Toward a More-Than-Human Analysis of Digital Health: Inspirations From Feminist New Materialism

Moving Beyond Clinical Imaginaries: Technogeographies of the Everyday Urban

In this paper, we analyse the intersections between care and place in mundane spaces not explicitly designed for the provision of care, and where digital technologies are used to mediate ecologies of distress in the city. We locate our analysis alongside studies of how digital technologies impact the experience of care within non-clinical spaces, whilst noting that much research on the use of technologies for care remains haunted by clinical imaginaries. Bringing together ideas of multi-sited therapeutic assemblages, technogeographies of care, and how places-by-proxy can act as conduits for care, we explore an example of an online app being used in public space to manage experiences of anxiety in an everyday urban environment. We reflect on this illustrative example to trace the movement of care as it is mediated through digital technologies-out of the clinic, beyond the home, and into the ordinary spaces of the city. We conclude that the entanglements of digital technologies and ordinary urban places prompt us to entirely reconsider questions of the where of care.

Vibrant Screens: Remote therapy and counselling through the lens of digital materiality

This article analyses the digital screen as a health technology. In particular, the article asks how screens as a part of therapy settings or counselling practices materialise - or fail to materialise - care. The empirical data comprise interviews with therapy and counselling professionals, whose experiences with technology during the COVID-19 pandemic were my original interest. Adopting a sociomaterial approach to technology use, it scrutinises not only how screens are used, but also how screens themselves act and operate. This approach foregrounds the screen as 'multiple', complicating a dichotomous understanding between in-person therapy and remote therapy. The article argues that the screen operates in a variety of ways that might either facilitate or degrade care and is an essential part of more-than-human care in digitalised societies. Acknowledging the agential capacities of all matter, the article also conceptualises screens as 'vibrant matter'.

'It's not as good as the face-to-face contact': A sociomaterialist analysis of the use of virtual care among Canadian gay, bisexual and queer men during the COVID-19 pandemic

The COVID-19 pandemic led to the widespread adoption of virtual care-the use of communication technologies to receive health care at home. We explored the differential impacts of the rapid transition to virtual care during the COVID-19 pandemic on health-care access and delivery for gay, bisexual and queer men (GBQM), a population that disproportionately experiences sexual and mental health disparities in Canada. Adopting a sociomaterial theoretical perspective, we analysed 93 semi-structured interviews with GBQM (n = 93) in Montreal, Toronto and Vancouver, Canada, conducted between November 2020 and February 2021 (n = 42) and June-October 2021 (n = 51). We focused on explicating how the dynamic relations of humans and non-humans in everyday virtual care practices have opened or foreclosed different care capacities for GBQM. Our analysis revealed that the rapid expansion and implementation of virtual care during the COVID-19 pandemic enacted disruptions and challenges while providing benefits to health-care access among some GBQM. Further, virtual care required participants to change their sociomaterial practices to receive health care effectively, including learning new ways of communicating with providers. Our sociomaterial analysis provides a framework that helps identify what works and what needs to be improved when delivering virtual care to meet the health needs of GBQM and other diverse populations.

Postdigital health practices: new directions in medical humanities

Digitalisation has changed the way we understand and practice health. The recent pandemic has accelerated some of the developments in digital health and brought about modifications in public access to information. Taking this into consideration, this programmatic paper sets the stage for and conceptualises postdigital health practices as a possible field of inquiry within medical humanities. While delineating some central aspects of said practices, I draw attention to their significance in contemporary strategies of knowledge production. Spotlighting online environments as the point of ingress for the analysis of these practices, I propose three possible foci of critical and methodological engagement. By spotlighting the serialisation, multimodality, and transmediality of such environments, I argue, we have a chance to both augment and go beyond the field's long-standing preoccupation with narrative, attend to various strategies of communicating illness experience, and re-frame them within larger questions of systemic inequalities. On this basis, and taking as examples COVID-19 and Long COVID, I sketch some of the directions that future strands of medical humanities may take and some of the questions we still have to ask for the field to overcome its own biases and blind spots.

