Abstract
New feminist materialism theories potentially offer a foundation for innovative ways to research health-related experiences from a more-than-human perspective. Thus far, however, few researchers have taken up this more-than-human and post-qualitative approach to investigate health topics. In this article, I outline some approaches I have developed. I begin with a brief overview of the central tenets of new feminist materialism scholarship and a discussion of some empirical studies where these perspectives have been employed to address health topics. I then list some key propositions, research questions, and things to think with from the feminist materialism literature that I have put to work as a basis for conducting empirical research and analyzing data. Then follows four examples drawn from my research on digital health, providing instances of how qualitative researchers can take up this approach and what insights can be generated from entering into this kind of “research assemblage.”
Keywords
Introduction
New materialism theory has begun to make an impact on approaches to empirical research in the social sciences. New materialisms incorporate a multitude of approaches, including new feminist materialism. Although researchers have begun to use new feminist materialism in qualitative analyses of health, attracted by the novel ways they offer for analyzing and conceptualizing human subjectivity and embodiment, agency and power relations, and the entanglements of humans with nonhumans in more-than-human worlds, the mechanisms by which empirical research can be undertaken while working with these ideas have tended to be insufficiently articulated. There is a certain vagueness or even mystique around how to “do” applied feminist materialism research. This can make it difficult for readers of their work or those who would like to adopt a similar approach to fully engage with their ideas and methods.
In the attempt to develop a clearer understanding of how researchers can take up and think with feminist materialism theory in qualitative health research, in this article, I outline some approaches I have developed when conducting analyses of the social impact and lived experiences of digital health technologies (e.g., health-related mobile phone apps, wearable monitoring devices, social media platforms, and online discussion forums). I begin with a brief overview of the central tenets of new feminist materialism theories as espoused by some of its most influential and inspiring scholars and a discussion of some empirical studies where these perspectives have been employed to address health topics using qualitative research materials. I then list some key propositions, research questions, and things to think with that I have drawn from the feminist materialism literature as a basis for conducting empirical research and analyzing data. Then follows four examples drawn from my research, providing instances of how qualitative researchers can go about taking up this approach and what insights can be generated from entering into this kind of “research assemblage” (Fox & Alldred, 2017).
New Feminist Materialism: A Brief Overview
Although a range of eclectic perspectives are included under the rubric of new materialisms, they share a critique of and focus on interrogating the nature of the “human,” including acknowledgment of the actors (including those normatively considered to be “nonhuman”) that come together to configure more-than-human worlds (Braidotti, 2018). A new materialisms approach contends that social justice and other political issues should involve recognition of the role of nonhumans as well as humans in knowledge production and power relations (Fox & Alldred, 2017; Ulmer, 2017). The use of the word “new” to characterize new materialisms can suggest a break with previous theoretical approaches to human subjectivity and embodiment. However, there is more continuity in theoretical development than this terminology suggests. Contemporary new materialisms, including new feminist materialism, have emerged over many years (Braidotti, 2018; Fox & Alldred, 2017).
The antecedents of contemporary feminist materialism are based in a range of theorists, including Spinoza, Foucault, Latour, Deleuze, and Guattari. In new feminist materialism scholarship, there is also a foundation in sociocultural and philosophical perspectives on embodiment such as those articulated by feminist theorists such as Elizabeth Grosz (1994) and Margrit Shildrick (1997), who have long argued for the importance of directing attention to the ontologies of the fleshiness, affective, and sensory dimensions of human existence, and the philosopher Merleau-Ponty (1962), who wrote about the phenomenon of intercorporeality, or the distribution of embodiment beyond the individual body to other humans as well as nonhumans.
Donna Haraway, Karen Barad, Rosi Braidotti, and Jane Bennett are among the most influential scholars in new feminist materialisms. These scholars’ writings are perhaps most inspiring for their insistence on emphasizing the vitalities, perversities, and vibrancies that emerge with and through human–nonhuman assemblages. Theirs is an affirmative ethics and politics, which celebrates the renewal and liveliness of the capacities that these assemblages generate.
These theorists adopt a range of terms to describe their more-than-human philosophies. Barad (2003) describes conducting analyses of “posthumanist performativity,” in which “practices/doings/actions” receive attention (p. 802). Matter (otherwise understood as things, objects, bodies, spaces, and places), she argues, is “an active participant in the world’s becoming” (Barad, 2003, p. 802). Haraway (1985), known well for her cyborg theory which highlighted the dissolving of boundaries between the human and the nonhuman, now insists that she is not a posthumanist, but rather a compostist (Haraway, 2015, 2016). She employs the metaphor of compost to describe the rich variety of human and nonhuman actors that come together in assemblages and their potential to generate vitalities. Bennett’s (2009, 2010) concept of “thing-power” draws attention to the agential capacities generated with and through humans’ entanglements with nonhumans.
