Navigating standards, encouraging interconnections: infrastructuring digital health platforms

Apps, websites and networked devices now offer to help consumers produce, access and share health knowledge, precipitating social scientific concern over the consequences of these so-called digital health platforms. This paper makes a novel contribution to this literature, taking up a recent call from Plantin et al. to adopt an infrastructural lens in exploring platforms. It argues, through empirical analysis of digital health platforms of different sizes, ages and nationalities, that this conceptual tool is necessary to surface the work entailed in creating and sustaining digital health platforms. Additionally, we suggest that the social scientific literature on platforms–and initial efforts to explore their infrastructural qualities–frequently focus too strongly on the dominant technology companies. Instead, we emphasise the value of drawing emergent companies’ platforms into empirical purview through returning to some of the infrastructures literature that informs Plantin et al.–particularly Susan Leigh Star and colleagues. We demonstrate empirically the importance of looking at standards as part of infrastructure building, and the broader set of interconnections between different actors and materials within an infrastructure. In doing so, we demonstrate the value of an infrastructural lens for understanding the density of interconnections that characterise digital health and propose some orientating questions for further enquiry into the infrastructural qualities of platforms

Everyday curation? Attending to data, records and record keeping in the practices of self-monitoring

This paper is concerned with everyday data practices, considering how people record data produced through self-monitoring. The analysis unpacks the relationships between taking a measure, and making and reviewing records. The paper is based on an interview study with people who monitor their blood pressure and/or body mass index/weight. Animated by discussions of ‘data power’ which are, in part, predicated on the flow and aggregation of data, we aim to extend important work concerning the everyday constitution of digital data. In the paper, we adopt and develop the idea of curation as a theory of attention. We introduce the idea of discerning work to characterise the skilful judgements people make about which readings they record, how readings are presented, and about the records they retain and those they discard. We suggest self-monitoring produces partial data, both in the sense that it embodies these judgements, and also because monitoring might be conducted intermittently. We also extend previous analyses by exploring the broad set of materials, digital and analogue, networked and not networked, involved in record keeping to consider the different ways these contributed to regulating attention to self-monitoring. By paying attention to which data is recorded and the occasions when data is not recorded, as well as the ways data is recorded, the research provides specificity to the different ways in which self-monitoring data may or may not flow or contribute to big data sets. We argue that ultimately our analysis contributes to nuancing our understanding of ‘data power’

Active buildings in the changing policy landscape: conceptual challenges and social scientific perspectives

As significant contributors to global CO2 and other GHG emissions globally, it is recognised that the energy and buildings sectors must find ways to decarbonise in order that climate change targets may be realised. For the energy sector, increasing levels of renewable energy production at all scales presents challenges for national electricity grids in matching supply to demand. Buildings as places of energy consumption and increasingly energy production, may become places for the intelligent storage and consumption of energy, providing grid flexibility through more complete integration into energy systems. Active buildings present a contemporary conceptualisation for addressing such environmental policy, technical and societal problems, incorporating low carbon building fabric design, renewable energy production and energy storage capacity with intelligent digitalisation. It is directed towards facilitating the scale-up of single buildings to neighbourhoods and beyond. With a number of building certifications, labels and conceptualisations already in existence, active buildings must offer a clear progression and differentiation of those already existing. A key factor under-represented in some existing concepts is understanding of the many diverse and valued roles that building play in society, as material places of commerce, education, healthcare, or home. Buildings, in all forms also have subjective and powerful values and meanings attached to them. For homes, these are formed through a multitude of factors; people’s past and anticipated future, life course transitions, social relationships, as well as wider social, economic and political contexts and structures, all of which vary in how they assemble in space and time. Such factors together also hold influence over how people carry out their everyday and energy practices. As buildings as homes are imagined as playing a dynamic role in future energy infrastructure, understanding the interplay between people, homes and energy and how this may alter as imaginaries are realised is essential to them fulfilling their many requirements. Adopting a social science lens, this paper outlines key international building certification schemes and conceptualisations, including their strengths and weaknesses, that should be drawn on in the formation of active buildings as homes. It also takes account of the changing policy and energy landscapes in the UK and raises critical questions for the conceptualisation of active buildings as active homes

Transformational innovation in home energy: How developers imagine and engage with future residents of low carbon homes in the United Kingdom

Decarbonisation and climate change targets require multiscale sociotechnical energy transitions that include significant changes to housing stock. In the UK, the development of Active Buildings, which directly seek to be efficient energy producers, have zero carbon emissions and provide grid flexibility, has the potential to make a significant contribution to meeting these targets. Active Homes as a particular type of Active Building represent a potentially transformational innovation by altering how energy is produced, distributed and consumed, in addition to how homes are designed, constructed and then lived in. In this paper we draw on insights from qualitative interviews with stakeholders involved in the development of different Active Homes to consider motivations for development, and their views on how residents will reside in and interact with the homes. We highlight a potential conflict between a desire to prioritise the needs of residents with a belief amongst some that to do so, user engagement with technology should be minimised. This has implications for design decisions, which in turn influence how residents experience and live within the homes. In illuminating these narratives, we indicate the necessity of ongoing engagement with residents to understand how Active Homes – with particular emphasis on the operation and control of technologies – are experienced, in order to inform the successful rollout of current and future developments