Listening, learning, caring: exploring assemblages of, ethics of and pathways to care for avoidant restrictive food intake disorder (ARFID)

Care has been theorised in relationship to eating disorders as a central consideration across diagnoses. In the context of avoidant restrictive food intake disorder (ARFID) specifically, there is room to further develop the nuances around layers of care involved in working towards well-being. In this paper, we engage with the stories of 14 caregivers of people with ARFID, exploring their pathways to care (or lack thereof) through the healthcare system in Aotearoa New Zealand. We explore the material, affective and relational aspects of care and care-seeking, engaging with the power and politics of care as it flows through care-seeking assemblages. Using postqualitative methods of analysis, we discuss how while participants were seeking care, they received (or, at times, did not receive) treatment, and unpack how care and treatment are not always synonymous. We work up extracts from parents' stories surrounding their caring for their children and how their actions were, at times, interpreted in ways that made them feel blame and shame rather than care. Participants' stories also offer glimmers of care within a resource-strapped healthcare system, which invite us to consider the potentiality of a relational ethics of care as an assemblage-shifting moment.

Dementia as a material for co-creative art making: Towards feminist posthumanist caring

This article generates new understandings of dementia through feminist posthumanist and performative engagements with co-creative artmaking practices during a six-month study in a residential care home in Norway. Dementia emerges within multisensorial entanglements of more-than-human materials in three different artmaking sessions, which first materialized in the form of collective photographs and vignettes and culminated in a final exhibition, Gleaming Moments, in the care home. Drawing on these photographs, vignettes, and the author's engagement as a research artist in the sessions, this analysis examined how dementia was enacted as a spark of inspiration, felted warm seat pads, and a friendly more-than-human touch, that is, a touch of human and nonhuman art materials. These findings suggest new ontologies of dementia within multisensorial artmaking practices, in which dementia functions as a material for co-creative artmaking rather than a disease. These findings disrupt dominant biomedical ontologies of Alzheimer's disease and other dementias, as well as humanist person-centered practices in dementia care, which have concretized an individual, rather than relational, focus on dementia. In contrast, this study explores dementia as a phenomenon within the entanglements of human and nonhuman intra-active agencies. By highlighting the significance of these agencies (i.e., sponge holder-painting, wool-felting, choir-singing, chick-making) for different worlds-making with dementia, this study provides an entry point for imagining feminist posthumanist caring. Thus, dementia becomes a matter in life that is not to be managed and defeated to achieve successful aging, but to be interrogated and embraced.

"There's an Etiquette to Zoom That's Not Really Present In-Person": A Qualitative Study Showing How the Mute Button Shapes Virtual Postpartum Support for New Parents

Virtual spaces that allow parents in the postpartum period to connect, support each other, and exchange information have been increasing in popularity. With the COVID-19 pandemic, many parents had to rely on virtual platforms as a primary means to connect with others and attend to their postpartum health. This study explored virtual postpartum support sessions through the web-based videoconferencing software, Zoom. Guided by feminist poststructuralism and sociomaterialism, we held seven virtual support sessions for parents caring for a baby 0-12 months in age, in Canada, and interviewed 19 participants about their experiences in the sessions. Our methodological approach allowed us to analyze discourses of (1) parenthood, (2) material realities of virtual environments, and (3) support and information on this virtual platform. The purpose of this research was to understand how technology influences postpartum support and learning through online videoconferencing for parents. Our findings document an overarching discourse of Zoom etiquette by which muting was a discursive practice that all participants used. The consistent use of the mute button while not talking structured conversation in virtual postpartum sessions and resulted in three themes: (1) minimizing disruptions; (2) taking turns; and (3) staying on task. The norm of using the mute button changed how parents received and gave support and information. Based on findings and broader literature, we discuss considerations for facilitation of virtual postpartum support sessions.

Photodiagnosis of genital herpes and warts: a sociomaterial perspective on users' experiences of online sexual health care

Online sexual health services potentially transform modes of engagement with service users. We report findings from an in-depth interview study with users of a photo-diagnosis service offered by an established UK-based online sexual health service (SH:24). Adopting a sociomaterial theoretical perspective, we analyse the interviews for descriptions of health care with and through the affordances offered by SH:24. We focus on how the interactions of service users and clinicians with nonhuman agents opened or closed off capacities for better health and wellbeing. Our findings explore navigating online and in-person service options; digitising bodies; temporal affordances; the tension between anonymous and personalised care; configuring digital privacy; and when automated care is not enough. We conclude that emerging practices of care within digital health services delivered by more-than-human collaborations reconfigure experiences of diagnosis and treatment and require detailed attention to understand how they create and close down opportunities to improve or maintain health.