A feminist materialism analysis takes a micropolitical focus, drawing attention to the onto-ethico-epistemological entanglements of matter and meaning (Barad, 2007). Barad (2007, 2014) uses the term “intra-action” to encapsulate the agential capacities generated when components of assemblages come together. This term differs from interaction by emphasizing that agencies are not exchanged between one actor and another, but rather emerge with and through the entanglements of actors as they be/come together in assemblages and respond to and enact each other.
“Agential cuts,” another term of Barad’s (2007, 2014), refers to the boundary-making work of distinguishing between the infinite array of meanings available when assemblages are formed. Barad’s concept of “diffraction” has also made an impact in what is sometimes referred to as “post-qualitative” research (Lather & St. Pierre, 2013). According to Barad (2014), a diffractive analysis differs from the standard reflective perspective taken in traditional qualitative research. Rather than look for similarities, the diffractive method focuses on difference. This is achieved in part by bringing different research and theoretical perspectives from different disciplines together, reading insights through each other to find new ways of looking and thinking about more-than-human worlds. From this perspective, what counts as “truth” is always contingent, contextual, and emergent, dependent on enactments of agential cuts. Research of any kind is viewed as performative and partial.
Because of their feminist standpoint, these scholars work to uncover the gendered dimensions of the more-than-human world. They are also concerned with other political issues, especially those relating to the environment and the Anthropocene. This is a key difference between feminist materialism and actor–network theory, which does not often seek to take an overtly political or ethical stance. Braidotti (2018) contends the critical analysis should work “to expose power as both entrapping and repressive (potestas) and empowering and affirmative (potentia)” (p. 3). This is a post-Foucauldian approach to power that deepens his insights about the productive and vital nature of power. Braidotti sees Foucauldian biopolitical perspectives as insufficient as they do not focus enough on the potential vital forces of more-than-human assemblages. Her emphasis, therefore, is on affirmative critique, analyzing changing notions of the “human,” in what she calls “the critical posthumanities” (Braidotti, 2018).
Feminist Materialism and Empirical Health Research
Qualitative health researchers have been interested in the materiality of embodiment and the relationships between material things, such as space, place, and objects, and human health for some time. In this journal, for example, the role of physical environments in contributing to or detracting from states of health and well-being has been acknowledged (Chang, 2016; Finell, Seppälä, & Suoninen, 2018), whereas the importance of recognizing the inevitable embodied nature of research has also received attention (Benoot & Bilsen, 2015; Ellingson, 2006; Sharma, Reimer-Kirkham, & Cochrane, 2009).
In concert with these interests in the materiality of human experience, new materialisms scholarship has gradually been taken up in empirical social research on health-related topics. Actor–network theory and Deleuzian approaches have dominated in this literature thus far (e.g., Alldred & Fox, 2017; Fox, 2017). Publications presenting qualitative analyses of health with more emphasis on new feminist materialism theory have only very recently begun to appear. For example, Dennis (2018) responds to the work of Braidotti to examine what she describes as the “enwinded” dimensions of smoking pleasure. She explored the sensory aspects of air and smoke, and how these entangle with smokers’ experiences, generating specific agential capacities that contribute to the pleasure of smoking. Frigerio, Benozzo, Holmes, and Runswick-Cole (2018) used an approach inspired by Barad to analyze an interview with a mother about her young daughter on the autism spectrum, identifying the key issues, dynamics, and intra-actions that prompted the mother to realize that her child was “different” from other children and to seek a diagnosis. Barad’s diffractive methodology was employed by Claiborne (2017) in analyzing her father’s encounter with Parkinson’s disease after exposure to pesticides and the assemblages of insects, humans, water, and chemicals that came together in his experiences.
Thus far, feminist materialism has been little employed in empirical research on digital health technologies. This is despite the fact that in recent years, digital health technologies have been championed and promoted as solutions for delivering better health care and preventive health by technology developers, government departments of health, health insurance companies, schools, and workplaces (Lupton, 2017a). One exception is a content analysis of apps designed to promote youth mental health, in which Fullagar, Rich, Francombe-Webb, and Maturo (2017) identified the affective arrangements and pedagogical modes of address through which embodied distress is rendered intelligible and actionable. In my own recent research, I have attempted to take up the work of feminist materialism scholars to analyze such topics as digital media relating to food activism (Lupton, 2019); health, fitness, and diet tracking apps (Lupton, 2018b; Lupton & Smith, 2018); and digital health technology use across the range available (Lupton, 2018a; Lupton & Maslen, 2018). My approach is outlined in more detail below, using examples from four different studies involving a variety of research materials to demonstrate the creative potential of these perspectives.
