Social Theory & Health

, Volume 11, Issue 3, pp 256–270 | Cite as

The digitally engaged patient: Self-monitoring and self-care in the digital health era

  • Deborah Lupton
Original Article


The phenomenon of digital health has emerged as a key dimension of contemporary healthcare policy and delivery in many countries. This review article focuses on one aspect of digital health discourses: the concept of patient engagement that encourages patients to take up the new digital media technologies to engage in self-monitoring and self-care, or what I term ‘the digitally engaged patient’. A critical approach is adopted to examine the sociocultural dimensions of eliciting patients to become ‘digitally engaged’ in their own medical care and preventive health efforts. It is argued that the techno-utopian discourses articulated in the mainstream healthcare policy literature concerning the possibilities and potentialities afforded by digital health technologies do not acknowledge the complexities and ambivalences that are part of using self-monitoring and self-care technologies for monitoring health and illness states, both for patients and for healthcare providers. These include the surveillance and disciplinary dimensions of using these technologies, the emotions and resistances they provoke, their contribution to the burden of self-care and the invisible work on the part of healthcare workers that they require to operate.


digital health digital media healthcare patient engagement telemedicine sociology 


  1. Andreassen, H. (2011) What does an e-mail address add? – Doing health and technology at home. Social Science & Medicine 72 (4): 521–528.CrossRefGoogle Scholar
  2. Andreassen, H. and Dyb, K. (2010) Differences and inequalities in health: Empirical reflections on telemedicine and politics. Information, Communication & Society 13 (7): 956–975.CrossRefGoogle Scholar
  3. Andreassen, H. and Trondsen, M. (2010) The empowered patient and the sociologist. Social Theory & Health 8 (3): 280–287.CrossRefGoogle Scholar
  4. Andreassen, H., Trondsen, M., Kummervold, P.E., Gammon, D. and Hjortdahl, P. (2006) Patients who use e-mediated communication with their doctor: New constructions of trust in the patient-doctor relationship. Qualitative Health Research 16 (2): 238–248.CrossRefGoogle Scholar
  5. Barello, S., Graffigna, G. and Vegni, E. (2012) Patient engagement as an emerging challenge for healthcare services: Mapping the literature,, accessed 16 March 2013.
  6. Beer, D. (2009) Power through the algorithm? Participatory web cultures and the technological unconscious. New Media & Society 11 (6): 985–1002.CrossRefGoogle Scholar
  7. Brittain, K., Corner, L., Robinson, L. and Bond, J. (2010) Ageing in place and technologies of place: The lived experience of people with dementia in changing social, physical and technological environments. Sociology of Health & Illness 32 (2): 272–287.CrossRefGoogle Scholar
  8. Cartwright, L. (1995) Screening the Body: Tracing Medicine’s Visual Culture. Minneapolis, MN: University of Minnesota Press.Google Scholar
  9. Cheney-Lippold, J. (2011) A new algorithmic identity: Soft biopolitics and the modulation of control. Theory, Culture & Society 28 (6): 164–181.CrossRefGoogle Scholar
  10. Coopmans, C. (2006) Making mammograms mobile: Suggestions for a sociology of data mobility. Information, Communication & Society 9 (1): 1–19.CrossRefGoogle Scholar
  11. De Vogli, R. (2011) Neoliberal globalisation and health in a time of economic crisis. Social Theory & Health 9 (4): 311–325.CrossRefGoogle Scholar
  12. Dentzer, S. (2013) Rx for the ‘blockbuster drug’ of patient engagement. Health Affairs 32 (2): 202.CrossRefGoogle Scholar
