Patienthood and participation in the digital era

The Negotiation of Medical Treatments by Parents of Children with Congenital Adrenal Hyperplasia in Poland

Congenital adrenal hyperplasia (CAH) is a rare inherited disease that requires continuous home-based treatment. The increasing accessibility of medical information and the presence of an active online community-particularly a dedicated Facebook group-enable parents of children with CAH to become engaged participants in discussions about therapy and innovative solutions. Drawing on ethnographic research, this study explores the complex dynamics of medical decision-making and negotiation between parents and doctors. Key areas of contention include: 1. Medication dosage. 2. The use of cortisol pump technology. 3. The availability of emergency hydrocortisone injection kits. 4. Early genital surgery. While parents actively seek knowledge and challenge medical approaches, their influence on biomedical practices remains limited. The study argues that these negotiations, though often subtle and slow, contribute to changing treatment and become the part of the "logic of care".

E-consultation as existential media: Exploring doctor-patient 'digital thrownness' in Danish general practice

In this article we use an existential media framework to explore the asynchronous, written and digital form of GP-patient communication that takes place through e-consultations in a Danish general practice context. This approach acknowledges e-consultation as more than a tool for information delivery and frames GP and patient not as skilful media users but as dependent co-existers: Both thrown into and trying to navigate the digital healthcare ecology. Through a thematic analysis of 38 semi-structured qualitative interviews with patients and GPs we carve out three themes unpacking the existential dimensions of e-consultation: 1. Patient and GP are placed in a Culture of non-stop connectivity and we show the ambivalences arising herein fostering both relief, reassurance and new insecurities. 2. Ethical challenges of responsible co-existence points to dilemmas of boundary setting and caring for self and co-exister in the digital encounter. 3. We-experiences illustrates the potential of e-consultation to signal GP presence, even when the GP is silent. We also discuss the existential ethics of care emerging from the contemporary digital healthcare ecology and call for empirically grounded studies of the existential dimensions tied to encounters in contemporary digital care infrastructures.

Signs and symptoms: Adverse events associated with a sterilization device

Sterilization is now the most common contraceptive method used by women of in the U.S., and sterilization devices have played an important role in its increased popularity. This mixed methods study examines a random sample of 2500 U.S. Food and Drug Administration (FDA) adverse event reports made between 2006 and 2017 about Essure, a sterilization device. Quantitative coding was used to examine patient problems; pain and bleeding were reported most frequently. Qualitative coding analyzed impacts of symptoms on patients' everyday lives and patients' healthcare experiences, including intimate relationships, mothering, and paid employment. Findings suggest that some patients struggled when their reported "subjective" symptoms didn't result in "objective" clinical signs of problems, and when physicians dismissed or deflected their concerns in diagnostic encounters. This paper raises important issues regarding the symptoms patients associated with Essure, the diagnosis of device-driven disease and injury, and the FDA's regulation of medical devices.

How and why to use 'vulnerability': an interdisciplinary analysis of disease risk, indeterminacy and normality

In recent years, 'vulnerability' has been getting more traction in theoretical, professional and popular spaces as an alternative or complement to the concept of risk. As a group of science and technology studies scholars with different disciplinary orientations yet a shared concern with biomedicine, self and society, we investigate how vulnerability has become a salient and even dominant idiom for discussing disease and disease risk. We argue that this is at least partly due to an inherent indeterminacy in what 'vulnerability' means and does, both within and across different discourses. Through a review of feminist and disability theory, and a discussion of how vulnerability and disease both get recruited into a binary conceptualisation of normal versus abnormal, we argue that vulnerability's indeterminacy is, in fact, its strength, and that it should be used differently than risk. Using COVID-19 management in the UK as an illustration of the current ambivalence and ambiguity in how vulnerability versus risk is applied, we suggest that instead of being codified or quantified, as it has started to be in some biomedical and public health applications, vulnerability and its remedies should be determined in conjunction with affected communities and in ways that are polyvalent, flexible and nuanced. The concept of vulnerability encapsulates an important precept: we must recognise inequality as undesirable while not attempting to 'solve' it in deterministic ways. Rather than becoming fixed into labels, unidirectional causalities or top-down universalising metrics, vulnerability could be used to insist on relational, context-specific understandings of disease and disease risk-in line with contemporary social justice movements that require non-hierarchical and non-universal approaches to problems and solutions.