Doing Feminist Materialism Research
A major difficulty with current feminist materialism empirical work is that a methodology for how to go about conducting it is often described in very vague terms: if indeed it is described at all. Researchers adopting a method informed by new materialisms acknowledge that they are part of a “research assemblage” (Fox & Alldred, 2017), in which their own embodied and experiential positions and interests contribute to what they choose to research and how their research material is analyzed. Analyses can therefore only ever be partial rather than making universal claims. In my case, for example, I select research topics and decide on methods for generating, analyzing and writing about the research materials that I generate based on aspects such as my educational background, my previous and current research experiences and ideas, a multitude of experiences outside academic work, and my embodied position as (among other attributes) a female-identifying, Anglo-Celtic, able-bodied, economically privileged senior academic living in a wealthy country. As is the case with any researcher, my unique and ever-changing standpoint and the affective forces that drive it inevitably affect my scholarship in ways that cannot always be easy even for myself to consciously identify.
Post-qualitative enquiry (Lather & St. Pierre, 2013) draws on new materialisms and other posthumanist theoretical positions to call into question fixed notions of selfhood and the human. Rather than focus on what humans are, it directs attention to how humanness is performed and practiced in entanglements with nonhumans (Fullagar, 2017). Fox and Alldred (2017) argue that the key question from a new materialist perspective is not what a method “is” but what it can “do”: What does the research assemblage offer to answer a particular research question? This is a new materialist approach to research itself. It focuses on the quality of the insights and critique that can be offered by analysis and directs attention to the micropolitics of assemblages. From a feminist materialism perspective, researchers make a series of agential cuts in deciding what to research and how to present their arguments. They seek to “think with theory,” acknowledging and highlighting the importance of the theoretical perspectives on which they are drawing in shaping their research questions, choice of research materials, and analysis (Marn & Wolgemuth, 2016; Mazzei, 2014). Some approaches seek to highlight the researcher’s sensory responses to the phenomena under investigation, using arts-based approaches or creative writing to identify more-than-representational elements of sensory and affective forces and flows (Borovica, 2019; Ulmer, 2016).
On account of what has sometimes been referred to as the “diffractive” analytical approach (drawing on Barad’s theory of diffraction), researchers outline how they focus at what research data “do” rather than what they mean. They seek to analyze research materials by tracing affective intensities in their empirical contexts (Bozalek & Zembylas, 2017; Davies, 2014; Lenz Taguchi, 2012; Mazzei, 2014). They “plug in theory” (Mazzei, 2014) and look for “the glow,” or places where the data generate affective resonances in the researcher (MacLure, 2013). Diffractive analysts see their approach as distinctively different from reflective analysis, which they characterize as involving critical reflection that focuses predominantly on language and discourse, and on meaning, sameness, and resonances (Bozalek & Zembylas, 2017; Davies, 2018) using “habitual normative readings” like coding (Mazzei, 2014). Diffractive analysis is considered to focus more on identifying difference and unpredictable insights, as theory-driven rather than generating the kind of coherent narrative that is viewed as characterizing reflective analysis. Researchers attempt to “think with theory,” allowing theoretical concepts to guide their analytic focus and reading these theories through one another and making new connections (Jackson & Mazzei, 2012; Mazzei, 2014).
Critics of post-qualitative and diffractive approaches have suggested that in these accounts, the intuition and affective responses of the researcher are mythologized, and the researcher’s responses tend to be highlighted over the worldviews and experiences of those who are the subjects of his or her research (Gerrard, Rudolph, & Sriprakash, 2017). It can be difficult to ascertain exactly what researchers are doing when they are conducting their analyses. This can be challenging for others who would like to attempt a similar approach but remain uncertain about how to go about it. Furthermore, most of the empirical studies drawing on feminist materialism theory that have been published thus far use a very small amount of research materials: typically, a handful of interviews or observations, small numbers of creative works, or an autoethnographical account. They assume and rely on the researcher being physically present when observing, talking to, or otherwise physically engaging with the subjects of her research in the same temporal and spatial context.
This can be a valuable approach, but it is limiting of possibility. When the research materials are generated by others in the absence of the researcher, such as when other people conduct interviews or observations and the researcher has to rely on taped or transcribed material for her analysis; or when the research materials are pre-created objects such as books, news articles, policy documents, survey data, websites, apps, photographs, or social media content; or when the researcher is dealing with a larger data set, this intense embodied approach to analysis cannot be undertaken. The multisensory engagements that can occur when researchers are physically present with their research subjects are closed off, and researchers must rely on other methods of sensitizing themselves to the research materials to make their agential cuts. In this context, “becoming with the data” works differently.
Some Propositions, Key Questions, and Research Materials to Think With
Emphasizing again that there is no one method for undertaking an empirical analysis that engages with feminist materialism theory, I outline the approach that I have developed here, portrayed as a series of propositions and key questions that I have found inspiring to creatively think with rather than as a definitive “cook-book” of methods. My approach incorporates both reflective and diffractive methods, depending on the research questions and materials I am working with. While post-qualitative and diffraction researchers sometimes overtly eschew what they view to be the overly prescriptive approach of attempting to find themes or discourses in research materials (St. Pierre, 2017), I would argue that this approach can be valuable, particularly if the research materials are voluminous.
