The Frictions and Flows of Data-Intensive Transformations: A Comparative Study of Discourses, Practices, and Structures of Digital Health in the U.S. and India

Thesis (Ph.D.)--University of Washington, 2014This dissertation examined the social and organizational implications of data-intensive transformations in healthcare through studying digital health and processes of informationalization in the U.S. and India. These transformations bring challenges of how to mobilize digital health data across different contexts of use and make data valuable for multiple stakeholders. To study these challenges I employed a combination of discourse analysis, ethnographic methods, and a comparative case study analysis to investigate digital health innovation across rural healthcare and urban consumer health and wellness settings in the U.S. and India. Through a communication lens this research examines sociotechnical interoperability for data across domains on three levels: discourses, communicative practices, and organizational structures and labor. Across the discourses and practices of different communities, I found communication gaps around health and wellness data. To explain these gaps I propose the concept of data valence to represent the different expectations and social values that mediate the social performance of data. Analysis through a data valence lens generated the following typology: actionability, connection, self-evidence, truthiness, discovery, accountability, and transparency. Mapping the multiple, and sometimes conflicting valences across contexts accounts for the multiple social and material lives of data and highlights tensions across stakeholder groups. I argue that this typology is portable to other fields of data-intensive work. In comparing cases of digital health pilot projects, the differences between reinforcing and redrawing professional boundary relations, and in the role of intermediary labor in translation of digital health data for clinical and administrative sensemaking, patient engagement, and algorithmic calibration, at one time support polyvalent data in the U.S. Telehealth case and hinder it in India mHealth. Further, in the aftermath of the terminated U.S. Telehealth project, aspects of the technology continued to materialize within organizational practices and structures, such that organizational changes became the technological residue of the pilot projects. This suggests digital health's emphasis on technological innovation overlooks essential organizational and communicative dimensions of informationalizing healthcare and needs to be expanded beyond measures of success and failure to account for how technological innovation extends into and co-evolves with a wider network of organizational practice

What We Talk About When We Talk Data: Metrics, Mobilization, and Materiality in Performing Health Online

In this paper we develop a critique of the concept of data as culturally embodied and materialized in and around online health and wellness communities. Drawing on two years of qualitative, ethnographic observations, participation, and interviews in the field of consumer health and wellness digital technologies with the designers and users of internet-based health and wellness data “tracking,” our work explores the gap between discourses of data, the practices of, with, around and through data, and the contexts in which data “live.” Together, through these discourses, practices, and contexts, what we term $2 emerge, allowing data to perform in different ways in different communities in different contexts and for different purposes.We extend an emerging scholarly conversation about the nature of data by pointing to the ways that data valences may be contested or negotiated at the boundaries of institutions. This is what we refer to as polyvalent data: when data has multiple, and sometimes contentious valences. Within institutions data valences come with more institutional authority and seemingly cohere and congeal within those institutional settings. What we see in our research is that at the intersections between institutions or, what we call interstices, the polyvalent nature of data is more apparent. We identify six data valences: 1) self-evidence, 2) actionability, 3) communication/connection, 4) transparency/openness, 5) truthiness, and 6) discovery and map their emergent symbolic and material performances across the discourses, practices, and contexts of health and wellness communities of practice

Materiality: Challenges and Opportunities for Communication Theory

Increasingly, communication researchers are issuing calls for attention to the role materiality plays in communication processes (e.g., Boczkowski, 2004; Boczkowski & Lievrouw, 2008; Leonardi & Barley, 2008; Leonardi, Nardi, & Kallinikos, 2013; Lievrouw, 2013). Resulting in part from the challenges of studying new communication and information technologies, this new focus on materiality offers opportunities for communication researchers to theorize beyond communication through, with, and, in some cases, without a medium to think about the material structures of mediation itself. In this chapter we propose a model for thinking through the communicative roles and functions of the materiality of everyday objects, by using one type of objects, documents, as an extended theoretical example of the importance of materiality for communication