MeST-talk: Postdoc Riccardo Pronzato

Enacting co-design, re-politicising co-design. A critical lens on eHealth interventions

The development of eHealth interventions and their implementation through digital platforms that integrate algorithmic systems are becoming increasingly common. To engage diverse stakeholders in producing these technologies and adapting them to users’ environments and conditions, co-design has emerged as an institutionalised participatory approach in healthcare. This institutionalization has favoured a shift from a focus on socio-political issues to technological solutions. However, digital technologies are not neutral tools; they are the outcomes of specific human practices and cultural environments – i.e., socio-cultural artifacts, and they function as social agents, which actively participate to everyday life and organisation processes. These computational systems, along with the narratives that surround them, contribute to the reproduction of specific forms of social power. Indeed, they can favour the systematization of social inequalities and discriminations, while the social narratives around them can legitimate and normalize their implementation and adoption. Alongside this, technological use is not linear, as extensive studies on digital inequalities have shown.

Starting from the co-design of an e-learning platform for informal caregivers of patients with dementia (project AGE-IT, PNRR PE8 “Age-It”), this intervention argues for the merits of scrutinising the co-design of eHealth technologies, in which algorithmic systems are integrated, as a dynamic process of enactment. Specifically, the concept of “enactment”, as declined by various authors, such as Annemarie Mol, Evelyn Ruppert, Nick Seaver and Ignacio Siles, is employed as a critical lens to examine a dual recursive dynamic. One the one hand, eHealth technologies are enacted by the practices of the individuals involved in the co-design process, such as researchers, stakeholders, tech producers and end users; on the other hand, these technologies enact individuals as objects of concern. Within this process, individuals both shape and are shaped by the sociotechnical systems they help produce, while different forms of social power, inequalities and knowledge imbalances are negotiated and actualised.

Given this scenario, I argue that the process of “enactment” can offer a critical lens through which co-design practices in healthcare can be re-politicised and the micro-politics of the relationships embedded into them examined, thus considering participation as a process that always need to be problematised. Theoretically, this contribution bridges Science and Technology Studies (STS), health sociology, co-design research, and critical algorithm studies to better understand the intersection of technological development, participation, health, culture and social power.