Physicians' Perspectives on AI in Clinical Decision Support Systems: Interview Study of the CURATE.AI Personalized Dose Optimization Platform

BACKGROUND

Physicians play a key role in integrating new clinical technology into care practices through user feedback and growth propositions to developers of the technology. As physicians are stakeholders involved through the technology iteration process, understanding their roles as users can provide nuanced insights into the workings of these technologies that are being explored. Therefore, understanding physicians' perceptions can be critical toward clinical validation, implementation, and downstream adoption. Given the increasing prevalence of clinical decision support systems (CDSSs), there remains a need to gain an in-depth understanding of physicians' perceptions and expectations toward their downstream implementation. This paper explores physicians' perceptions of integrating CURATE.AI, a novel artificial intelligence (AI)-based and clinical stage personalized dosing CDSSs, into clinical practice.

OBJECTIVE

This study aims to understand physicians' perspectives of integrating CURATE.AI for clinical work and to gather insights on considerations of the implementation of AI-based CDSS tools.

METHODS

A total of 12 participants completed semistructured interviews examining their knowledge, experience, attitudes, risks, and future course of the personalized combination therapy dosing platform, CURATE.AI. Interviews were audio recorded, transcribed verbatim, and coded manually. The data were thematically analyzed.

RESULTS

Overall, 3 broad themes and 9 subthemes were identified through thematic analysis. The themes covered considerations that physicians perceived as significant across various stages of new technology development, including trial, clinical implementation, and mass adoption.

CONCLUSIONS

The study laid out the various ways physicians interpreted an AI-based personalized dosing CDSS, CURATE.AI, for their clinical practice. The research pointed out that physicians' expectations during the different stages of technology exploration can be nuanced and layered with expectations of implementation that are relevant for technology developers and researchers.

A digital innovation typology: Navigating the complexity of emerging technologies to negotiate health systems research with young people

Objective

This study aims to explore young people's perspectives of emerging technologies and health systems research in an adolescent health community of practice.

Methods

The context of this integrated knowledge translation study is the Wellbeing Health & Youth Centre of Research Excellence in Adolescent Health. A theory-building, non-systematic review was conducted to examine the concepts and interrelationships of emerging technologies associated with digital innovation and health systems. This typology informed the design of an online workshop with young people to explore their views, concerns, and ideas about health systems research.

Results

A digital innovation typology was identified to differentiate and explain emerging technology concepts and interrelationships that can be applied to the health systems context. Aligned with this typology, youth perspectives about digital health challenges and opportunities were identified to support future research, policy, and practice.

Conclusion

The integrated findings from this study can assist the navigation of complex emerging technologies, and the negotiation of equitable health systems research, between youth and adult stakeholders. Further, with these typology-related resources, mutual learning and the public involvement of young people in health systems research and priority setting agendas can be supported.

Responsibility in Medical Sociology: A Second, Reflexive Look

Personal responsibility has emerged as an important element in many countries' public health planning, and has attracted substantial debate in public health discourse. Contemporary medical sociology typically resists such "responsibilization" as victim-blaming, by privileged elites, that obscures important structural factors and inequities. This paper, based primarily on a broad review of how contemporary Anglophone medical sociology literatures treat responsibility and blame, points out advantages of taking responsibility seriously, particularly from the individual's perspective. These advantages include: empowerment; responsibility-as-coping-mechanism; moral dignity; and the pragmatic logic of doing for oneself, rather than passively awaiting societal reforms. We also offer possible reasons why sociologists and their subjects view these issues so differently, and suggest some areas for future research.

Diversity via datafication? Digital patient records and citizenship for sexuality and gender diverse people

In 2018, the Australian Government adopted an ‘opt-out’ strategy to increase participation in My Health Record (MHR), the national digital patient record system. Opt out was rationalised through discourse on the universal right to health. Media controversy ensued due to privacy fears, security and commercial exploitation of patient information. LGBT community organisations warned that people with complex health needs should consider their privacy and legal situation when deciding whether or not to opt out of MHR. With reference to the health needs of sexuality and gender diverse people, we examine MHR’s rights universalism, possessive individualism, and state-based rationalisation of health governance. MHR hails all but no-one in particular, erasing diversity and straightwashing data medicine. It is a technological solution to state-based imperatives for health governance, an emphasis that does not serve minority communities or address health needs that attract stigma and prejudice. We counterpose these effects with citizenship framings seated in critical approaches to data assemblages and sexuality and gender diversity. We suggest ways in which data medicine, of which MHR is but one example, can be made more relevant and effective for individuals and communities whose healthcare is poorly served by mainstream health systems.