These propositions and questions have been drawn from my reading of feminist materialism and other new materialisms theory, in conjunction with my review of and engagement with how other social researchers have taken up materialist approaches as I have discussed above. They can be used in relation to many kinds of social research material, including survey responses, media artifacts, artworks and performances, interviews, ethnographic observations, policy documents, autoethnographies, and many more. They can work to inspire and provoke ideas when formulating research approaches and analyzing research materials.
Propositions
Research focuses on understanding and mapping ontologies of the “human” (understood as a category that is difficult to define and may include “more-than-human,” “posthuman,” “transhuman,” and other varieties).
Human subjects are unstable and emergent knowing, sensing, embodied, affective assemblages of matter, thought, and language, part of and inseparable from more-than-human worlds.
These assemblages generate relational connections and affective forces and agential capacities.
Together, these connections, forces, and capacities constitute thing-power.
Because of the constantly changing nature of these assemblages, there are possibilities for change, resistances or improvisations, or for thinking otherwise.
Power is transitory as it is enacted within and between assemblages and is both constraining and enabling.
All matter has an agential capacity to affect and be affected.
Researchers are part of the research assemblages they are addressing.
Analyses are only ever partial, the results of specific agential cuts or interpretations of the research materials based on researchers’ standpoints and their choices in thinking with theory.
These propositions can be taken up in many different ways in more-than-human research. They can be developed into a series of key research questions that can be used to guide the ways in which empirical research is conceptualized and carried out, including the choice of how to approach the collection of research materials and their analysis. The following key research questions are some that I have developed for my health-related research.
Key Questions for Qualitative Health Research
What are the key humans and nonhumans, practices, imaginaries, assumptions, and discourses operating across different spaces and sites relating to health?
What conditions of action and possibility do users, developers, and promoters of health and medical technologies establish?
What can human bodies do when coming together with things and places?
How are health, illness, and health care configured and enacted?
How do humans incorporate and improvise with material objects and places?
What relational connections, affective forces, and agential capacities are generated?
What is the thing-power of these assemblages?
How is this thing-power constraining or enabling?
What are the potentials for thinking or doing otherwise?
Addressing these key questions to health and medical topics can identify the micropolitical dimensions of people’s engagements with things, spaces, and places across the manifold contexts in which they come together with other humans and nonhumans. In adopting a micropolitical focus, they can explore the details and complexities of how patients and lay people come together with health care and public health workers, and the role of policies, practices, procedures, and technologies in these enactments. These approaches can begin to explain why some initiatives like digital health technologies are successful and why others fail to work as imagined. They can take account of aspects such as socioeconomic status, gender, age, sexual identity, geographical location, ethnicity or race, and the biographical features of people’s lives in shaping their experiences of health and health care.
Research Materials
In a more-than-human approach to critical social analysis, many kinds of research materials can come under investigation: not only human bodies but also those of other living things, as well as nonliving objects, spaces, places, and atmospheres. In the context of health research, these are some possibilities (among many): human bodies (or parts of them—organs, blood, sweat, tears, bones, limbs, skin, gametes, fetuses), nonhuman animals, policy documents, news articles, journals, online patient support networks, websites, search engines, telemedicine technologies, social media content (status updates, tweets, likes, shares, hashtags), photographs, television programs, films, videos, audio recordings, digital memes, GIFs, robots, hospitals, clinics, waiting rooms, homes, furniture, clothing, wearable devices, apps, mobile devices, video games, sounds, smells, tastes, haptic sensations, digital data sets, artworks, design artifacts, heart pacemakers, continuous glucose monitors, cities, rural landscapes, air, earth, water, sunshine, and so on; the list is infinitely expandable.
Some Examples
In some recent studies, I have been using a range of research materials to conduct a more-than-human analysis of digital health technologies that engage with feminist materialism. In what follows, I present some examples I have been working with, using the propositions and key research questions outlined earlier. I show how I approached the generation and analysis of the research materials, demonstrating what each material can offer in terms of generating insights into the possibilities and limitations of digital health technologies. This approach and materials can be used in qualitative research on any health topic. I begin with a government digital health policy document published online. This is followed by examples drawn from studies focusing on people who engage in self-tracking and commuting cyclists who use digital devices to monitor their rides, and finally from a participatory design stakeholder workshop. These studies were all approved by the University of Canberra’s human ethics research committee.
Example 1: Digital Health Policy Document
A government policy document from a more-than-human research perspective can be viewed as a material object that is part of heterogeneous and dynamic assemblages. These kinds of policy documents are usually configured by several human actors and agencies working in consultation rather than a single author. Like any other type of official document with a public-facing and policy orientation, it is written in the service of pragmatic purposes. As a government document, it has a political purpose that presents the government agency to the public in certain ways, often seeking to demonstrate that the government has a clear and authoritative plan of action to serve its publics. In doing so, a policy document draws on the government’s foundational ideologies and key preoccupations. Its authors (who are often anonymous, speaking with an institutional voice) have positioned the policy as an agential cut, a bureaucratic attempt to make meaning from an infinite range of possible meanings, and doing this by conforming to the expectations of the policy document genre and the political environment in which they are producing it. In the case of a digital health policy document, it has many potential audiences, from commercial entities to other government agencies, health care institutions, health care practitioners, and educators to citizens themselves.
