“Putting people in charge of their own health and care?” Using meta‐narrative review and the example of online sexual health services to re‐think relationships between e‐health and agency

Abstract

IntroductionPolicy discussions reference ideas of informed and active users of e‐health services who gain agency through self‐management, choice and care delivered outside clinical settings. In this article, we aim to problematize this association by “thinking with” material from multiple disciplines to generate higher order insights to inform service development, research and policy.MethodsDrawing on meta‐narrative review methods, we gathered perspectives from multiple disciplines using an iterative process of expert consultation to identify seminal papers citation mapping, synthesis and peer review.ResultsWe identify six relevant paradigms from sociology, philosophy, health services research, public health, the study of social movements and computer studies. Bringing these paradigms together illuminates the contrasting epistemological and ontological framings that co‐exist in this area, including competing conceptualizations of e‐health technologies as: neutral tools for service delivery, mediators within complex and unpredictable clinical interactions and as agents in their own right.DiscussionThere is a need for e‐health policy to recognize many human and non‐human actors, the blurred boundaries between them and the unpredictable and evolving interactions that constitute engagement with e‐health care. Established models for e‐health service development and policy making are not designed for this landscape. There is nothing to be gained by asking whether e‐health, in general, either “increases” or “decreases” agency. Rather specific types and aspects of e‐health have diverse effects and can be simultaneously enabling and disempowering, and be differentially experienced by differently positioned and resourced actors.

How do users of a ‘digital-only’ contraceptive service provide biometric measurements and what does this teach us about safe and effective online care? A qualitative interview study

“…16 This gap in the evidence has implications for the 'digital-only' or 'digital-first' services that are increasingly part of health policy. 9 Sexual health services have been early adopters of digitally enabled self-care, 17 possibly because self-care is particularly attractive where stigma is a barrier to service access. 1 Online testing for sexually transmitted infections is now routine practice in many public health systems 5 18 19 and there is an expanding market for online contraception.…”

Beyond Health Literacy: Navigating Boundaries and Relationships During High-risk Pregnancies

“…Agency in healthcare is often defined as the patient's ability to contribute, influence, and decide on treatment that might contribute to a shared decision making [100] and it is often linked to notions of empowerment [13] and autonomy [89]. While autonomy implies independence and enables women to willingly act as they want (e.g., decision-making, freedom of movement and gender role attitude), women's agency is an important constituent of empowerment and socially shaped by the living experiences and circumstances [89].…”

Contraception in Person-Contraception Online (CiP-CO) cohort study

“…[1][2][3][4] Sexual and reproductive health (SRH) services have been early adopters of digital healthcare. 5 Online testing for sexually transmitted infections (STIs) is now routine in many public health systems [6][7][8] and there is an expanding market for online contraception within the private sector. 9 There is little research on the impact of online contraceptive services within public sector contexts.…”

“…International and UK health policy suggest that digital healthcare could improve user experience and access 1–4. Sexual and reproductive health (SRH) services have been early adopters of digital healthcare 5. Online testing for sexually transmitted infections (STIs) is now routine in many public health systems6–8 and there is an expanding market for online contraception within the private sector 9.…”