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
Year: 2014
Type: dissertation
Abstract: This 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 iv 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.v TABLE OF CONTENTS Chapter 1 Introductionincredibly fortunate to have such a brilliant, inspiring, compassionate and supportive committee.Kirsten, my co-chair, is both the reason I began a PhD and the reason I finished this dissertation.Working with me week after week throughout the writing stages, she read and provided invaluable feedback on all chapters.In particular she guided me through developing a structure for communicating my ideas.Throughout the process she recognized the multiple dimensions of this work and made me feel heard-in short, she helped me discover my academic voice.Her mentorship empowered me think, write, and be the kind of scholar I aimed to be.Her unparalleled academic and moral integrity was my guiding light throughout the process.She has also taught me the true value of mentorship, a lesson I intend to pass along.My other co-chair, Gina Neff, has been an inspiring and supportive mentor and colleague throughout the many years we have worked together.She generously provided access to her research networks and opportunities for fieldwork and collaboration that became integral pieces of this dissertation.She not only read and commented on this dissertation, she also worked with me on much of the U.S.-based research, in particular, the development of "data valence" in Chapter Four.I am so fortunate to have had Gina to think with and learn from over these years.Some of my most favorite moments in my graduate career involve us brainstorming at the whiteboard.She taught me about how to be in the field, how to move from fieldnotes, to theory, to practice, and how to effectively communicate my research across different professional and academic audiences.Always treating me as the scholar I aimed to be, she empowered me to pursue the many directions of my research across conventional and unconventional territory.As a mentor, Phil Howard has been generous with his time, listening to me at different stages in the process, he helped me to: think creatively in my methodological approach, hone in on the "hooks" in a sea of data, and frame both my research and myself as a scholar for different audiences.Ron Krabill was a wonderfully supportive mentor throughout the process.He challenged me to grapple with issues of inequality and capital in ways that made my research stronger and more responsive to the challenges that face our society today.I am fortunate to have received funding, or indirect financial support, for this project from a number of different sources.From the National Science Foundation (NSF) I received a Doctoral Dissertation Research Improvement Grant that enabled me to conduct fieldwork in India and pursue the scope and quality of dissertation I had envisioned.From Intel I
Author: Brittany Fiore-Silfvast
Language: English
Subfield: Management Information Systems
Domain: Social Sciences
SDG: Reduced inequalities
Open Access status: green
OpenAlex ID: W2289609421