One example is Public Health England’s (PHE) digital strategy document “Digital-First Public Health” that is readily available online on the Gov.UK website (PHE, 2017). This document was identified during a process of generating a background analysis of British digital health policies, one of a corpus of texts collected as part of a study of English young people and digital health. I read the document informed by the analytic perspective outlined earlier, that sensitized me to identifying the relational connections, affective forces, and agential capacities that were evident in the words and phrases it employed. I further looked for the ways in which PHE positioned itself and its audiences, and how the phenomenon of digital health was discursively portrayed in the text.
The language used in the strategy document draws on a range of relational connections and affective forces to position PHE as taking charge of digital health and leading the way. The usual techno-solutionist buzz words are employed in the attempt to create sociotechnical imaginaries of transformation and positive change. The document begins with the following words: This is a time of digital innovation. Technology is constantly changing the way people live, interact, learn, play and work, offering new opportunities to change the way Public Health England (PHE) connects and interacts with people.
In these opening lines of the document, PHE represents digital technologies as lively, active, forceful, and transformative, working on people’s lives and transforming them, changing PHE’s method of connection and interaction with the citizens it attempts to influence. The document goes on to represent digital technologies as “tools” which “offer new ways to gather and analyse data, engage within PHE and with our stakeholders, and improve public health.” They are described as potentially “driving efficiency and deliver value for money across PHE.” In these opening statements, digital technologies are presented as separate entities from the people they affect, exerting a powerful impact on people rather than the other way around.
There are sociotechnical imaginaries embedded within these claims that ascribe great power and potential to digital technologies as agents of change and of connection. They are positioned as novel, part of a “rapidly changing world” that “offers many opportunities but also some challenges to public health.” Novelty, therefore, can be confronting, provoking anxiety as well as excitement and opportunity, and creating the need for “new thinking about public health provision models, data, governance, partnership and engagement.” PHE positions itself here as aware of changing times, but willing to adapt to these and also benefit from novel technologies. It goes on to state that it has “committed” to develop “a digital strategy to meet user and government expectations.”
PHE, therefore, constitutes itself here as an agent that must show itself to serve both government and citizens. It must do so while also acknowledging and seeking to reduce “health inequalities.” The document responds to expectations that PHE will be able to manage and respond to the rapidly changing digital technology environment and do so in a way that acknowledges the diverse array of stakeholders involved (the technologies themselves, the developers and entrepreneurs who make and manage them, other government agencies, politicians, citizens, etc.).
Citizens in this document are positioned variously as partners, customers, and users of technologies, as well as those who may potentially be marginalized by new digital health initiatives. The PHE not only represents itself as protector and promoter of citizens’ health, and therefore in a caring and inclusive role, but also incorporates technical and business jargon in the attempt to aspire toward the maxims of efficiency and rationality. The document treads a fine line, therefore, between managerial, rationalist discourses, and those portraying PHE as caring advocate of its constitutents’ health and well-being. There are clear affective investments in not only the potentials but also the complexities of digital technologies expressed in the document. The technologies themselves tend to be presented in a techno-utopian and techno-determinist way. They are portrayed as having the agential capacity to shape human behavior. The role of humans in designing and incorporating these technologies—manifesting their thing-power (or resisting it)—is largely not acknowledged. The technologies are represented as powerful agents that manifest their capacities on, rather than with, humans.
This document is attempting to outline a process and program by which PHE can shape and transform health care delivery and public health services. It is also notable that the (anonymous) authors of the document give little acknowledgment of the complexities of the more-than-human and indeed, more-than-digital worlds in which PHE is attempting to promote the use of digital health technologies to citizens and health care professionals. As a policy document, it has the capacity to have a material effect on these services. It is impossible to ascertain what these effects are from the document itself. Further research needs to examine policy in action—how the relevant actors and agencies identified in the document respond to it (if at all), or, indeed, resist its framing of the situation.
Example 2: Interview From Self-trackers Project
Material from telephone interviews with people engaging in self-tracking using a range of technologies and methods provides another resource for understanding digital health rationales and practices: this time from a lived experience perspective that can help to access the experiences, feelings, and relational connections of research participants. Here, I provide an example of Roger, one of the participants in my interview study of Australian people who engage in self-tracking of their bodies, health, and other aspects of their lives (Lupton & Smith, 2018). A market research company commissioned by me undertook the interviews and transcribed them. I worked with the audio files and the transcripts to undertake my analysis.
Roger is a 50-year-old project manager with trade certificate qualifications who lives in Melbourne. Roger said that the milestone of turning 50 was a turning point for him. He decided that it was time to take better care of his health and took up self-tracking to do this. He had seen friends and colleagues successfully using smartwatches or apps for health tracking, and this encouraged him to try these devices. In his interview, Roger described how he tracks his body weight, physical fitness, sleep, and blood pressure. He uses a smartwatch for physical activity, heart rate, and sleep, a set of scales for his body weight and has his blood pressure checked by his doctor every few months.
