Critical Perspectives on Digital Health Technologies

Discussions of digital health technologies in the popular media and the medical and public health academic literature frequently comment on how these technologies might offer new or improved ways of delivering health care, conducting health promotion activities and monitoring public health. Following the presentation of an overview of the range of digital health technologies that are currently in use, I review the work of researchers in the field of critical digital health studies who have addressed their broader social, cultural and political dimensions. The discussion focuses on four major topics: health and medical websites and platforms; telemedicine and telehealth; the politics of digital health; and digitised embodiment. I end with identifying some important directions for future research in critical digital health studies.     

Moving Out of the Dark Ages: An Argument for the Use of Digital Video in social Work Research

ABSTRACT

The fields of anthropology and sociology are the origins of qualitative research. Early qualitative researchers documented findings through the use of copious notes. The invention of portable audio recorders lead to qualitative researchers taping their findings. The use of recording devices as the primary source of data documentation has been embraced by social work researchers. Though, in the last twenty years several advances in visual recording devices have been made which offer a significant potential for advancement in the data collection and analysis. Social Work continues to rely on the technology of the 1960s. The use of digital video presents many advantages over audio. Video gives depth, can be easily analyzed using a PC, and offers diversity in presentation of findings. This article discusses the history of qualitative research; the use of technology in data collection; the emergence of visual methods; the emergence of social work in the field; and a call for social work researchers to use video technology in their research.     

Measuring the Psychobiological Correlates of Daily Experience in Adolescents

Mapping the psychobiological correlates of social contexts, experiences, and emotional responses of adolescents in their daily lives provides insight into how adolescent well‐being shapes, and is shaped by, experience. Measures of these psychobiological correlates are enabled by devices and technologies that must be precise and suitable for adolescent participants. The present report reviews the most often used research measures, and suggests strategies for best practice, drawn from practical experience. The rapid advances in technological methods to collect attuned measures of psychological processes, social context, and biological function indicate the promise for multimodal measures in ecological settings. Attaining these methodological goals will support research to secure comprehensive, quality data, and advance the understanding of psychobiological function in ambulatory settings.     

Assistive technology for disabled visual artists: exploring the impact of digital technologies on artistic practice

Abstract

Disabled artists with physical impairments can experience significant barriers in producing creative work. Digital technologies offer alternative opportunities to support artistic practice, but there has been a lack of research investigating the impact of assistive digital tools in this context. This article explores the current practice of physically impaired visual artists and their experiences around the use of digital technologies. An online survey was conducted with professional disabled artists and followed up by face-to-face interviews with 10 invited artists. The findings illustrate the issues disabled artists experience in their practice and highlight how they are commonly using mainstream digital technologies as part of their practice. However, there is little awareness around novel forms of technology (e.g. eye gaze tracking) that present new creative opportunities. The importance of digital tools for supporting wider practice (i.e. administrative and business tasks) was also highlighted as a key area where further work is required.     

Looking at Digital Art: Towards a Visual Methodology for Digital Sociology

Over the last decade there has been a call for a new kind of sociological gaze, a digital sociology for a digital age. Has there been fundamental change in the key principles, the nature, and functions of social life in a digital age? In social and cultural theory, there is a long history of looking at how technology transforms art. In this article, I will use the medium of digital art to consider the unique nature of the digital age, the demand for a digital sociology, and the interrelated speculative imagination of such claims. Broadly situated within the sociology of art the methodological contribution of this article is to offer an analysis of artworks themselves, via the construction of a digital visual methodology. What digital culture, politics, and revealed in digital art? How can looking at digital art expand the tools for understanding digitally mediated lives?     

Examining Outpatient Treatment Dropout in Adolescents: A Literature Review

This literature review explores the research to date on adolescent mental health treatment drop out. As many as one in five adolescents in the United States has been diagnosed with an Axis-I psychiatric disorder. Adolescents with Axis-I psychiatric disorders face significant short- and long-term consequences if they do not obtain mental health treatment. However, treatment dropout research has focused on child and adult populations with little focus on the unique issues that are likely to impact adolescents. The theoretical underpinnings for understanding adolescent mental health treatment are explored in relation to adolescent psychological development and the therapeutic alliance. The review concludes with suggestions for future research to extend our understanding of adolescent treatment drop out.     