Theorising health equity research for people with intersex variance through new materialism

Health inequalities impact sex-variant people in highly differentiated ways. This is evidenced in much academic and activist intersex research documenting the highly specific forms of inequalities arising from misrecognition, discrimination and human rights abuses inherent to pathologised accounts of non-normative bodies. Important theoretical work further interrogates the implications of sex variant subjectivities, identities and bodies for static or binary notions of both sex and gender. In this paper, we aim to contribute further to this scholarship. We draw upon feminist materialist and Deleuzean-informed understandings of materials or matter to rethink debates over sex-variant subjectivities, identities and bodies in relation to inequalities in health. We argue 'the turn to matter' and associated new materialist theories draw attention to the complex, dynamic relational assemblages and entanglements mutually constituting the affective, embodied and socio-material worlds of intersex people. Informed by these theories, we propose that inequalities can be more fully addressed through a new health equity research agenda that is co-produced with sex-variant people. This agenda will enable a fuller exploration of the unsettling but transformative capacities of intersex matters and meanings with the contextually specific understandings of equity in relation to health and health care.

Antibiotic assemblages and their implications for the prevention of antimicrobial resistance

Individual antibiotic use for common infections is a focus for public health efforts seeking to prevent antimicrobial resistance (AMR). These approaches employ a binary opposition of responsible and irresponsible antibiotic use with a focus on the knowledge, behaviours and intentions of the individual. To overcome these unhelpful tendencies and reveal new entry points for AMR prevention, we adopted assemblage theory to analyse personal experience narratives on individual antibiotic use in community settings. Antibiotic use was irregular, situationally diverse and shaped by factors not always under personal control. Individuals were focussed on preventing, moderating and treating infections that threatened their health. Our analysis shows that antibiotic assemblages are both cause and effect of individual efforts to manage infections. We suggest that AMR prevention needs to look beyond the antibiotic as object and the (ir)responsible use binary to engage with the antibiotic effects individuals seek in order to manage infectious diseases. This antibiotic assemblage orientation is likely to be more meaningful for individuals seeking out methods for promoting their health in the face of common infections.

Rethinking digital biopedagogies: How sociomaterial relations shape English secondary students' digital health practices

It is widely recognised that while many young people in high-income countries are active users of digital health technologies, their engagement can be short term. In this article, we draw on feminist materialism theory to analyse findings from the two qualitative phases of a mixed-methods three phase study of English secondary students' digital health practices. Bringing together work on biopedagogies alongside more-than-human thinking, we analyse our participants' accounts of their intra-actions with human and nonhuman affordances and materialities. Our findings reveal how young people's capacity for navigating the digital health landscape and translating knowledge into health practice is highly contingent on the complex engagement of different actors in digital health assemblages, including more-than-digital relational connections. Our study found that key human actors - typically in face-to-face settings - were crucial in doing the affective work necessary to guide adolescents through the tensions and conflicts they experienced when dealing with competing knowledges and expectations. The research underlines the ways in which feminist materialism perspectives can supplement scholarship on biopedagogies, specifically contributing to the theorising on young people's learning and embodiment through digital practices.

It's about time: on the need of a temporal language for ecologically dimensioned medical humanities and public health scholarship

The COVID-19 pandemic has highlighted multiple system dependencies that urge us to rethink our relationship with other humans, non-humans and their various environments. Whereas a growing body of literature highlights the need for ecologically dimensioned medical humanities, focusing on where and how our healths unfold relationally through their ecologies, this paper argues that little attention has been paid to the when of health. In reply, this paper sets out to expand this understanding, first by grounding the ecological argument for medical humanities in a wider net of relational ontologies, and second by highlighting the need to think temporally, specifically multitemporally, about the relationalities of health. The paper advances the sociological concepts of 'time' and 'temporalities' to help us think about various tempi, rhythms, urgencies and legacies of how health unfolds unevenly into the future.

Coronavirus, capitalism and a 'thousand tiny dis/advantages': a more-than-human analysis

This paper establishes a relational, post-anthropocentric and materialist approach to the Covid-19 coronavirus pandemic. Analysis of the 'pandemic assemblage' reveals that the virus has subverted the social and economic relations of capitalism, enabling its global spread. This insight establishes a materialist framework for exploring socio-economic disparities in Covid-19 incidence and death rates, via a more-than-human and monist analysis of capitalist production and markets. Disparities derive from the 'thousand tiny dis/advantages' produced by people's daily interactions with human and non-human matter, making sense of the unequal occupational patterning of coronavirus incidence. This more-than-human approach supplies a critical alternative to the mainstream public health and scientific perspectives on the pandemic, with important implications for current and future policy to counter future microbiological outbreaks.

