Drawing on science and technology studies (STS), and specifically the concept of infrastructure as conceptualised by Bowker and Star (2000; Star 1999), this paper argues and empirically demonstrates that self-care may be considered a practice that is thoroughly sociotechnical, material, distributed and de-centred. Comparing the practices related to medication in the treatment of asthma, type 2 diabetes and haemophilia, we show that in practice there is no ‘self’ in self-care. More specifically, the ‘self’ in self-care is an actor who is highly dependent on, and intertwined with infrastructures of care, in order to be self-caring. Infrastructures of care are the more or less embedded ‘tracks’ along which care may ‘run’, shaping and being shaped by actors and settings along the way. Obtaining prescriptions, going to the pharmacy, bringing medication home and administering it as parts of daily life are commonplace activities embedded in the fabric of life, especially for those living with a chronic condition. However, this procurement and emplacement of medication involves the establishment and ongoing enactment of infrastructures of care, that is, the connections between various actors and locations that establish caring spaces and caring selves. Locations and actors are included as allies in treating chronic conditions outside the clinical setting, but these infrastructures may also be ambiguous, with respect to their effects; they may simultaneously contribute to the condition’s management and neglect. Particularly precarious is management at the fringes of healthcare infrastructure, where allies, routines and general predictability are scarce. We conclude by arguing that these insights may induce a greater sensitivity to existing infrastructures and practices, when seeking to introduce new infrastructures of care, such as those promoted under the headings of ‘telemedicine’ and ‘healthcare IT’

This article analyses an experiment into healthcare governance in Denmark inspired by principles of value-based health care and intended to re-orient the focus of healthcare governance from 'productivity' to 'value for the patient'. The region in charge of the experiment exempted nine hospital departments from activity-based financing and accountability based on diagnosis-related groups, which allegedly incentivised hospitals in 'perverse' and counterproductive ways. Instead, the departments were to develop new indicators from their local practices to support and account for quality and value for the patient. Drawing on the actor-network theory concept of 'translation', this article analyses how the experiment was received and put into practice in the nine departments, and how it established new kinds of accountability relations. We argue that the experiment provides fruitful inspiration for future governance schemes in healthcare to embrace the local complexities of clinical practices. In particular, we argue that the locally developed indicators facilitated what we call 'dialogical accountability', and we discuss whether this represents a feasible way forward for value-based health care.

This article starts from the paradox that, although participation is a defining trait of participatory design (PD), there are few explicit discussions in the PD literature of what constitutes participation. Thus, from a point of departure in Actor-Network Theory (ANT), this article develops an analytical understanding of participation. It is argued that participation is a matter of concern, something inherently unsettled, to be investigated and explicated in every design project. Specifically, it is argued that (1) participation is an act overtaken by numerous others, rather than carried out by individuals and (2) that participation partially exists in all elements of a project. These traits are explicated in a design project called 'Teledialogue', where the participants are unfolded as networks of reports, government institutions, boyfriends, social workers and so on. The argument is synthesised as three challenges for PD: (1) participants are network configurations, (2) participation is an aspect of all project activities and (3) there is no gold standard for participation.

The focus on digital data for improved management and quality of healthcare is paramount. In particular, the vast volumes of accumulated data in clinical systems have created high hopes for repurposing data to serve secondary purposes beyond the practices of direct clinical care, such as research, improvement and efficiency. This article contributes with an understanding of the pivotal, but often unnoticed “data-work” involved in such efforts. The article is based on a regional project in Danish healthcare, in which nine hospital departments were given the task of developing new indicators for quality to substitute the previous accountability regime based on Diagnosis-Related Groups. Using the concept of “friction,” we analyze the challenges of turning clinical ideas into data-supported indicators and of collecting data from existing repositories. Especially, we turn attention to the interaction between clinicians and it-personnel to focus on the interdisciplinary and collaborative aspects of this work.

Chronic diseases pose a major challenge to contemporary western healthcare systems, and consequently there are numerous initiatives designed to meet these challenges. Patient empowerment is considered to be extremely important in chronic disease management. But what does it mean to become an 'active patient', managing a condition? This article argues that people are always active in shaping their agency and the agency of numerous others, and that we need to attend to these processes of configuration in order to better understand and conceptualize the problem of chronic disease management. This article analyses the daily practices of people with Type 2 Diabetes, with the use of what is described as the 'sociology of attachment' in the field of science and technology studies. The implications of seeing and analysing chronic conditions in this manner are that determinist understandings of chronic conditions are challenged. Accordingly, an experimental and constructive attitude towards the production and assembling of the chronically ill body is enabled. Such an attitude holds that relations with multiple other bodies and entities, such as technologies, the disease, medication and so on continuously and relentlessly affect how the condition unfolds and consequently, the room for interventional strategies and transformation of the chronically ill body is enlarged.