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
01/08/2015 © The University of Sheffield
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
01/08/2015 © The University of Sheffield
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
01/08/2015 © The University of Sheffield
01/08/2015 © The University of Sheffield
1972
01/08/2015 © The University of Sheffield
1977
01/08/2015 © The University of Sheffield
01/08/2015 © The University of Sheffield
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
…
01/08/2015 © The University of Sheffield
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
01/08/2015 © The University of Sheffield
01/08/2015
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
01/08/2015 © The University of Sheffield
Research design
01/08/2015 © The University of Sheffield
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)
01/08/2015 © The University of Sheffield
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.”
01/08/2015 © 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.
01/08/2015 © The University of Sheffield
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.
01/08/2015 © The University of Sheffield
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
01/08/2015 © The University of Sheffield
01/08/2015 © The University of Sheffield
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.
01/08/2015 © The University of Sheffield
QUESTIONS?
01/08/2015 © The University of Sheffield
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

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

  • 1.
    Utilising symbolic interactionismto explore users’ interpretations of technologies designed to support health and social care European Society for the Study of Symbolic Interaction (ESSSI) Conference Mark Hawker
  • 2.
    My perspective • Iam 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 01/08/2015 © The University of Sheffield
  • 3.
    Problem statement • Weare 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 01/08/2015 © The University of Sheffield http://www.parliament.uk/business/publications/research/ key-issues-for-the-new-parliament/value-for-money-in- public-services/the-ageing-population/
  • 4.
    One example, telecaresystems • 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 01/08/2015 © The University of Sheffield
  • 5.
    01/08/2015 © TheUniversity of Sheffield 1972
  • 6.
    01/08/2015 © TheUniversity of Sheffield 1977
  • 7.
    01/08/2015 © TheUniversity of Sheffield
  • 8.
    01/08/2015 © TheUniversity of Sheffield
  • 9.
    Six dimensions underpinningmy 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 … 01/08/2015 © The University of Sheffield
  • 10.
    Six dimensions underpinningmy 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 01/08/2015 © The University of Sheffield
  • 11.
    01/08/2015 My (theoretical) approachto healthcare technology usage
  • 12.
    A note ondomestication • “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 01/08/2015 © The University of Sheffield
  • 13.
    Research design 01/08/2015 ©The University of Sheffield 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
  • 14.
    What have Ifound? • 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) 01/08/2015 © The University of Sheffield
  • 15.
    Uncertainty, change andidentity “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.” 01/08/2015 © The University of Sheffield
  • 16.
    ‘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. 01/08/2015 © The University of Sheffield
  • 17.
    A creative useof 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. 01/08/2015 © The University of Sheffield
  • 18.
    Discussion • Telecare systemsare 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 01/08/2015 © The University of Sheffield
  • 19.
    01/08/2015 © TheUniversity of Sheffield An Interactive Healthcare Technology Usage Model (IHTUM)
  • 20.
    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. 01/08/2015 © The University of Sheffield
  • 21.
    QUESTIONS? 01/08/2015 © TheUniversity of Sheffield
  • 22.
    Utilising symbolic interactionismto explore users’ interpretations of technologies designed to support health and social care European Society for the Study of Symbolic Interaction (ESSSI) Conference Mark Hawker