Diversity via datafication? Digital patient records and citizenship for sexuality and gender diverse people

In 2018, the Australian Government adopted an ‘opt-out’ strategy to increase participation in My Health Record (MHR), the national digital patient record system. Opt out was rationalised through discourse on the universal right to health. Media controversy ensued due to privacy fears, security and commercial exploitation of patient information. LGBT community organisations warned that people with complex health needs should consider their privacy and legal situation when deciding whether or not to opt out of MHR. With reference to the health needs of sexuality and gender diverse people, we examine MHR’s rights universalism, possessive individualism, and state-based rationalisation of health governance. MHR hails all but no-one in particular, erasing diversity and straightwashing data medicine. It is a technological solution to state-based imperatives for health governance, an emphasis that does not serve minority communities or address health needs that attract stigma and prejudice. We counterpose these effects with citizenship framings seated in critical approaches to data assemblages and sexuality and gender diversity. We suggest ways in which data medicine, of which MHR is but one example, can be made more relevant and effective for individuals and communities whose healthcare is poorly served by mainstream health systems.

Women's Articulations of Aging: “Learning to Be Affected” Through Experiences in Recreational Ballet

In this article, we draw upon the experiences of mature recreational dancers who participated in classes facilitated by a professional ballet company and catered to older adults. Moving with 11 women through a 10-week ballet course, and immersing ourselves in the empirical material, we recognized opportunities for broadening our analysis of aging dancing bodies. Inspired by a Latourian understanding of bodies and a recent new materialist turn in humanities and social sciences, we became curious about the ways that the women were being affected by their experiences in ballet. The ballet studio, the barre, muscles, sweat, and music were all discussed as influential aspects contributing to their understandings of aging and dancing. Moving beyond biomedical prescriptions and extending socio-cultural constructions, we reveal opportunities for Latourian theory to dance with us toward re-imagining what is possible for aging recreational ballet dancers. Here, we allow the women's articulations of aging in ballet to exist as unique expressions unbound by limitations. Moving with women as they learn to become more affected through dance, we are given the opportunity to think about bodies, ballet and aging differently.

Coping with COVID-19: The sociomaterial dimensions of living with pre-existing mental illness during the early stages of the coronavirus crisis

In this article, we use the case study method to detail the experiences of five participants who reported living with pre-existing mental illness during COVID-19. We adopted a sociomaterial analytical approach, seeking to identify how human and nonhuman agents came together to generate states of wellbeing or distress during this challenging period. As the case studies show, feelings of anxiety, fear and risk were generated from the following sociomaterial conditions: loss of face-to-face contact with friends and family members; concerns about hygiene and infecting others; financial stress; loss of regular paid employment or volunteering work; public spaces; and the behaviour of unknown others in public spaces. The agents and practices that emerged as most important for opening capacities for coping and maintaining wellness during lockdown included: the space of the home; contact with a small number of intimate others; online therapeutic care; practising self-care skills learnt from previous difficult times; helping and supporting others; engaging in leisure activities; and the companionship of pets. Contributing to an affirmative approach to more-than-human assemblages of health, distress and recovery, these findings demonstrate what bodies can do in times of crisis and the agents and practices that can generate capacities for coping.

Sociomaterialities of health, risk and care during COVID-19: Experiences of Australians living with a medical condition

People living with pre-existing illnesses were identified as one of the groups most at risk when COVID-19 erupted. In this article, using the method of case studies developed from interviews, we explore how Australians in this category considered their risk and responded to it as they were learning about COVID-19 and living with restrictions and lockdown conditions in the early months of the pandemic. Building on the literature on assemblages of health and illness, therapeutic landscapes and the materialities of care, our analysis considers sociomaterialities of health, risk and care described in six featured case studies. Each person recounted a unique narrative that described the coming together of several different human and nonhuman agents in their experiences. Yet a number of overarching and intersecting themes can also be traced across the participants' narratives: the vital contributions of lay care and self-care as part of the materialities of care, health and wellbeing; the role played by social networks, both online and in-person, for people in learning about and coping with COVID-19 and its potential risks; previous embodied and affective experiences of illness, vulnerability and care; and the role played by place and space in generating either therapeutic or distressing affective atmospheres. These findings have implications for better understandings of the situated sociomaterial contexts of how embodied experience, affective forces and encounters and relationships with other people and with things, place and space come together in crises such as COVID-19.

