In this PhD project there has been a fruitful relationship between the traditions of ethnography and participatory design, as both fields informed my engagement with the project. Taking part in participatory design activities in the ElderTech and Healthy Home projects opened up a field of investigation to ethnographic studies, and proved valuable in the exploration of healthcare technology in the home. The process of identifying problems and designing the projected system provided an arena for ethnographic study of the experiences of the project participants, healthcare professionals, patients, relatives, business partners, and computer scientists. Furthermore, studying and evaluating the pilot study of the prototypes provided unique opportunities to explore how users appropriate new technology, and how routines and working arrangements are transformed, as described earlier. Thus, the participatory design processes provided a field of investigation for the ethnographic studies, making it possible to follow negotiations and transformations at first hand, observing what took place.
Furthermore, the participatory design process also benefited from my ethnographic studies of how elderly people and pregnant women with diabetes manage their conditions in their everyday lives. The complexity of the interplay of the work of healthcare professionals, and their collaboration with patients and their practices of in-home self-care would have been difficult to explore in a participatory design workshop
(Randall et al. 2007, 77), and the ethnographic studies and analyses thus helped me gain an understanding of the setting of the projected system. The ethnographic analysis identified tensions and dilemmas in the field, which open up the design space and address the roles of technology and design (Dourish 2007, 13)11. Thus, the ethnographic studies address broader concerns, for example, the risks and responsibilities associated with the development of new technology for supporting pregnant women with diabetes in their self-monitoring and self-treatment. In this sense, ethnographic studies provided a tool for grasping complexity, bringing sensitivity to general issues that help to open up the design space.
Throughout this study, the two traditions of ethnography and participatory design intertwined in a mix of methods and activities. Moreover, my engagement in fieldwork and participatory design activities continuously interacted with the analyses of categories and patterns, drawing on different theoretical traditions to conceptualize my observations. The ongoing process of analysis was manifested in the writing of several articles during the PhD projects. Analysis took the form of an iterative process, involving a continuous shift between theory and data, with theory constantly inspiring the development of research questions, while acquiring data inspired the use of a theoretical framework (Hammersley & Atkinson 2007, 159). This interplay of data and theory was important, as it helped to explore from different perspectives the research question of what happens when healthcare technology is introduced to the home, unfolding the complexity of negotiations and transformations. Furthermore, this interplay is an important tool, as analysis helps reveal what is at the core of the research, and further informs the ongoing investigation. This enabled me to adjust further investigations, which would perhaps benefit from my asking different research questions in a different setting (ibid., 160), for example, when moving from elderly people to women in their 20s and 30s, or moving from asking questions about managing disease, to questions about managing health. Finally, this interplay helps to test the validity of preliminary findings by returning to the field, or by exploring whether the same patterns exist in other settings.
Thus, there has been an ongoing shift among research questions, fieldwork, participatory design activities, analysis, and theoretical framework (see figure 4, below).
11 The discussion of the role of ethnography in the design of technology stretches back to Anderson, in 1994. For a more recent contribution, see Dourish (2006) and Crabtree et al. (2009).
Figure 4: Overview of case studies and published papers.
Summing up
In this chapter, I have introduced the two cases – the ElderTech study and the Healthy Home project – that were central to exploring what happens when new healthcare is introduced to the home. The two cases address assistive technology for monitoring the health of the elderly, and for supporting self-monitoring and self-treatment among patients suffering from chronic conditions. The cases address challenges to the Danish healthcare sector, and the envisioned solutions that make use of healthcare technology, as described in the previous chapter. The current chapter describes the methods I used to explore these cases, by means of ethnographic studies of practices and experiences of the participants in the cases, in one instance, and, in the other, by partaking in a participatory design study in which users were engaged in the development of technology that supports self-care. I have also emphasized the interplay of fieldwork, participatory design activities, analysis, and the use of theory in the exploration of the research questions guiding the PhD project. In the following section, I introduce the theoretical approach of symbolic interaction, which has proved useful for conceptualizing and analyzing the fields of healthcare and healthcare technology in the home.
Chapter 3: Theoretical approach
To conceptualize the processes relating to the introduction of healthcare technologies, the dissertation draws on the field of Science Technologies Society (STS). Jensen et al.
(2007) introduce STS as a research community in which researchers come from diverse academic traditions, ranging from anthropology and sociology, to philosophy, history, and geography. This multi-professional perspective addresses various subjects, from the study of cancer research to user involvement in the development of technology (Jensen et al. 2007, 7). Unifying this heterogeneous field of STS research, however, is a shared interest in gaining a nuanced understanding of how organizational, technological, or scientific reality is constructed through concrete, material, and symbolic activity (Jensen et al. 2007, 11). Central to STS studies is an exploration of constellations or networks of humans, machines, and other entities. In these studies of how material artifacts tie locations, humans, systems, and interests together, traditional dichotomies of macro- and micro-scale studies are dissolved (Jensen et al. 2007, 11). Thus, empirical exploration and theorizing about practices within a socio-material network are fundamental to STS.