'Putting people in charge of their own health and care'? Using meta-narrative review and the example of online sexual health services to re-think relationships between e-health and agency.

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Abstract

Introduction
Policy discussions reference ideas of informed and active users of e-health services who gain agency through self-management, choice and care delivered outside clinical settings. In this article we aim to problematize this association by ‘thinking with’ material from multiple disciplines to generate higher order insights to inform service development, research and policy.

Methods
Drawing on meta-narrative review methods, we gathered perspectives from multiple disciplines using an iterative process of expert consultation to identify seminal papers citation mapping, synthesis and peer review.

Results
We identify six relevant paradigms from sociology, philosophy, health services research, public health, the study of social movements and computer studies. Bringing these paradigms together illuminates the contrasting epistemological and ontological framings that co-exist in this area, including competing conceptualisations of e-health technologies as: neutral tools for service delivery; mediators within complex and unpredictable clinical interactions and as agents in their own right.

Discussion
There is a need for e-health policy to recognise many human and non-human actors, the blurred boundaries between them and the unpredictable and evolving interactions that constitute engagement with e-health care. Established models for e-health service development and policy making are not designed for this landscape. There is nothing to be gained by asking whether e-health (in general) either ‘increases’ or ‘decreases’ agency as it is constructed and inflected by specific types and aspects of e-health in ways that might be simultaneously enabling and disempowering, and are differentially experienced by differently positioned and resourced actors.
Original languageEnglish
JournalHealth expectations : an international journal of public participation in health care and health policy
Publication statusAccepted/In press - 25 Mar 2019

Keywords

  • e-health, agency, sexual health

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