2.
Petersson, Jesper, 1974
(författare)
Geographies of eHealth: Studies of Healthcare at a Distance
2014
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
This thesis examines the proliferation of healthcare services using information and communication technology to overcome spatial and temporal obstacles. These services are given such names as telemedicine and telecare, which are sometimes grouped together as telehealthcare under the umbrella term eHealth. My main argument is that a prevalent and overoptimistic rhetoric of how the possibilities of digitalization are expected to produce a homogenous and ubiquitous healthcare space conceals many of the spatiotemporal complexities involved in introducing telehealthcare and in the overall organizing of healthcare. To counteract such simplifications, I contend that we need a relational understanding of the technical and the geographical as always nested in the social and vice versa. With such an approach, it is arguably possible to begin to tease apart the many spatiotemporal entanglements of these innovations and to trace their political ramifications. This position is developed by integrating perspectives from science and technology studies with insights from human geography. The four constituent papers of this thesis pursue this argument in qualitatively grounded case studies of telehealthcare and its geographies. Paper I looks at various initiatives for fetal tele-ultrasonography, demonstrating that this practice cannot be reduced to a mere transparent relay for the speedy transmission of digital information across space and time. The paper investigates how its introduction could affect medical knowledge production, power hierarchies, and subject positions, for example, the status attributed to the fetal figure. Paper II traces Swedish transformations of telehealthcare. The use of telemedicine to reach those outside medicine’s range has arguably been accompanied by efforts to achieve intra-organizational streamlining via telemedicine. This process has continued with the emergence of telecare for personal use directed toward the overlapping groups of the elderly people and patients with chronic conditions. I contend that this shift can be understood through a geographical lens as attempts to save space and time by keeping as many patients as possible out of costly hospitalization and preventing them from engaging scarce specialist resources. Paper III compares four telemedicine projects in Sweden. In detailing how the purpose of practicing telemedicine differed between these projects in relation to, for example, the specifics of distance, care availability, and treated medical conditions, the paper demonstrates the existence of many versions of telemedicine. Whereas this fluidity could further the spread of telemedicine, it could also cause problems. To various actors wanting to use telemedicine in a homogenous and fixed way for national streamlining purposes, this diversity has generated confusion when they wished to align telemedicine in a preferred direction. The paper concludes that technology travels best when it can contain both fluid and fixed relationships. Paper IV argues that, whatever is claimed about creating a space- and time-independent healthcare by means of telehealthcare, the use of telecare to connect the standardized spaces of healthcare with the fluid everyday lives of elderly people and patients with chronic conditions actually works by unfolding new spaces of visibilities and establishing new temporalities as well. By investigating these spatiotemporalities, I demonstrate how these applications draw together discourses on individual freedom with medically derived algorithms and concerns about how to make best use of scarce healthcare resources.
3.
Åberg, Linnéa
(författare)
Standardiseringsarbetets kollektiva praktik. En studie om att kvalitetssäkra integrationssatsningen Samhällsorientering för nyanlända.
2020
Doktorsavhandling (övrigt vetenskapligt/konstnärligt) abstract
Societal efforts to support the integration of newly arrived immigrants have been repeatedly highlighted in the political debate in Sweden and they are described as inadequate and ineffective. Demands have been made for improvements and one of the designated efforts is Civic Orientation (CO). The Civic Orientation programme is a course about Swedish society, targeting newly arrived refugees and their relatives who have received a residence permit. It provides basic information about Swedish society to aid and expedite integration (SFS 2010:1138). The criticism has led to the production of written, national instructions containing correct information that should be provided by the civil servants in CO. The aim is that quality should be high and equal across the country. The overall aim of the dissertation is to deepen the understanding and knowledge of the work-process to develop standard guidelines, that will be used in a welfare sector, where it is difficult to establish definitive knowledge. The dissertation's purpose is also to deepen the understanding and knowledge of instruction work as a collaborative activity. The term ‘instruction work’ covers both work that experts and managers undertake when they develop written guidelines, and work done when implementing these guidelines in local practice. The thesis is rooted in activity theory where work is viewed as a collaborative activity aimed at taking on a task, event or object, such as interpreting, paying attention, participating, thinking, and performing. The study involves five different categories of actors: a representative from the county administrative board, experts from various authorities and universities, coordinators and the head of a unit from a management group in a municipality, and integration workers, who are the local civil servants. The study is based on a field study where video recorded observations of meetings, lectures and workshops have been conducted. Semi structured interviews and written communication have also been used. The result shows that there are different perceptions of what work needs to be done to ensure that the instructions are correct. A variety of, sometimes contradictory, tasks developed: to make the information scientifically correct with multiple perspectives on social phenomena, to make educational simplification, to provide an ideal image of Sweden according to policy, or to describe Swedish society as irrational with hinders and obstacles (papers 1- 3). Another major task was to make the instructions politically neutral which meant producing information that was not offensive for external readers such as politicians and the general public (paper 1). When guideline models have been used for other welfare activities, the work is usually based on analysis of the needs of the target groups. That task took on an obscured role and was first noticed as important by the civil servants in the latter part when the material was used during implementation (papers 1, 3). A further result concerns the work of developing standard guidelines. The study shows that there is formal instruction work (paper 1) which is the planned work, most often done by experts and/or researchers, and informal instruction work (paper 2) often hidden and performed by civil servants in the implementation phase. This informal work is about transforming the instructions to be useful for the individual in the local situation. But the study also shows a third type of work - semi-formal instruction work (paper 3) that is also carried out by the local civil servants, where they, with their biographical and informal instruction work experience, try hard to influence formal instruction work. One conclusion is that it is more fruitful and accurate to perceive standardized instructions as dynamic and integrated in the practical work, than to see them as fixed by an externally controlled process. Developing standards to be used to improve practice is an ongoing fluid process that never ends, and that involves tensions and conflicts that need to be addressed.