Are cash transfers the answer for child nutrition in sub‐Saharan Africa? A literature review

Early evidence is ambiguous on the effects of cash transfer programmes on children, but until the last few years there has been little focus on Africa. We review the literature on 20 cash transfer schemes, including 12 from sub‐Saharan Africa. Such interventions have shown improvements in household diet and, in some cases, to agriculture, but have not always improved child health. However, a larger perspective focusing on two key time periods for nutrition—adolescence and the first 1,000 days of life reveals more opportunities for impact. In particular, the opportunity to empower young women to access secondary education and the reduction of adolescent pregnancy rates can improve the health of African children. Cash transfer programmes show promise, though there is room for improvement.     

Advances in monitoring and evaluation in low- and middle-income countries

Data to inform and improve health care systems in low- and middle-income countries (LMICs) has been facilitated by the development of monitoring and evaluation (M&E) systems. The drivers of change in M&E systems over the last 50 years have included a series of health concerns that have animated global donors (e.g., family planning, vaccination campaigns, and HIV/AIDS); the data requirements of donors; improved national economies enabling LMICs to invest more in M&E systems; and rapid advances in digital technologies. Progress has included the training and expansion of an M&E workforce, the creation of systems for data collection and use, and processes for assessing and ensuring data quality. Controversies have included the development of disease-specific systems that do not coordinate with each other, and a growing burden on health care deliverers to collect data for a proliferating number of health and process indicators. Digital technologies offer the promise of real time data and quick adaptation but also raise ethical and privacy concerns. The desire for speed can cast large-scale evaluations, considered by some to be the gold standard, in an unfavorable light as slow and expensive. Accordingly, there is a growing demand for speedy evaluations that rely on routine health information systems and privately collected “big data” from electronic health records and social media.     

Digital technologies and the biomedicalisation of everyday activities: The case of walking and cycling

Walking and cycling have been transformed by digital technologies, which range from mapping apps for wayfinding, through ‘wearables’ which monitor activity, to social media apps for comparing activity within social groups. Some technologies are explicitly orientated to health projects, others are not, yet all have potentially profound effects on bodies, health‐orientated identities, and understandings of health. This paper uses the concept of biomedicalisation to explore emerging literature on the intersection of digital technologies with everyday mobility, focusing on walking and cycling. Beyond simply ‘medicalising’ mobility (by bringing it into the realm of public health), digital technologies contribute to various transformations of health: encouraging some health practices, inhibiting others; creating or excluding individual and collective health‐related identities; and reconfiguring health and well‐being. There is research evidence on the contingent and multiple relationships between digital technologies and social practices, with specific themes including quantification; the role of apps in framing walking as extraordinary, cycling as competitive; enabling users to perform as healthy, neoliberal citizens; and digital careers. There has been less attention on how social divisions are reproduced or disrupted by the mediation of mobility through digital technologies. Further research should consider the impact of digital technologies on political economies of health.     

Troubled hearts,care pathways and hospital restructuring: Exploring health services research as active knowledge

This paper explores the socially active character of contemporary forms of expertise through an institutional ethnographic analysis of health services research. The paper draws primarily on interview research to investigate how health services research helps shape text-mediated relations linking government health-care policy with local reform initiatives. In the paper, I focus on the use of a particular research report by managers, physicians, and others at a community hospital in Toronto, Canada as part of their efforts to standardize and reduce the duration of care provided to heart attack patients. I discuss how, through its intertextual presence, health services research helps to co-ordinate medical and managerial practices and rationalities into medico-administrative relations. I offer two examples of this process. The first focuses on the relations co-ordinated through the textual observance of inefficiency. The second addresses how the report helped resolve the problem of physicians’ resistance to reforming cardiac care. My analysis contributes to current perspectives on the relationship between discourse and action.     

