedded into everyday life through processes of
„appropriation‟ and „articulation work‟ that we took into the Net.Weight study. As people
engaged in self care for over-weight and obesity management, our participants were
positioned as potential „users‟ of digital technologies such as the internet, to support their
self care practices. But how did this group of largely older people engage with technology
and appropriate it into their everyday lives and self care practices? What happened when
these „users‟ were engaged in a process of „design-in use‟?
In policy discourse, older people are typically defined as „digitally excluded‟ and interventions
offer access and training, often in public places. However, as the critical social science
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literature has shown, the picture is more complex than this. Early work by Wyatt et al (2002)
and Selwyn (2003) pointed to the importance of understanding agency with respect to non-
use of technologies. Selwyn (2003), in his analysis of those who stand „apart from
technology‟, emphasised the importance of different „readings‟ of technologies for
understanding different types and levels of engagement. Developing these themes, Wyatt
and Henwood (2005) and Henwood and Wyatt (2009) have explored gendered and aged
meanings attached to the internet and have argued for the importance of understanding
„relational‟ aspects of internet use and the ways in which the internet can be understood as a
site of both gender and age construction. Bose (2010), in her study of computer technologies
and embodiment in later life, and drawing on people‟s „technobiographies‟ (Henwood et al,
2001), has drawn attention to the generational significance of technologies, both in terms of
embodied competencies and cultural meanings where computer and internet technologies
are „coded as the domain of “youth” ‟ (Bose, 2010, p15). Gender and age are combined by
Loe (2010) in her study of women in their 90s and their engagement with everyday
technologies and routines of self care when she found that „Lifelong gender roles and
expectations‟ (including care work, relationship work and health work) continue to „organize
elders‟ lives and technology use in old age‟ (Loe, 2010, p322).
The Net.Weight survey showed that digital exclusion – if inclusion is deemed to have been
provided via access - was not a problem in the Net.Weight survey sample, with 84% having
access at home. However, people aged 60 or over were less likely to use the internet than
younger ones and, although lack of skill, knowledge, confidence and enthusiasm were not
reported as a problem for the majority, older people felt less confident than younger ones
and were more likely to agree with the statement that „the internet is not useful or interesting‟
than their younger counterparts. The internet was not widely used to support weight
management or to access local health information and services, with just under half of
respondents using it „sometimes‟ to access information about diets and exercise. Use of
social networking sites and other forms of potential support for weight management were
rarely used, especially by those in the older age groups.
In the participatory learning workshops and the reflective interviews held six months
afterwards, we learned much more about how age relates to computer and internet use. Age
was mobilized in participants‟ accounts as a way of making sense of their relationships to
computers and the internet- especially their non-use:
you gave us a lot of positive things to interact and not to be scared of computers, and not to be scared of really anything to do with the future where (we‟re??) not being of the computer age, you know. (Sandy, 54)
Olga (77) was asked about her interest in blogs, a topic covered in the workshops:
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It's terribly (pause), you‟re shooting something off into the ether, aren't you? I think a personal one-to-one, I mean, I did get, in the past, in groups, I've belonged to quite a lot, from that you know, which is a much more eye-to-eye contact, more personal…probably a generation thing (Olga, 77)
Georgia, one of the younger workshop participants at 54, summed up why she wasn‟t really
interested in going further with computers and the internet:
Maybe it's because of my age and I wasn‟t brought up on the computers so it's more, it's not like a natural thing that I do regularly… (Georgia)
Engagements with the internet were also shown to be relational, with gender and generation
being closely intertwined for many women, as this focus group extract suggests:
Female participant 1: ….I don‟t even know, I can just about put a video in…my
husband used to do it all and I never…
Female participant 2: Yes, but I don‟t use it – I make my grand-daughters use it.
Interviewer: You said that earlier you „weren‟t allowed‟ to use the internet?
Female participant 3: No. Because I went on it once and I lost the whole blinking lot –
twice I done it. [They] got an old one for me to play with.
Here, women make sense of their lack of confidence with computers and the internet, by
characterising them as technologies with which their male partners or children in the family
are more skilled and, perhaps, more entitled.
Sandy (54) was heavily reliant on her husband and son to help her with computers and the
Internet before the workshops. Her account suggests that her relationship to these
technologies was shaped by both gendered and generational relationships:
I mean the one day, I don‟t know what I did and the whole screen went black, and I said to [husband], „I‟ve finished with this computer‟, and I went and sat down you see, so he said to me, „did you switch it off?‟ I said, „I think I did, you know‟, but I hadn‟t! [laughs] So I‟d done something that the whole screen went black, because I mean, John, my son, gave me a computer to play with, and then I phoned him and I said to him „I don‟t know what‟s wrong but the computer‟s not working anymore!‟ So he said, „now what have you done?’
