Knowledge, care and practices of self-monitoring

This project explored the everyday practices of self-monitoring by people who had acquired monitoring devices independently of health professionals.

It was qualitative study covering blood pressure and BMI monitoring and was interested in what people actually do when they self-monitor in everyday contexts, how they understand or use any information that results, or how this may or may not integrate with their wider healthcare.

Consumer technology for people to monitor or track their own health is a rapidly expanding area. Devices formerly seen only in the clinic, such as blood pressure monitors, are widely available to buy now. Alongside this, there has been an explosion of digital and wearable devices such as fitness trackers and apps.

In this context, self-monitoring for health has become an increasingly popular practice, and potentially has great social and cultural significance. Yet comparatively little was known about it. This project examined what people actually do when they self-monitor in everyday contexts, how they understand or use any information that results, or how this may or may not integrate with their wider healthcare.

It is claimed that self-monitoring could transform healthcare, promoting self-care and saving costs. This raises important questions about the distribution of responsibilities for health and care, the role of health professionals, and the production, distribution and control of knowledge. We were interested in exploring the ways in which people produce data and knowledge through self-monitoring, who is it shared with, how it is used, and what roles health care professionals, other organisations, family members and personal networks play.

-Commercial companies constitute self-monitoring as a daily lifestyle practice through their design and marketing of devices. These shape devices as aesthetically pleasing and the practice as enjoyable and shared. This contrasts and is sometimes at odds with clinical framing of self-monitoring as individual, medical and time-limited.

-In practice, self-monitoring might be a shared, where partners or friends monitored together, sharing devices and results. Family and friends may encourage monitoring,
offering help with acquiring or using devices and keeping records. It can also be a private activity where people wish to avoid the scrutiny of others, or protect them from worry.
People trod a fine line between respecting loved one’s privacy and autonomy, and showing care or concern for their health, and a shared future.

-Where devices are used and stored can mediate engagements with self-monitoring. Sometimes they are placed near to hand or visibly which acts as a reminder to monitor and may be seen by others as an invitation to ‘have a go’. When devices are stored away this may signal an end of engagement, or a wish to preserve one’s sense of self, avoid other’s scrutiny or protect them from engaging with monitoring.

-People keep records in diverse ways, using paper, computers, device memories, apps, or keep track in their heads. They do not necessarily record all the readings they take, but may be selective, recording only the data they are happy with, or that they feel they need to be reminded of. When people shared their results, this was mostly with limited local or intimate networks.

- Clinicians sometimes invited patients to self-monitor blood pressure, but were concerned about their own and their patients’ investments, and tried to direct this to make it more manageable. Our interviewees, however, sometimes had their own reasons for bringing their self-monitoring records to the clinic, hoping to use them to direct discussions about their own concerns.

We have written brief executive summaries for different audiences - (brief/one page Summary of Findings, an Executive Summary (general) and an Executive Summary for Commercial Partners). see links.

We have also published a number of academic papers from the project developing conceptual thinking in relation to how markets for self-monitoring devices are constituted (in Critical Public Health) issues of care and surveillance (in Social Science and Medicine), data practices (in Big Data and Society) and digital health platforms (in Information, Communication and Society). Other papers are in progress.

We have developed an interactive website - House of Tracking (see links)- which showcases some of the findings from our interviews with people who self-monitor. This uses verbatim excerpts from the interviews, voiced by actors. It shows the different activities and issues related to tracking that happen in different rooms around the home. A live, online event about the House of Tracking was held on 10th November, as part of the Festival of Social Science. We think the House of Tracking could be of interest to general audiences, health charities, and clinicians.