Identity, place narrative and biophilic urban development: Connecting the past, present and future for sustainable liveable cities

Urbanization presents sustainability challenges for the natural environment, resources and ecological systems, whilst high levels of pollution and disconnect from the natural environment can adversely impact the health and wellbeing of urban residents. Rapid urbanisation can also curtail processes of placemaking, including place attachment and place identity, raising questions around the social sustainability and liveability of cities into the future. With such concerns in mind, cities are increasingly called upon to develop in ways that are environmentally, socially, and economically sustainable. The concept of biophilia has been applied to sustainable urban development, in which nature and green infrastructure are systematically incorporated into cities to reduce adverse impacts to the natural environment while supporting the social, cultural and economic sustainability of communities. This paper explores findings from community focus groups centred on perceptions of a proposed biophilic urban development in Wales, UK. We highlight how community members understand and negotiate possible impacts the development may have on the city by drawing on their own emplaced experiences, as well as their perception of the city in relation to broader contexts of economic crisis and environmental change. We highlight the importance of temporally and spatially situated understandings of innovative building developments, as part of sustainable urban developments, and how such transformative processes should enable community place-making, and as such become valued, and sustained through time

Living in an active home: household dynamics and unintended consequences

To meet UK decarbonisation and climate change targets, significant changes to existing and future housing stock will be required. The development of Active Buildings has the potential to contribute to meeting these targets. Active Homes, as a particular type of Active Building, alter how energy is produced, distributed and consumed, as well as how homes are designed, constructed and then lived in. Before occupation, Active Homes are designed and developed around imaginary users, yet residents do not always live in the homes in ways envisaged by developers. This paper draws on data from a qualitative longitudinal study involving in-depth interviews with Active Home inhabitants and developers across five UK case sites. Interviews elucidate how developers envisage future residents and their assumptions about how people will live. As the household is a particularly gendered sphere of society, three qualitative longitudinal case studies are then presented to explore the way gender interweaves with women’s experiences of Active Home residence. Expert visions do not always fully encompass the gendered household dynamics of everyday life. Implications are drawn from how these Active Homes are experienced and lived in: what considerations developers can give to the design, controls and information that are more tailored to residents’ needs

From active houses to active homes: understanding resident experiences of transformational design and social innovation

Active Buildings can contribute to efforts to address decarbonisation and climate change targets, and have the potential to support social aspirations for technical and infrastructural change. Yet achieving such goals is challenging. Active Homes as a type of Active Building represent a particularly interesting prospect; altering how energy is produced, distributed, and consumed, but also how homes are designed, constructed, and lived in are studied. Active Homes are designed with expectations of how residents will engage with them, but residents do not always live in the homes in ways envisaged by developers. Hence, there is a risk that the homes will not be experienced as comfortable living environments, or otherwise perform as anticipated. Thus, understanding resident perspectives is crucial to the successful wider rollout of Active Homes. We draw on social science research with designers, developers, and residents to explore expectations of life in an Active Home. Our longitudinal research design enables us to contrast early expectations with post-occupancy experiences, elucidating what residents consider to be successful aspects of Active Home developments. Our research reveals instances where expectations remain unfulfilled, or where living in the homes has been experienced as challenging or disruptive. In highlighting such insights, we offer recommendations relevant for future development

Living well in low carbon homes project report

Final report for the Living Well in Low Carbon Homes Project, part of the Active Building Centre Research Programm

Healthcare practitioner views and experiences of patients self-monitoring blood pressure: vignette study

Background Home self-monitoring of blood pressure is widely used in primary care to assist in the diagnosis of hypertension, as well as to improve clinical outcomes and support adherence to medication. The National Institute for Health and Care Excellence (NICE) care pathways for hypertension recommend specific guidelines, although they lack detail on supporting patients to self-monitor. Aim To elicit primary care practitioners’ experiences of managing patients’ home blood pressure self-monitoring, across surgeries located in different socioeconomic areas. Design & setting A qualitative focus group study was conducted with a total of 21 primary care professionals. Method Participants were GPs and practice nurses (PNs), purposively recruited from surgeries in areas of low and high deprivation, according to the English indices of multiple deprivation. Six vignettes were developed featuring data from interviews with people who self-monitor and these were used in five focus groups. Results were thematically analysed. Results Themes derived in the thematic analysis largely reflected topics covered by the vignettes. These included: advice on purchase of a device; supporting home monitoring; mitigating patient anxiety experienced as a result of home monitoring; valuing patients’ data; and effect of socioeconomic factors. Conclusion The work provides an account of methods used by primary care practitioners in the management of home blood pressure self-monitoring, where guidance may be lacking and primary care practitioners act on their own judgement. Findings complement recent policy documentation, which recognises the need to adopt new ways of working to empower patients (for example, additional support from healthcare assistants), but lacks detail on how this should be done