However, like many participants, Sandy gained experience and confidence in the
workshops:
I said to John the other day, „oh, I know what I haven‟t done in a long time, I must do my blog, update it, you know, tell people what‟s been going on and things like that‟. He said to me, „no, you just want to show off to [granddaughter]!‟ So I said to him, „yes..‟. (Sandy)
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Here, Sandy can be seen as using the technology to communicate both „what‟s been going
on‟ and a new sense of digital confidence, to the younger generation who are seen to „own‟
the technology.
Practice with computers and the internet was deemed important as participants embedded
technology into their everyday lives- a process of embodiment that Bose (2010), following
Mauss (1979) refers to as „body technique‟. Again, Net.Weight participants made sense of
this practice in terms of age and generation. Virginia (60) explained why she preferred to
work with people her own age:
I‟ve got some younger friends that sort of say „oh you just do this, this, and this‟, and that is so intensely annoying... They‟ve got to stand back and let me do it and if I get stuck, you know, it‟s my learning style...and them leaning over my shoulder and pressing some buttons and arriving at where I want to be just doesn‟t help...My older friends...they know about these things…they understand that you have to go through the process yourself and at your speed. (Virginia)
Virginia‟s experience was shared by others and may well be one of the reasons why
participants felt able to share their experiences with others in workshops where older people
were in the majority. However, participants wanted to go further than simply sharing their
individual experiences and improve their own individual skills and confidence in a mutually
supportive environment. They were keen to explore ways in which both healthy living
strategies and the information and technologies often heralded as tools for the prevention of
unhealthy living, could build on their collective experience and be appropriated in ways that
were more meaningful for the older people living in the city.
Like others in the workshops, Olivia enjoyed using her new found knowledge and skills in
blogging to support and motivate others, informing them, via Net.Weight Community5 about
swimming classes for older people and about a local radio host with whom one could
exercise „at a distance‟:
I don‟t know what she looks like, but she does this buttock clenching. You do it to a record, you have to sit there and clench your buttocks. It sounds like it‟s a good idea actually. I do it, if I‟m there with the radio on and I‟m at the computer……I told people about that, because I think you should listen to that. It‟s sort of quite motivating if you‟re indoors (Olivia, age not given).
Others shared recipes or blogged about their preferred healthy living approaches. For
Alexander (63), this was gardening with his dog (Let’s get gardening to burn the fat off), and
5 Net.Weight Community is a website set up as a prototype community-based resource where participants
could share experiences and information in an online environment in ways that reflected their interests and concerns. http://research.cmis.brighton.ac.uk/net.weight.community/
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for Amanda, this was keeping fit with her grandson (Weight loss with George), both sets of
activities grounded very much in their everyday lives and loves.
In engaging in an exercise to come up with ideas to re-design the local Active for Life
website (run by the PCT and the city council), participants again sought to bring their
experiences of age and ageing in the city to bear. Many felt that the site‟s use of „50 and
over‟ group didn‟t make sense as „life doesn‟t end at 49‟ and whereas „if you‟re over 70, you
don‟t want aerobics‟, the younger old may well do. In seeking an appropriate image and
slogan for their re-designed sites, participants wanted positive images of age and ageing.
One suggested: „How about two racing grannies and “Go for it”? ‟
Conclusion
In so far as self care is seen as key to the „prevention‟ strategy for older people, it is
important to think critically about self care. This paper has drawn on a study that explored
self care in relation to weight management and healthy living, where the majority of
participants were over 45. Their accounts illustrate how they negotiate between two co-
exiting discourses – self-care and self-help. While participants did, at times, position
themselves within self care discourse, taking individual responsibility for weight and health
and their management (often leading to feelings of inadequacy and self-blame which
undermined their attempts at self care), there were also very clear signs of resistance to the
idea that poor health and/or overweight is something that can be prevented by good
„management‟ alone. Both their resistances and their alternative positionings drew heavily on
their experiences of age and ageing, often alongside gender, suggesting the limitations of
generic healthy living messages and a simple causal relationship between information and
healthy choices and behaviours.
Participants‟ accounts of engaging with information about weight management show that
there are resistances to the „view from nowhere‟ and that lived experiences have produced
alternative „views from somewhere‟. These „somewhere‟ experiences include the embodied
experience of ageing and the desire for local, accessible and age-appropriate activities and
services also suggest the importance of the design and planning of services for „active
ageing in place’.
The study‟s participative approach facilitated the opening up of a space where participants
could engage with information and technologies often said to facilitate self care. It
demonstrated clearly that there was an interest not simply in improving individual skills and
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confidence in information and technology „use‟ to support self care, but in engaging critically
to appropriate and shape technologies in ways that support collective as well as individual
goals, thereby facilitating self-help as well as self care in the prevention of „unhealthy
ageing‟.
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