Hype, evidence gaps and digital divides: Telehealth blind spots in rural Australia

Despite high unmet demand for health services across rural Australia, uptake of telehealth has been slow, piecemeal and ad hoc. We argue that widespread failure to understand telehealth as a socio-technical practice is key to understanding this slow progress. To develop this argument, we explore how technocentric approaches to telehealth have contributed to critical blind spots. First, the 'hype' associated with the technological possibilities of telehealth discourages thoughtful consideration of the unanticipated consequences when technologies are rolled out into complex social fields. Second, it contributes to critical gaps in the telehealth evidence base, and particularly a paucity of analyses focussing on the experiences of service users and patients. A third blind spot concerns the limited attention paid to the social determinants of health and digital divides in rural areas. The final blind spot we consider is an apparent reluctance to engage community stakeholders in co-designing and coproducing telehealth services. We used an iterative approach to identify studies and commentary from a range of academic fields to explain the significance of the telehealth blind spots and how they might be addressed. Insights suggest how expanding understanding of the social dimensions of telehealth could enhance its accessibility, effectiveness and responsiveness to community needs and contexts.

Understanding digital health ecosystem from Australian citizens' perspective: A scoping review

BACKGROUND

Digital health (DH) and the benefits of related services are fairly well understood. However, it still is critical to map the digital health care landscape including the key elements that define it as an ecosystem. Particularly, knowing the perspectives of citizens on this digital transformation is an important angle to capture. In this review we aim to analyze the relevant studies to identify how DH is understood and experienced by Australian citizens and what they may require from DH platforms.

MATERIALS AND METHODS

A scoping literature review was conducted across several electronic databases (ACM Digital Library, OVID, PubMed, Scopus, IEEE, Science Direct, SAGE), as well as grey literature. Additionally, citation mining was conducted to identify further relevant studies. Identified studies were subjected to eligibility criteria and the final set of articles was independently reviewed, analyzed, discussed and interpreted by three reviewers.

RESULTS

Of 3811 articles, 98 articles met the inclusion criteria with research-based articles-as opposed to review articles or white papers- comprising the largest proportion (72%) of the selected literature. The qualitative analysis of the literature revealed five key elements that capture the essence of the digital health ecosystem interventions from the viewpoint of the Australian citizens. The identified elements were "consumer/user", "health care", "technology", "use and usability", "data and information". These elements were further found to be associated with 127 subcategories.

CONCLUSIONS

This study is the first of its kind to analyze and synthesize the relevant literature on DH ecosystems from the citizens' perspective. Through the lens of two research questions, this study defines the key components that were found crucial to understanding citizens' experiences with DH. This understanding lays a strong foundation for designing and fostering DH ecosystem. The results provide a solid ground for empirical testing.

Domestic violence, coercive control and mental health in a pandemic: disenthralling the ecology of the domestic

ABSTRACTDomestic and family violence is a social and public health issue typically positioned in policy frameworks as a consequence of gendered social and economic structures. In this paper, we deploy an approach that draws on Hörl's neo-ecological thinking to propose that the home, as a site of domestic violence, can be usefully framed as an ecology of the domestic, a posthumanist hybrid matrix of bodies, spaces and objects in which various practices enact the smooth running of the domestic together with practices of domestic and family violence, including coercive control. Our interest is in coercive control and in the impact that the COVID-19 pandemic had on practices which enact this aspect of domestic violence. Our exploration of the practices that enact coercive control draws on the work of Law and others. We examine how practices, which are not compatible, or that do not cohere, are able to coexist in a domestic ecology and what occurs when there is a disruption as occurred with the pandemic.