For Roger, using a digital automated form of self-tracking means that he can’t lie about his activity or health: You get a lot of real information. In the past when you exercise you always make claims about how much you’ve done or how far you’ve walked. When you have a GPS tracker on you it tells the truth. It’s something you can’t deny. I like to get a real understanding. I find it quite surprising, you’d be surprised how much distance you can cover with a jog. I probably cover 14 or 16 kilometres a day. Even with office work I’d probably cover 8 kilometres.
Throughout his interview, Roger continually referred to the value of the information that these monitoring practices and technologies generate. He claimed that with a lot of health conditions, getting a lot of information can get you out of the denial phase. It’s something real and you’ve got to address it . . . It’s good to keep track of things, having something telling you you’ve been a bit of a slob and you’ve got to get out there and do a bit more exercise.
Roger described the information he is accumulating and reviewing about his body and health as key to spurring him on to continue with his health-promoting activities: It’s given me information that tells me if I want to improve my health, I’ve got to do more. Not so much motivation, motivation comes from within. But it gives you more control and more understanding of the reality.
These small excerpts from Roger’s interview provide insights into how he has responded to the affordances of the digital health technologies he has taken up and the role these technologies play in his life. From a more-than-human research perspective, his account of his enactments of digital health highlights the biographical and relational contexts in which he decided to make a change in his behavior in the interests of promoting his health using self-tracking technologies. A key birthday led to his awareness that he was getting older and should take better care of his aging body so that his future health would be protected as he moves into the middle-years life stage. His observations of other people’s experiences of using digital self-tracking devices encouraged him to give them a try.
Roger positioned digitized self-tracking as offering powerful affordances to help in his project of taking control of his health and future well-being. He considers the technologies he uses as more accurate than his embodied sensations and memory and therefore as calling him to account. These devices, unlike his physical sensory responses, “do not lie” and give him “real information.” Roger enjoys being able to quantify his physical activity and to see how the numbers change. These practices help him counter his affective forces of uncertainty and anxiety about his aging body and losing control of his health. Roger comes together with these devices to generate the agential capacities of better knowledge and control of his body and health and motivating forces to keep him physically active.
Together with interview data from other participants in this study (Lupton & Smith, 2018), analysis of Roger’s interview highlights the intersections between self-trackers’ embodied sensations, their engagements with their data and devices, the trajectories of their life experiences, and relationships with other people and affective forces. They demonstrate how the kinds of imaginaries about digital health technologies that are presented in policy documents and other promotional materials (such as developers’ websites and app stores) can be animated in lived experiences.
Example 3: GoPro Video and Interview From Self-Tracking Cyclists Project
A study conducted with colleagues focused on commuting cyclists’ use of digital self-tracking devices (including bike computers, wearable devices, and apps) to monitor their rides. In addition to conducting two interviews with our participants, we used tiny GoPro action cameras to capture the more-than-representational elements of their cycling-self-tracking experiences (Lupton, Pink, LaBond, & Sumartojo, 2018; Sumartojo, Pink, Lupton, & LaBond, 2016). We gave our research participants a GoPro camera to affix to the front of their cycling helmets and asked them to turn on the camera when they put the helmet on as they were preparing for one of their commutes to or from work on their bicycle and to turn it off after the arrival at their destination. The camera recorded the participants’ activities as they prepared for their cycle trip from the perspective of the cyclist (the “helmet-view”), so when we viewed the footage later, we could see what devices they used, when they turned them on and off, what the physical landscape and weather conditions were like as they progressed on their cycling trip, how often they stopped and why, and if and when they looked at their self-tracking device during or after the trip.
A few days after participants had recorded their ride, we sat down with them and watched the footage together on a laptop computer. This encounter was also videoed. We asked questions of the cyclist as we watched the video together, probing them to explain to us how they were feeling just before, during and immediately after the ride, what they were looking at and thinking about. This approach allowed us to gain insights into the more-than-human worlds in which the cyclists undertook and monitored their trips and engaged with their devices and the data they generated. Our research materials for analysis consisted of three videos for each participant: an initial interview, the video of the cycling trip, and the video of our interviewees and ourselves reviewing the cycling trip video together. The interviews were conducted by members of our team, and I took part in some of them. We analyzed the materials by viewing the set of videos we had for each participant, partially transcribing them and generating case studies for each participant that drew on the visual and audio materials.
An example of one of our participants is Alison, a 48-year-old academic who lives in the small city of Canberra, which is known for its infrastructure of pleasant bicycle paths and cycling culture. Alison is a keen commuting and recreational cyclist and has been cycling for most of her life. She rides to work because she enjoys the exercise and the scenery. She often stops to admire the environment through which she is cycling, taking photos of trees, flowers, or the lake, and posting them to Instagram and Twitter. Alison noted that she also cycles because she has a medical condition which predisposes her to weight gain, and exercise is the only way she can manage it.