Small-fiber neuropathy: answering the burning questions

Small-fiber neuropathy is a peripheral nerve disease that most commonly presents in middle-aged and older people, who develop burning pain in their feet. Although it can be caused by disorders of metabolism such as diabetes, chronic infections (such as with human immunodeficiency virus), genetic abnormalities, toxicity from various drugs, and autoimmune diseases, the cause often remains a mystery because standard electrophysiologic tests for nerve injury do not detect small-fiber function. Inadequate ability to test for and diagnose small-fiber neuropathies has impeded patient care and research, but new tools offer promise. Infrequently, the underlying cause of small-fiber dysfunction is identified and disease-modifying therapy can be instituted. More commonly, the treatments for small-fiber neuropathy involve symptomatic treatment of neuropathic pain.     

Prevalence Rates of Youth Gambling Problems: Are the Current Rates Inflated?

While there is a general consensus in the literature that it is common for youth to gamble, considerable variability in the reported prevalence rates of youth problem gambling has been found. More recently, issues concerning the possible overestimation of these rates have been raised. Arguments underlying the proposition that problem gambling rates for youth are inflated are examined. It is acknowledged that more rigorous research is required, including the need for the development and refinement of current adolescent instruments and screening tools, agreement upon a gold standard criterion for adolescent problem gambling, and clarity of nomenclature issues. The advancement of scientific knowledge concerning the underlying risk factors associated with the onset and course of youth gambling involvement and the role of effective adolescent prevention and treatment programs will require these fundamental research questions to be addressed.     

Interface methods: renegotiating relations between digital social research,STS and sociology

This paper introduces a distinctive approach to methods development in digital social research called ‘interface methods’. We begin by discussing various methodological confluences between digital media, social studies of science and technology (STS) and sociology. Some authors have posited significant overlap between, on the one hand, sociological and STS concepts, and on the other hand, the ontologies of digital media. Others have emphasized the significant differences between prominent methods built into digital media and those of STS and sociology. This paper advocates a third approach, one that (a) highlights the dynamism and relative under‐determinacy of digital methods, and (b) affirms that multiple methodological traditions intersect in digital devices and research. We argue that these two circumstances enable a distinctive approach to methodology in digital social research – thinking methods as ‘interface methods’ – and the paper contextualizes this approach in two different ways. First, we show how the proliferation of online data tools or ‘digital analytics’ opens up distinctive opportunities for critical and creative engagement with methods development at the intersection of sociology, STS and digital research. Second, we discuss a digital research project in which we investigated a specific ‘interface method’, namely co‐occurrence analysis. In this digital pilot study we implemented this method in a critical and creative way to analyse and visualize ‘issue dynamics’ in the area of climate change on Twitter. We evaluate this project in the light of our principal objective, which was to test the possibilities for the modification of methods through experimental implementation and interfacing of various methodological traditions. To conclude, we discuss a major obstacle to the development of ‘interface methods’: digital media are marked by particular quantitative dynamics that seem adverse to some of the methodological commitments of sociology and STS. To address this, we argue in favour of a methodological approach in digital social research that affirms its maladjustment to the research methods that are prevalent in the medium.     

The Longitudinal Influence of Coparenting Conflict on Parental Negativity and Adolescent Maladjustment

This study addresses two limitations of coparenting research: first, little research on coparenting has been conducted with families of adolescents, and second, there is little understanding regarding the child and family contexts in which coparenting is most salient. The longitudinal relation of coparenting conflict to parenting and adolescent maladjustment across 3 years was investigated among 516 2-parent, 2-adolescent families. Coparenting conflict predicted as much or more unique variance in parenting and adolescent adjustment as did marital quality and disagreement together. After controlling for stability, coparenting conflict predicted mothers' and fathers' negativity and adolescent antisocial behavior (but not depression). Importantly, the influence of coparenting conflict in all cases varied as a function of family type, adolescent gender, or initial level of antisocial behavior, or all. The implications of these results for family processes in different relational and developmental contexts are discussed.     

Adolescent Pregnancy's Intergenerational Effects: Does an Adolescent Mother's Education Have Consequences for Her Children's Achievement?