How Perceptions of Responsibility and Affective Consequences Influence Parents' Digital Media Engagement in Relation to Human Papillomavirus Vaccination

Individuals are expected to be responsible for their own health and that of their families-and act accordingly. Yet, being in a position of responsibility might be undesirable for individuals either unable or reluctant to comply with the expectations this responsibility entails. In this article, I explore how parents experience the process of engaging responsibly with digital media in relation to the question of human papillomavirus vaccination. The study is based on interviews with eighteen Danish parents, and my findings show that these parents not only understand themselves but also other actors in terms of responsibility, and that being positioned in terms of responsibility can have negative affective consequences. I argue that meeting the expectations of biological citizenship should not necessarily be a goal in relation to complex health topics.

Turning the gaze: Digital patient feedback and the silent pathology of the NHS

Online review and rating sites, where patients can leave feedback on their experience of the health-care encounter, are becoming an increasing feature of primary care in the NHS. Previous research has analysed how digital surveillance is re-shaping the clinical gaze, as health-care professionals are subject to increased public monitoring. Here, we draw on an empirical study of 41 GP practice staff to show how the gaze is turning, not simply from the patient to the health-care provider, but additionally to the body politic of the NHS. Drawing on focus group and interview data conducted in five UK practices, we show how discourses of online reviews and ratings are producing new professional subjectivities among health-care professionals and the extent to which the gaze extends not only to individual health-care interactions but to the health-care service writ large. We identify three counter-discourses characterising the evolving ways in which online reviews and ratings are creating new subjects in primary care practices: victimhood, prosumption versus traditional values and taking control. We show how the ways in which staff speak about online feedback are patterned by the social environment in which they work and the constraints of the NHS they encounter on a day-to-day basis.

Understanding 'passivity' in digital health through imaginaries and experiences of coronavirus disease 2019 contact tracing apps

Growing interest is being directed to the health applications of so-called 'passive data' collected through wearables and sensors without active input by users. High promises are attached to passive data and their potential to unlock new insights into health and illness, but as researchers and commentators have noted, this mode of data gathering also raises fundamental questions regarding the subject's agency, autonomy and privacy. To explore how these tensions are negotiated in practice, we present and discuss findings from an interview study with 30 members of the public in the UK and Italy, which examined their views and experiences of the coronavirus disease 2019 contact tracing apps as a large-scale, high-impact example of digital health technology using passive data. We argue that, contrary to what the phrasing 'passive data' suggests, passivity is not a quality of specific modes of data collection but is contingent on the very practices that the technology is supposed to unobtrusively capture.

An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study

Background

Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence.

Objective

This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants.

Methods

The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively.

Results

A total of 365 participants enrolled and started the study, and 81.0% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, and 72.86% of the time, respectively.

Conclusions

This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies.

Trial Registration

ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111

Hormonal Health: Period Tracking Apps, Wellness, and Self-Management in the Era of Surveillance Capitalism

Period tracking is an increasingly widespread practice, and its emphasis is changing from monitoring fertility to encompassing a more broad-based picture of users' health. Delving into the data of one's menstrual cycle, and the hormones that are presumed to be intimately linked with it, is a practice that is reshaping ideas about health and wellness, while also shaping subjects and subjectivities that succeed under conditions of surveillance capitalism. Through close examination of six extended interviews, this article elaborates a version of period tracking that sidesteps fertility and, in doing so, participates in the "queering" of menstrual technologies. Apps can facilitate the integration of institutional medical expertise and quotidian embodied experience within a broader approach to the self as a management project. We introduce the concept of "hormonal health" to describe a way of caring for, and knowing about, bodies, one that weaves together mental and physical health, correlates subjective and objective information, and calls into question the boundary between illness and wellness. For those we spoke with, menstrual cycles are understood to affect selfhood across any simplistic body-mind division or reproductive imperative, engendering complex techniques of self-management, including monitoring, hypothesizing, intervening in medical appointments, adjusting schedules, and interpreting social interactions. Such techniques empower their proponents, but not within conditions of their choosing. In addition to problems with data privacy and profit, these techniques perpetuate individualized solutions and the internalization of pressures in a gender-stratified, neoliberal context, facilitating success within flawed structures.