Alison’s commute video showing a typical trip to and from work begins in her apartment as she gathers her gear and prepares herself for her ride. She opens her phone and starts running her Strava app to track her ride as soon as she gets a network connection. She then places the phone in her pannier and cycles off to the campus where she works. Alison’s commute takes place primarily on cycle paths that cut through bushland areas or alongside residential areas, and a significant section is along a lake. In the review of the footage with the interviewer, Alison pointed out places that she likes to stop to take photos. She described herself as a “defensive rider,” explaining that throughout her trip she is paying attention to features of the path she is riding along (where she knows there are bumps or dips), as well as keeping a close eye out for children who might be using the cycle path and dogs, especially watching out to see whether they are on a leash (she has been charged by dogs in the past when cycling). Alison noted that the last 1-km section of the commute to her partner’s house is especially difficult, with several bends in the path, an uphill section, a dip, and a spot where pedestrians often enter the path. The footage ends as they approach her partner’s house, and she turns off the GoPro.
As she watched the video finishing, Alison explained that the remaining part of her routine consists of taking her phone out of her panniers, uploading her trip data from her phone app to the Strava platform, and wheeling her bike into her partner’s house. She added that they look at the Strava platform together to check the data recorded of their rides while cooling down from the trip. The video footage of Alison’s commute and her explanations of what she was doing and thinking during the commute provide many insights into the complex entanglements of humans and nonhumans during a cycling trip to work. Together, the images from the video and Alison’s interpretations of it show the relational connections of Alison with her bicycle, her cycle pannier, her phone, the Strava app and platform, her house, her partner’s house, the landscape through which she cycles, and the spatial features of the cycle path over which she travels. These materials draw our attention to the role played by Alison’s partner in influencing the direction of her commute, encouraging her to continue monitoring her trips using Strava, reviewing the data together, and so on. Other humans, as well as nonhuman animals, play roles as potential hazards or obstacles on the cycle paths that Alison must be aware of. The affective force of caution about possible living or nonliving hazards to pay attention to during the trip is combined with pleasure at the physical movement of her body on the bicycle through the spaces in which she travels, her enjoyment, and appreciation of the beauty of the landscape (often causing her to stop her ride and use her phone to record and share images).
Digital technologies intertwine with each other and with the more-than-human worlds through which Alison travels. Her smartphone is used both as a metricized tracking device to monitor and record aspects such as distance covered by the cycle trip and the length of time it takes (incorporating the Strava app and platform) and as an image recording and sharing device (together with the Instagram and Twitter platforms) that focuses on the aesthetic attributes of the cycling trip. These dynamic assemblages, involving a diverse array of humans and nonhumans that constantly change as Alison moves through the landscape on her bicycle, generate agential capacities of traveling to work, exercising her body, managing her body weight, avoiding human and nonhuman hazards, enjoying the beauty of the landscape, sharing this beauty with others online, and spending time with her partner relating to their shared interest in cycling. The multisensory, embodied, affective, and relational dimensions of digitized self-tracking are highlighted in this example, as are the more-than-digital elements of Alison’s self-tracking practices.
Example 4: Design Artifact From Stakeholders Workshop
Using design research methods can generate artifacts that provide insights into people’s imaginaries, hopes, and fears. In a co-design workshop with a range of stakeholders from government and nongovernment agencies, health care consumer networks, and health care providers, I provided small groups of the participants with three collaborative tasks using design probes. The first task asked the groups to work together to map the landscape of digital health. Each group was provided with a large-scale map template showing various actors in the digital health ecosystem. These included a patient and a medical practitioner at the center of the map, with other potentially involved groups at either side: family and friends, the medical community, the industry community and government organizations. Participants were given a set of technology cards to fill in the details of the kinds of digital technologies they wanted to place on the map, as well as actor cards to contribute additional people. The technology cards invited participants to fill in details such as what the name of the technology was, what kind of technology it was (app/software, medical device, wearable technology, website, or other), and to provide a description of what it does. The participants were asked to fill in as many cards as they could in the time allowed and to stick the cards on the map. They were also asked to draw on the map with pens to show the relationships between the human actors and the technologies.
The groups then presented their map to the other groups, describing the details of the landscape they had created and explaining the advantages and disadvantages their group had identified in this landscape. Each group, once they have finished their map in the time allowed, gave a short presentation to the other groups in turn, holding up the map and explaining why they had included the human and nonhuman actors they had chosen, and the rationale for the connections they had drawn between the actors. They also reflected on the question of “what works” in digital health as they were talking about and presenting their maps. The presentations were video-taped and later transcribed and together with the design artifact generated from this group activity and the others made during the workshop, provided the research materials for analysis (Lupton, 2017b).