“‘Ninja’ levels of focus”: Therapeutic holding environments and the affective atmospheres of telepsychology during the COVID-19 pandemic

The COVID-19 crisis in Australia led to a rapid increase in the use of telehealth services to offer psychological therapy (often referred to as ‘telepsychology’). In this article, we discuss the intersection of the social psychology concepts of therapeutic holding spaces and containment with more-than-human theory as it relates to Australia's mental health sector during the COVID-19 crisis. Drawing on our recent qualitative survey research into Australian psychologists' use of telepsychology during the crisis, we consider the ways that they worked to build and maintain therapeutic holding spaces and alliances over teleconferencing platforms during this extraordinary time of social crisis and isolation. We explore and contextualise three important findings from our study: 1) the limited viewing area of a flat screen makes it difficult for therapists to read and respond to their client's body language and requires different forms of returned bodily gestures in order to show empathy; 2) most respondents implemented different affective and relational strategies online to ensure they were not missing important non-verbal cues from their clients; and 3) the traditionally ‘safe’ therapeutic holding space created in face-to-face therapy can be easily subverted by client-end interruptions, and concerns around safety or personal privacy in the client's home environment. In bringing these issues to the fore, we highlight the online therapeutic holding space as a temporally and socially situated human-technological assemblage in which a series of affective, spatial, relational and sense-making agencies coverage, opening or closing off capacities for therapists and their clients.

Parturescence: A theorisation of women's transformation through childbirth

PROBLEM

The potential for positive transformation through giving birth is under-acknowledged and poorly understood.

AIM AND METHOD

By drawing on theories of new feminist materialism to open up ways of thinking about childbirth and maternity care, we discuss how aspects of the process of matrescence, a woman's 'mother-becoming', pertain to women's opportunities in childbirth. We introduce the term, 'parturescence', as a moniker for the opportunity for 'becoming', and therefore transformation, offered in birth giving.

RESULTS AND DISCUSSION

Using Davies' interpretation of Bergson's lines of descent and ascent we suggest the conditions of a woman's parturescence (whether birth giving will result in a positive or negative transformation) is enabled by 'with woman' midwifery care. The intra-action between this care, and the materiality of birth - the pain and exhaustion women experience in labour and birth, results in a rematerialisation of who and what women are and the opportunity for women's transformation.

CONCLUSION

The development of this theory of parturescence unifies disparate aspects of maternity care and birth literature, provides insight into the potential mechanisms and conditions that impact women's parturescence, and suggests that birth, including the challenging and destabilising parts, is not just for the production of a baby, but also a site of women's 'becoming'.

The eating disorder recovery assemblage: Collectively generating possibilities for eating disorder recovery

In this paper, we explore the affective-discursive-material aspects of the supportive eating disorder recovery assemblage. We approach recovery as an “assemblage” to facilitate an understanding of how human (people, systems of care, etc.) and nonhuman (affect, discourses, etc.) forces generate possibilities or impossibilities for recovery. Moving away from framings of recovery as an individual achievement, we consider the relationality and dynamism of eating disorder recovery in interviews with 20 people in recovery and 14 supporters of people in recovery. We draw from experiential accounts to theorize a supportive eating disorder recovery assemblage in relation to trust and love mobilized in interactions and relationships. This supportive eating disorder recovery assemblage can scaffold new understandings of recoveries as multiple and co-produced. Supportive eating disorder recovery assemblages generate improvisational spaces, albeit loosely contained and bounded, for different pathways to and manifestations of “recoveries”. This work builds on a body of feminist scholarship on eating disorders/disordered eating that takes up gendered relationships of power in treatment settings, extending toward and analysing material, affective, embodied, and potentially affirming dimensions of care and emotion in participants’ lives.

'Keeping It Real': women's Enactments of Lay Health Knowledges and Expertise on Facebook

This article presents findings from a qualitative study concerning Australian women's use of Facebook for health and medical information and support and the implications for understanding modes of lay knowledge and expertise. Thinking with feminist new materialism theory, we identify the relational connections, affective forces and agential capacities described by participants as technological affordances came together with human bodily affordances. Affective forces were a dominant feature in users' accounts. Women were able to make relational connections with peers based on how valid or relevant they found other group members' expertise and experiences, how supportive other members were, how strong they wanted their personal connection to be and how much privacy they wanted to preserve. We identified three modes of engagement: 1) expertise claims based on appropriation and distribution of biomedical knowledge and experience; 2) sharing experiential knowledge without claiming expertise and 3) evaluation and use of knowledge presented by others principally through observing. We conclude that an 'expert patient' is someone who is familiar with the rules of engagement on sites such as Facebook and is able to negotiate and understand the affects and levels of disclosure and intimacy that such engagement demands.