Although substantial work has examined the influence of adolescent pregnancy on mothers’ developmental outcomes, few studies have investigated the influence of adolescent mothers’ educational attainment on their children's achievement. This article examined the reading and math achievement trajectories of children born to adolescent and nonadolescent mothers with various levels of educational attainment. Results demonstrate that higher levels of maternal education predicted children's higher initial achievement at kindergarten and growth in achievement through eighth grade. The achievement of children with adolescent mothers, however, never reaches parity with the achievement of their peers with nonadolescent mothers. Race also predicted achievement differences. Black and Latino children of adolescent mothers were at greater risk for underachievement.     

Resolving design issues in developing a nutrition app: A case study using formative research

Mobile phone apps have become ubiquitous in health, but they often fail to demonstrate effectiveness in achieving behavior outcomes among intended users. A failure to conduct formative research on app content or functions may contribute to some of this shortfall. We describe simple research procedures we followed when building a nutrition app for low-income household cooks. Our studies improved the placement and design of key screen controls, helped select and guide an illustrator who created graphic support for textual content, and tested whether adding secondary users to the primary audience would attract additional app use.Whether because of these preliminary tests, or for other reasons, our app has generated heavy use by its intended market and has demonstrated desired effects on client behavior. We offer our experiences in formative evaluation as potential tools for other app developers to adapt to their circumstances.     

Mental Health Service Delivery to Sexual Minority and Gender Non-Conforming Students in Schools: A Winnicottian Approach

Current research highlights the increased risk factors that sexual minority (lesbian, gay, bisexual) and gender minority (transgender/gender non-conforming) students face as compared to their heterosexual and cisgender peers. These risk factors include higher rates of depression, suicide, substance use, school dropout, sexually transmitted infections, experiences with bullying on school campuses and increased risk of homelessness. Although this research has aided our understanding of the needs and risks of this population of youth, few articles have emerged from these data which offer a comprehensive theoretical approach to work clinically with these adolescents in school-based settings. This article explores how school mental health staff can address the behavioural health needs of sexual and gender minority students through the adoption of a Winnicottian theoretical approach. With an intensive focus on academic achievement, schools have historically been limited in their usage of evidence-based data to create programs which adequately address the mental health needs of student populations on their campuses. Yet, sexual and gender minority students are likely to be present in almost every school in the country. Schools can serve as gateways to mental health access and can offer innovative and culturally responsive practices across racial, ethnic, class, and geographic lines. As the single largest holders of the student population in the United States, schools have the ability to play a significant role in mental health service provision for sexual and gender minority youth.     

Exploring hope as a mediator between religiosity and depression in adolescents

ABSTRACT

Multiple studies have found an inverse relationship between adolescent religiosity and adolescent depression. However, further research is needed to better understand the complexity of this relationship. One potential mediator that may help to explain this relationship is hope. Prior research has found that adolescent religiosity is predictive of increased adolescent hope and that higher levels of adolescent hope have been associated with multiple positive outcomes, including mental health in adolescents. However, no research has explored the mediational role of hope between religiosity and depressive symptoms in adolescents. Cross-sectional data from 459 adolescents were used to test this mediational or indirect effect. The direct effect between religiosity and depressive symptoms was not significant. However, there was a significant indirect effect whereby higher levels of adolescent religiosity were associated with higher levels of adolescent hope, which in turn were associated with lower levels of adolescent depressive symptoms.     

Chinese Parenting Behaviors,Adolescent School Adjustment,and Problem Behavior

The present research examined the relationship between supportive and controlling dimensions of parenting behaviors and Chinese adolescent outcomes (school adjustment and problem behavior). Researchers collected self-report data from 589 adolescents in Hangzhou, China. Results showed the factor structure for the Parent Behavior Measure in the Chinese sample was different from the factor structure based on Western research. Specifically, paternal support did not emerge as a viable factor. Parental monitoring and involvement predicted positive adolescent outcomes, whereas punitiveness and permissiveness predicted negative outcomes. Surprisingly, maternal support predicted more adolescent problem behavior, especially for boys. Guilt induction, love withdrawal, and positive induction did not predict any significant adolescent outcomes when other parenting behaviors were controlled. School adjustment mediated and gender moderated the relationship between parenting and adolescent problem behavior. The importance of considering parenting behaviors, adolescent school adjustment, gender, and cultural norms when examining adolescent problem behavior was discussed.