The landscapes of digital health produced by the five groups in the workshop and the groups’ verbal explanations of them when presenting their map to other workshop participants provided rich accounts of the relational connections and flows of affects operating between humans and nonhumans. Not only could all the participants see how the other groups had conceptualized and visually represented these relationships, but they could also hear their explanations for their creations. Using the maps and the transcripts of the presentations, I was able to identify the range of digital health technologies and human actors and group identified by the workshop participants as important in contemporary digital health in Australia.
Beyond these details, I could use the artifacts and presentations to identify the entanglements of the human–nonhuman assemblages that were created by the participants. As they explained their maps, the participants often referred to affective forces underpinning the connections they had drawn: patients’ trust in their health care providers, their reliance on family networks, the ambivalence that medical professionals can feel about “empowered” patients, the risk-taking in which digital health companies engage, the Australian public’s distrust of the government and what it might do with the personal medical data, and so on.
The agential capacities that emerged from these research materials included opportunities for the government to save money, streamline services, and profit from personal health data; patients to receive better health services and take control of their health; health care providers and carers to provide better care; health researchers to gain insights from analyzing big data sets from the health care system; and corporations to profit from their digital health devices and software. Blockages or barriers to the realization of these capacities related back to affective forces (distrust of government’s or industry’s motives, fear of authority being undermined, ambivalence about patients having more control) and relational connections (e.g., lack of interoperability of software systems, patients’ and health care providers’ lack of awareness or expertise in the use of electronic health records, apps failing to deliver what they promise, government’s refusal to adequately fund training for health care professionals, or efficient software systems).
Conclusion
In this article, I have provided an overview of the potential of feminist new materialism theory for contributing to innovative and creative qualitative research inquiries into digital technologies designed to monitor and promote human health and embodiment. Using four examples, I have demonstrated how a more-than-human approach drawing on feminist new materialism can be applied to different types of research materials: a government digital health policy document, an audio-taped and transcribed telephone interview, video footage of bicycle trips made using an action camera combined with a face-to-face interview in which both participant and interviewer watched the video together and discussed it, and design artifacts and discussions generated from a participatory design workshop. I have shown how these materials can be analyzed drawing on the propositions and key research questions that I have developed.
As I noted earlier, feminist new materialism scholars are interested in adopting an affirmative ethics that identifies the workings and effects of power relations and the ways in which humans come together with objects in ways that can be generative of agencies or otherwise close them off. These scholars are interested not only in gendered relations and performances, but also in any form of identity and embodiment, and what bodies can do when they assemble with nonhumans. My analysis of my selected research materials points to the ways in which key affects, biographical experiences, and relational connections such as a person’s desire to overcome ill-health, become physically fitter, live longer, enjoy the open air, natural scenery and feeling of movement, avoid injury or enjoy exercise with their partner intra-act with the affordances offered by the digital technologies they have chosen to use. This more-than-human perspective can show how nondigital elements such as weather conditions, place, and space and nonhuman animals, as well as relational connections with other humans, can contribute to agential capacities and how people may respond to or resist governmental imaginaries of using digital health technologies to save money, offer better services to citizens, or reduce the burden of ill-health in the population based on affective responses such as lack of trust in government agencies.
These examples are but small fragments of the larger corpuses of research materials generated in the studies discussed. My analysis of them is configured by a series of agential cuts that are partial and shaped by my specific interests and capacities. I was not physically present when most of these materials were generated and therefore had to reply on my responses and interpretations of the research materials after they had produced by others. Despite this, I was still able to work productively and creatively with the materials, and I drew on my experiences and interests as a researcher to formulate the studies from which they were drawn and contributed to the generation of the materials in this way. I acknowledge that conceptualizing a research question and ways of addressing it are also forms of agential cuts through which boundaries are established and meaning is produced.
The examples that have been put to work here to illustrate what more-than-human research informed by feminist materialism can contribute to new ways of think and doing applied qualitative research and the beginnings of an approach—better understood as a lively assemblage of thinking and doing rather than as a “method”—for how to go about it. Taken together, these research materials uncovered different aspects or perspectives on the topic under investigation. The relational connections, affective forces, and agential capacities emerging in, with, and through these research materials themselves not only intertwine but also diverge. Similarities and differences are evident. These research materials, as they are interpreted from my perspective as the research analyst, generate an intriguing research assemblage that demonstrates the imaginaries and lived experiences of digital health, what bodies can do when they come together with digital health technologies, and how the potential vitalities of digital health technologies can be animated or thwarted.
As I have shown, the research assemblage that is configured when feminist materialism theory comes together with qualitative research methods can engender a “thing-power” (Bennett, 2004) that can enliven critical qualitative analyses of health-related technologies. This more-than-human perspective can work to disrupt and challenge normative assumptions, uncover networks of power, including resistances and reinventions, and identify new capacities and possibilities for what human–nonhuman digital health assemblages can do as part of an affirmative analytical ethics.
Footnotes
Acknowledgements
A small section of this article was published in an earlier version on my blog, “This Sociological Life.”
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for the projects drawn on in this article was provided by the University of Canberra and RMIT University.
