Elisabeth Späth (Furtwangen University) & Valeska Cappel (University of Lucerne)
A two-day symposium on “Digital Self-Tracking: Between Empowerment and New Barriers“, organized by the Schader-Stiftung and Furtwangen University, took place from 17.-18. April 2018 at the Schader-Forum in Darmstadt, Germany. The symposium was initiated by Stefan Selke, Johannes Achatz and Elisabeth Späth, who are examining the ethical aspects of digital self-tracking in the research project VALID (see project description, in German). The idea to start this symposium was to meet project partners as well leading experts in the field of self-tracking in order to exchange views on current self-tracking practices and their potential to create (more or less) barriers and empowerment of patients. Following the foundation’s motto “Dialogue between Social Sciences and Practice“, experts from a wide range of scientific disciplines (sociology, ethics, health and culture sciences, and medicine) and specific fields of practice, such as patient participation, health insurances, development and certification of health-apps, were invited. This motto was also reflected in the symposium’s structure by providing presentations of ongoing and completed projects as well as four workshops.
On the first day, Stefan Selke welcomed all guests, introducing the VALID project. Discussions on concepts and ideas on sampling criteria were led by scientific advisory board member Claudia Bozzaro (University Freiburg). Gerrit Fröhlich (University Trier) presented their on-going project “Reflexive Self-Scientificization” („Reflexive Selbstverwissenschaftlichung”) on lay-people’s perspective on as well as experiences with diet-tracking apps, pointing out that they try to minimize subjective impact on estimating their well-being/health status (“they make the world a laboratory“). Highlighting relevant insights from a completed project, Nils Heyen (Fraunhofer-Institut ISI Karlsruhe) introduced the prosumer approach, which captures the idea that the self-tracker is producer and consumer of “knowledge“. Furthermore, he shed light on the “future(s)“ of self-tracking by applying a scenario-methodology to current practices and projecting possible societal consequences of self-tracking activities. After a coffee-break, participants split up to attend workshops on “Data and Performance/Achievement“ given by Jana Wegener (Kulturwissenschaftliches Institut Essen) and “Data and Barriers“ given by Peter Langkafel (Healthcubator GmbH). On the following day, two sub-projects of the VALID project were presented: Christof Dame (Charité Berlin, Neonatologie) gave interesting insights into practices of data tracking/monitoring done by parents regarding their premature infants, calling to “track“ and interpret the interaction between father, mother and infant (e. g. bonding). Melike Sahinol (Orient-Institut Istanbul) gave an overview of her research topics, such as human enhancement and cultural meanings of human interventions in bodies, with specific regard to regulations in Turkey, and addressed the particular methodological challenge to conduct interviews with vulnerable groups (here: children with 3D-printed prostheses). After a lunch break, Christina Westphal emphasized in her workshop on “Data and Measuring“ the pitfalls of defining “good“ – in a quality- and ethics-related sense – criteria for the certification of health-apps. Manuela Pfinder (AOK Baden-Württemberg, department of health promotion) presented the pay-as-you-live tariff model from a health insurance perspective. Exemplifying the interface between theory and practice, Sylvia Sänger (University of Applied Health Sciences, Campus Gera) gave an empirical-analytical account on whether the health care system empowers or rather hinders patients to be “health literates“. In respect to evaluating where to “place“ digital self-tracking on a spectrum between empowerment new barriers, she posed the question of how knowledge can be shared so that everyone can benefit from and contribute to knowledge production at the same time.
In the following, we want to highlight the talks specifically revolving around the economy of conventions (EC) as well as related topics. Valeska Cappel (University of Lucerne) gave a theoretical introduction on the EC to illustrate the benefit of conventionalist thinking in the field of self-tracking. She presented some main concepts of the EC, like the investments in forms, to show how this theoretical frame can help as a methodological approach to start empirical research for analyzing preventive health-apps. The EC hereby serves as a useful approach to grasp the variety and normativity of the situation. In her presentation she focused on the question of the genesis of classifications in preventive health apps and the situational practice. Her empirical research involves qualitative expert interviews, focus groups with different actors from the health sector as well as an artefact analysis. Interestingly, a guest compared the theory of EC with the design thinking approach, because it, too, essentially falls back onto non-hierarchical thinking and exchanging different motives, which might be particularly relevant for a developer’s perspectives. An important aspect was raised in respect to the methodological approach as one should distinguish between an interviewee’s verbal response and their actual behavior. This might be an important hint in the context of analyzing how people justify their behavior, indicating the challenge especially in the field of self-tracking, to get into the situation of visible orders of justification.
Drawing from interviews with self-tracking people, Karolin Kappler (University Hagen) illustrated different types of ambivalences evolving from self-tracking practices in her talk on the habitualization of the body-subjective body relationship („Körper-Leib Habitualisierung“). One type of ambivalence she highlighted lies in the “confusion“ of the relationship between well-being and counting calories; against the supposing benefit of self-tracking by structure and self-monitoring, it is not that clear that self-tracking really does good to one’s health and well-being. Although the data recommended to eat more or less calories, the interviewees explained in some cases, they physically speaking do not feel well after following this advice and prefer to act in a different way. Through qualitative interviews with self-trackers, she caved out the orders of justifications in regard to the use of self-tracking apps. She emphasized self-care as a new form of order of justification: the practice of self-tracking brings a certain type of valence to the fore in the sense that it is “good“ to “be able to take care after oneself“. In this light, theories on individualism and hedonism may gain new relevance in the study of digital self-tracking. An important open question she raised was directed towards which kind of understanding of common good is compatible with this new self-care order of justification.
Rainer Diaz-Bone (University of Lucerne) subsequently gave a stimulating overview of the EC and its main concepts, introducing pragmatism, and structuralism as a form of megaparadigm to frame the EC; following this line of thought, conventions are seen as logics of coordination, which fall back onto certain values and practices. Diaz-Bone brought in John Dewey’s process philosophy, which serves as a useful additional insight into EC, taking reality as constantly-changing entity and, with it, changing values and habits.
From an ethical perspective, EC may be relevant because this theory shows that situations are characterized through a plurality of normativities: actors, objects and dispositives are involved in mobilizing specific valences, valuations and qualities in situations. Therefore, quantification is always based on normative fundamentals. The insights provided by the EC basically demand to look at the genesis of data production and question the situational definition of health, to be able to understand how these quantifications and classifications are invented and who exactly pushes a certain view, or like Alain Desrosières said: “Quantification means to invent a convention first and measure then”. Diaz-Bone emphasized that the starting point of the research concerning self-tracking should not focus on the data itself, but rather on the initiation of the process of the data formation.
In the light of the different ambivalences concerning the potentials, and downsides coming along with digital self-tracking, we may repeat Karolin Kappler’s illustrative quote at the very end of her presentation: “Not everything that can be counted counts, and not everything that counts can be counted.“ (Albert Einstein)