Defining participatory health informatics - a scoping review

Healthcare has been shifting toward individuals participating in decision-making and empowered to be active in their treatment, and health monitoring. The term "participatory health informatics" (PHI) started to appear in literature. A clear definition of PHI is missing, and facets of PHI still have to be shaped. The objective of this paper is to offer a definition of PHI considering themes and technologies that make healthcare participatory. We searched Pubmed, ACM Digital Library, IEEE Xplore, EMBASE, and conference proceedings for articles that reported about use of information technology or informatics in the context of PHI. We performed qualitative synthesis and reported summary statistics. 39 studies were eligible after screening 382 titles and abstracts and reviewing 82 full texts. The top 5 person-centered key themes related to PHI included empowerment, decision-making, informed patient, collaboration, and disease management. Finally, we propose to define PHI as multidisciplinary field that uses information technology as provided through the web, smartphones, or wearables to increase participation of individuals in their care process and to enable them in self-care and shared decision-making. Goals to be achieved through PHI include maintaining health and well-being; improving the healthcare system and health outcomes; sharing experiences; achieving life goals; and self-education.

Experimental Study on Wound Area Measurement with Mobile Devices

Healthcare treatments might benefit from advances in artificial intelligence and technological equipment such as smartphones and smartwatches. The presence of cameras in these devices with increasingly robust and precise pattern recognition techniques can facilitate the estimation of the wound area and other telemedicine measurements. Currently, telemedicine is vital to the maintenance of the quality of the treatments remotely. This study proposes a method for measuring the wound area with mobile devices. The proposed approach relies on a multi-step process consisting of image capture, conversion to grayscale, blurring, application of a threshold with segmentation, identification of the wound part, dilation and erosion of the detected wound section, identification of accurate data related to the image, and measurement of the wound area. The proposed method was implemented with the OpenCV framework. Thus, it is a solution for healthcare systems by which to investigate and treat people with skin-related diseases. The proof-of-concept was performed with a static dataset of camera images on a desktop computer. After we validated the approach’s feasibility, we implemented the method in a mobile application that allows for communication between patients, caregivers, and healthcare professionals.

Ensuring patient and public involvement in the transition to AI-assisted mental health care: A systematic scoping review and agenda for design justice

BACKGROUND

Machine-learning algorithms and big data analytics, popularly known as 'artificial intelligence' (AI), are being developed and taken up globally. Patient and public involvement (PPI) in the transition to AI-assisted health care is essential for design justice based on diverse patient needs.

OBJECTIVE

To inform the future development of PPI in AI-assisted health care by exploring public engagement in the conceptualization, design, development, testing, implementation, use and evaluation of AI technologies for mental health.

METHODS

Systematic scoping review drawing on design justice principles, and (i) structured searches of Web of Science (all databases) and Ovid (MEDLINE, PsycINFO, Global Health and Embase); (ii) handsearching (reference and citation tracking); (iii) grey literature; and (iv) inductive thematic analysis, tested at a workshop with health researchers.

RESULTS

The review identified 144 articles that met inclusion criteria. Three main themes reflect the challenges and opportunities associated with PPI in AI-assisted mental health care: (a) applications of AI technologies in mental health care; (b) ethics of public engagement in AI-assisted care; and (c) public engagement in the planning, development, implementation, evaluation and diffusion of AI technologies.

CONCLUSION

The new data-rich health landscape creates multiple ethical issues and opportunities for the development of PPI in relation to AI technologies. Further research is needed to understand effective modes of public engagement in the context of AI technologies, to examine pressing ethical and safety issues and to develop new methods of PPI at every stage, from concept design to the final review of technology in practice. Principles of design justice can guide this agenda.

Social Media Use for Health Purposes: Systematic Review

Background

Social media has been widely used for health-related purposes, especially during the COVID-19 pandemic. Previous reviews have summarized social media uses for a specific health purpose such as health interventions, health campaigns, medical education, and disease outbreak surveillance. The most recent comprehensive review of social media uses for health purposes, however, was conducted in 2013. A systematic review that covers various health purposes is needed to reveal the new usages and research gaps that emerge in recent years.