  13. Dyb, K. and Halford, S. (2009) Placing globalizing technologies: Telemedicine and the making of difference. Sociology 43 (2): 232–249.CrossRefGoogle Scholar
  14. Goggin, G. (2011) Ubiquitous apps: Politics of openness in global mobile communities. Digital Creativity 22 (3): 148–159.CrossRefGoogle Scholar
  15. Greaves, F., Ramirez-Cano, D., Millett, C., Darzi, A. and Donaldson, L. (2013) Harnessing the cloud of patient experience: Using social media to detect poor quality healthcare. BMJ Quality & Safety 22 (3): 251–255.CrossRefGoogle Scholar
  16. Greene, J. and Hibbard, J.H. (2012) Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of General Internal Medicine 27 (5): 520–526.CrossRefGoogle Scholar
  17. Greener, I. (2003) Patient choice in the NHS: The view from economic sociology. Social Theory & Health 1 (1): 72–89.CrossRefGoogle Scholar
  18. Halford, S., Lotherington, A.T., Obstfelder, A. and Dyb, K. (2010) Getting the whole picture? New information and communication technologies in healthcare work and organization. Information, Communication & Society 13 (3): 442–465.CrossRefGoogle Scholar
  19. Hortensius, J., Kars, M., Wierenga, W., Kleefstra, N., Bilo, H. and van der Bijl, J. (2012) Perspectives of patients with type 1 or insulin-treated type 2 diabetes on self-monitoring of blood glucose: A qualitative study BMC Public Health,, accessed 5 May 2013.
  20. Huniche, L., Dinesen, B., Nielsen, C., Grann, O. and Toft, E. (2013) Patients’ use of self-monitored readings for managing everyday life with COPD: A qualitative study. Telemedicine and e-Health 19 (5): 396–402.CrossRefGoogle Scholar
  21. Joyce, K. and Loe, M. (2010) A sociological approach to ageing, technology and health. Sociology of Health & Illness 32 (2): 171–180.CrossRefGoogle Scholar
  22. Loe, M. (2010) Doing it my way: Old women, technology and wellbeing. Sociology of Health & Illness 32 (2): 319–334.CrossRefGoogle Scholar
  23. Long, S.O. (2012) Bodies, technologies, and aging in Japan: Thinking about old people and their silver products. Journal of Cross-Cultural Gerontology 27 (2): 119–137.CrossRefGoogle Scholar
  24. Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body. London: Sage.Google Scholar
  25. Lupton, D. (1996) Your life in their hands: Trust in the medical encounter. In: V. James and J. Gabe (eds.) Health and the Sociology of Emotions. Oxford: Blackwell Publishers, pp. 157–172.Google Scholar
  26. Lupton, D. (1997a) Consumerism, reflexivity and the medical encounter. Social Science & Medicine 45 (3): 373–381.CrossRefGoogle Scholar
  27. Lupton, D. (1997b) Foucault and the medicalisation critique. In: A. Petersen and R. Bunton (eds.) Foucault, Health and Medicine. London: Routledge, pp. 94–110.Google Scholar
  28. Lupton, D. (2012) M-health and health promotion: The digital cyborg and surveillance society. Social Theory & Health 10 (3): 229–244.CrossRefGoogle Scholar
  29. Lupton, D. (2013) Quantifying the body: Monitoring, performing and configuring health in the age of mHealth technologies. Critical Public Health, advance online publication 3rd May, doi:10.1080/09581596.2013.794931.Google Scholar
  30. Malykhina, E. (2013) Home is where the health is: Obamacare positions ‘telehealth’ tech as a remedy for chronic hospital readmissions,, accessed 12 April 2013.
  31. Marcus, G. (2006) Assemblage. Theory, Culture & Society 23 (2–3): 101–106.CrossRefGoogle Scholar
  32. Mol, A. (2009) Living with diabetes: Care beyond choice and control. Lancet 373 (9677): 1756–1757.CrossRefGoogle Scholar
  33. Mol, A. and Law, J. (2004) Embodied action, enacted bodies: The example of hypoglycaemia. Body & Society 10 (2–3): 43–62.CrossRefGoogle Scholar