Objective

This study aimed to provide a systematic review of social media uses for health purposes that have been identified in previous studies.

Methods

The researchers searched for peer-reviewed journal articles published between 2006 and 2020 in 12 databases covering medicine, public health, and social science. After coding the articles in terms of publication year, journal area, country, method, social media platform, and social media use for health purposes, the researchers provided a review of social media use for health purposes identified in these articles.

Results

This study summarized 10 social media uses for various health purposes by health institutions, health researchers and practitioners, and the public.

Conclusions

Social media can be used for various health purposes. Several new usages have emerged since 2013 including advancing health research and practice, social mobilization, and facilitating offline health-related services and events. Research gaps exist regarding advancing strategic use of social media based on audience segmentation, evaluating the impact of social media in health interventions, understanding the impact of health identity development, and addressing privacy concerns.

Adolescents' and young adults' experiences of a prototype cancer smartphone app

Objective

Smartphone cancer-related apps have been shown to meet some of the needs of adolescents and young adults (AYAs) during their cancer trajectory. However, there is a lack of apps evaluated by AYAs; thus, the quality of many of these apps has been contested. The aim of this study was to investigate the usefulness of a cancer smartphone app called Kræftværket. The AYA participants reflected on their first experiences of the app and whether it was a relevant and useful tool during and after their cancer trajectory.

Methods

A total of 20 AYA cancer patients aged 16-29 years (n = 10 on treatment, n = 10 in follow up) were provided with a prototype of the Kræftværket app during a 6-week test period (April-May 2018). After the test period, n = 17 participated in focus group interviews, which were analyzed thematically.

Results

The following themes were found: Sharing personal information (anonymity, safe communication, tough topics, videos and YouTube clips, tracking statistics); Normalcy (Seeing oneself reflected in in others, not alone, general and specific communities); Need for interaction (response from the app, information provided by the app, the app should give more back); and An everyday tool (integrating the app into daily routines, competition between app and Facebook group, temporary needs).

Conclusions

The app was perceived to be most relevant at disease onset. During the treatment period, both diagnosis-specific information and communities were requested. There was a call for a clearer distinction between the purpose of the app and other Facebook communities and for a notification function.

"Sharing Is Caring:" Australian Self-Trackers' Concepts and Practices of Personal Data Sharing and Privacy

Self-tracking technologies and practices offer ways of generating vast reams of personal details, raising questions about how these data are revealed or exposed to others. In this article, I report on findings from an interview-based study of long-term Australian self-trackers who were collecting and reviewing personal information about their bodies and other aspects of their everyday lives. The discussion focuses on the participants' understandings and practices related to sharing their personal data and to data privacy. The contextual elements of self-tracked sharing and privacy concerns were evident in the participants' accounts and were strongly related to ideas about why and how these details should be accessed by others. Sharing personal information from self-tracking was largely viewed as an intimate social experience. The value of self-tracked data to contribute to close face-to-face relationships was recognized and related aspects of social privacy were identified. However, most participants did not consider the possibilities that their personal information could be distributed well-beyond these relationships by third parties for commercial purposes (or what has been termed "institutional privacy"). These findings contribute to a more-than-digital approach to personal data sharing and privacy practices that recognizes the interplay between digital and non-digital practices and contexts. They also highlight the relational and social dimensions of self-tracking and concepts of data privacy.

Credibility Contests: Media Debates on Do-It-Yourself Coronavirus Responses and the Role of Citizens in Health Crises

During the early months of the COVID-19 pandemic in Europe and North America, news outlets ran a series of stories reporting on "do-it-yourself" (DIY) coronavirus responses that were created and implemented by citizens. This news discourse exemplifies and can illuminate wider shifts in the roles of citizens in science, as individuals outside professional science institutions are becoming more actively involved in scientific knowledge production than before, while the epistemic authority of professional "expert" scientists has been increasingly contested. This paper focuses on DIY citizenship, taking news discourses on citizens' DIY coronavirus responses as a lens to explore wider questions around the changing ways in which the roles of different public health actors are delineated and represented under conditions of significant social and epistemic uncertainty. We aim to shed new light on the nature of-and the role of the news media in mediating-the credibility contests and boundary work that is currently at play around DIY citizenship. We do so by focusing on four discourses: polarized discourses around DIY face masks and hand sanitisers; delineation of credible from incredible interventions and actors around DIY coronavirus treatments and tests; delineation of professional science from "fringe" citizen science; and discourses declaring that "we're all in this together." We conclude that making sense of these discourses requires a thorough appreciation of the context in which they emerged. Our analysis reveals how emancipatory accounts of DIY citizenship can mask structural inequalities underlying who can and is expected to "do-it-themselves," and how.