  34. Morden, A., Jinks, C. and Ong, B.N. (2012) Rethinking ‘risk’ and self-management for chronic illness. Social Theory & Health 10 (4): 78–99.CrossRefGoogle Scholar
  35. Mort, M., Finch, T. and May, C. (2009) Making and unmaking telepatients: Identity and governance in new health technologies. Science, Technology & Human Values 34 (1): 9–33.CrossRefGoogle Scholar
  36. Mort, M., May, C. and Williams, T. (2003) Remote doctors and absent patients: Acting at a distance in telemedicine? Science, Technology, & Human Values 28 (2): 274–295.CrossRefGoogle Scholar
  37. Mort, M. and Smith, A. (2009) Beyond information: Intimate relations in sociotechnical practice. Sociology 43 (2): 215–231.CrossRefGoogle Scholar
  38. Nettleton, S. (2004) The emergence of e-scaped medicine? Sociology 38 (4): 661–679.CrossRefGoogle Scholar
  39. Nicolini, D. (2007) Stretching out and expanding work practices in time and space: The case of telemedicine. Human Relations 60 (6): 889–920.CrossRefGoogle Scholar
  40. Oudshoorn, N. (2008) Diagnosis at a distance: The invisible work of patients and healthcare professionals in cardiac telemonitoring technology. Sociology of Health & Illness 30 (2): 272–288.CrossRefGoogle Scholar
  41. Oudshoorn, N. (2009) Physical and digital proximity: Emerging ways of health care in face-to-face and telemonitoring of heart-failure patients. Sociology of Health & Illness 31 (3): 390.CrossRefGoogle Scholar
  42. Oudshoorn, N. (2011) Telecare Technologies and the Transformation of Healthcare. Houndmills, UK: Palgrave Macmillan.CrossRefGoogle Scholar
  43. Oudshoorn, N. (2012) How places matter: Telecare technologies and the changing spatial dimensions of healthcare. Social Studies of Science 42 (1): 121–142.CrossRefGoogle Scholar
  44. Oudshoorn, N. and Somers, A. (2006) Constructing the digital patient: Patient organizations and the development of health websites. Information, Communication & Society 9 (5): 657–675.CrossRefGoogle Scholar
  45. Ringquist, L. (2013) Re-admissions: Is telehealth the answer?,, accessed 14 April 2013.
  46. Rozenblum, R. and Bates, D.W. (2013) Patient-centred healthcare, social media and the internet: The perfect storm? BMJ Quality & Safety 22 (3): 183–186.CrossRefGoogle Scholar
  47. Ruppert, E. (2011) Population objects: Interpassive subjects. Sociology 45 (2): 218–233.CrossRefGoogle Scholar
  48. Salander, P. and Moynihan, C. (2010) Facilitating patients’ hope work through relationship: A critique of the discourse of autonomy. In: R. Harris, N. Wathen and S. Wyatt (eds.) Configuring Health Consumers: Health Work and the Imperative of Personal Responsibility. Houndmills, UK: Palgrave Macmillan, pp. 113–125.CrossRefGoogle Scholar
  49. Swan, M. (2012) Health 2050: The realization of personalized medicine through crowdsourcing, the quantified self, and the participatory biocitizen. Journal of Personalized Medicine 2 (3): 93–118.CrossRefGoogle Scholar
  50. Thielst, C.B. (2011) Social media: Ubiquitous community and patient engagement. Frontiers of Health Services Management 28 (2): 3.Google Scholar
  51. Topol, E. (2012) The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books.Google Scholar
  52. Veitch, K. (2010) The government of health care and the politics of patient empowerment: New Labour and the NHS reform agenda in England. Law & Policy 32 (3): 313–331.CrossRefGoogle Scholar
  53. Waldby, C. (1997) The body and the digital archive: The Visible Human Project and the computerization of medicine. Health 1 (2): 227–243.Google Scholar

Copyright information

© Palgrave Macmillan, a division of Macmillan Publishers Ltd 2013

Authors and Affiliations

  • Deborah Lupton
    • 1
  1. 1.Department of Sociology and Social PolicyUniversity of SydneyCamperdownAustralia

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