Clinical Information Systems - Seen through the Ethics Lens

OBJECTIVE

The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately.

METHODS

A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education.

RESULTS

By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders' attitudes, but not to evaluate specific implementations.

CONCLUSION

Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

Big data and data processing in rheumatology: bioethical perspectives

Big data analytics and processing through artificial intelligence (AI) are increasingly being used in the health sector. This includes both clinical and research settings, and newly in specialties like rheumatology. It is, however, important to consider how these new methodologies are used, and particularly the sensitivities associated with personal information. Based on current applications in rheumatology, this article provides a narrative review of the bioethical perspectives of big data. It presents examples of databases, data analytic methods, and AI in this specialty to address four main ethical issues: privacy and confidentiality, informed consent, the impact on the medical profession, and justice. The use of big data and AI processing in healthcare has great potential to improve the quality of clinical care, including through better diagnosis, treatment, and prognosis. They may also increase patient and societal participation and engagement in healthcare and research. Developing these methodologies and using the information generated from them in line with ethical standards could positively affect the design of global health policies and introduce a new phase in the democratization of health.Key Points• Current applications of big data, data analytics, and AI in rheumatology-including registries, machine learning algorithms, and consumer-facing platforms-raise issues in four main bioethical areas: privacy and confidentiality, informed consent, the impact on the medical profession, and justice.• Bioethical concerns about rheumatology registries require careful consideration of privacy provisions, set within the context of local, national, and regional law.• Machine learning and big data aid diagnosis, treatment, and prognosis, but the final decision about the use of information from algorithms should be left to rheumatology specialists to maintain the promise of fiduciary obligations in the physician-patient relationship.• International collaboration in big data projects and increased patient engagement could be ways to counteract health inequalities in the practice of rheumatology, even on a global scale.

Secret groups and open forums: Defining online support communities from the perspective of people affected by cancer

Objective

A quarter of people diagnosed with cancer lack social support. Online cancer communities could allow people to connect and support one another. However, the current proliferation of online support communities constitutes a range of online environments with differing communication capacities and limitations. It is unclear what is perceived as online cancer community support and how different features can help or hinder supportive group processes. This study aimed to explore how perceived support is influenced by the different features and formats of online support environments.

Methods

In-depth qualitative interviews were conducted with 23 individuals affected by a range of cancer diagnoses, including both cancer survivors and family members. Data were analysed using deductive thematic analysis guided by a constructivist epistemological perspective.

Findings

Online supportive communities were defined and differentiated by two themes. Firstly, ‘Open forums’ were identified with thematic properties which facilitated a uniquely informative environment including ‘Safety in anonymity’, ‘Perceived reliability’ and ‘Exposure and detachment’. Secondly, ‘Secret groups’ were identified with thematic properties which enhanced an emotionally supportive environment including ‘Personalised interactions’, an overt ‘Peer hierarchy’, and ‘Crossing the virtual divide’.

Conclusions

Properties of groups can engender different degrees of interpersonal relations and different supportive interactions. In particular, support community designers may want to adapt key features such as anonymity, trustworthiness of websites, and the personalised nature of conversations to influence the development of supportive environments. In personalised peer-led groups, it may be prudent to provide guidance on how to reassert a positive environment if arguments break out online.

Datafication and accountability in public health: Introduction to a special issue

In recent years and across many nations, public health has become subject to forms of governance that are said to be aimed at establishing accountability. In this introduction to a special issue, From Person to Population and Back: Exploring Accountability in Public Health, we suggest opening up accountability assemblages by asking a series of ostensibly simple questions that inevitably yield complicated answers: What is counted? What counts? And to whom, how and why does it count? Addressing such questions involves staying attentive to the technologies and infrastructures through which data come into being and are made available for multiple political agendas. Through a discussion of public health, accountability and datafication we present three key themes that unite the various papers as well as illustrate their diversity.