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RUCKENSTEIN, M. (2015). Uncovering Everyday Rhythms and
Patterns: Food tracking and new forms of visibility and temporality
in health care. Techno-Anthropology in Health Informatics:
Methodologies for Improving Human-Technology Relations, 215,
28-40.
Uncovering everyday rhythms and patterns:
food tracking and new forms of visibility
and temporality in health care
Minna RUCKENSTEIN
University of Helsinki
Abstract. This chapter demonstrates how
ethnographically-oriented research on emergent
technologies, in this case self-tracking technologies,
adds to Techno-Anthropology’s aims of
understanding techno-engagements and solving
problems that deal with human-technology
relations within and beyond health informatics.
Everyday techno-relations have been a long-
standing research interest in anthropology,
underlining the necessity of empirical engagement
with the ways in which people and technologies co-
construct their daily conditions. By focusing on the
uses of a food tracking application, MealLogger,
designed for photographing meals and visualizing
eating rhythms to share with health care
professionals, the chapter details how personal data
streams support and challenge health care practices.
The interviewed professionals, from doctors to
nutritionists, have used food tracking for treating
patients with eating disorders, weight problems,
and mental health issues. In general terms, self-
tracking advances the practices of visually and
temporally documenting, retrieving,
communicating, and understanding physical and
mental processes and, by doing so, it offers a new
kind of visual mediation. The professionals point
out how a visual food journal opens a window onto
everyday life, bypassing customary ways of seeing
and treating patients, thereby highlighting how self-
tracking practices can aid in escaping the clinical
gaze by promoting a new kind of communication
through visualization and narration. Health care
professionals are also, however, acutely aware of
the barriers to adopting self-tracking practices as
part of existing patient care. The health care system
is neither used to, nor comfortable with, personal
data that originates outside the system; it is not seen
as evidence and its institutional position remains
insecure.
Keywords. ethnography, visibility, enacting care,
everyday rhythms, food tracking
Introduction
In recent years, self-tracking has become an expanding field of
technology development, encouraging the measuring of various
kinds of bodily and mental functions, including everyday
movements, physical activity, and body weight. This chapter
demonstrates how ethnographic research supports Techno-
Anthropology by exploring and working with the detailed ways in
which technologies participate in and promote new kinds of social,
material, and emotional encounters. In the more action-oriented and
design-oriented applications of Techno-Anthropology that aim to
promote favorable changes in health care, ethnographic research
offers a good grounding for understanding what is required for
successful implementation of self-tracking practices [1].
Furthermore, this kind of perspective underlines the indivisibility of
human and nonhuman agents and forces in care work by
demonstrating, for instance, how personal data streams, data
visualizations, and communication concerning the data become an
active part of care processes alongside health care workers and
patients [2]. Thus in order to share methodological
recommendations with current and future practitioners in Techno-
Anthropology, the chapter outlines how an ethnographically-
oriented approach supports the exploration of self-tracking practices
and the communication and encounters generated by personal data
streams within health care.
Technological devices for self-tracking include scales,
pedometers, sleep trackers, mood trackers, emotion trackers, and
heart-rate variability measuring devices. These instruments are
linked to the notion that self-monitoring tools, as they continue to
enter daily use, offer an effective opportunity for people to
understand their own lives as sets of numerical phenomena that can
be examined and acted upon [3-6]. Tens of thousands of health
related applications and devices have been developed, and self-
tracking practices are expanding to new areas as the collection and
analysis of personal data are advocated and implemented in different
social contexts and institutions, including the workplace, schools,
and hospitals. People are being seduced, encouraged, obliged,
pushed, and coerced into using tracking devices for monitoring
aspects of their bodies and lives and for producing personal data
which can be used for the purposes of others [6].
This article sheds light on recent attempts to include self-tracking
in health care practices in Finland by focusing on the uses of
MealLogger, a visual food tracking application.
1
In exploring the
1
More information about different features and uses of the MealLogger can be found at
www.meallogger.com. The application was originally developed in Finland under the name of MealTracker.
Other simple and easy-to-use applications developed in Finland focusing on food photo-journaling – for
instance, See How You Eat and Nordic Diet Coach – have also been surveyed for this article. The focus on
tensions and changes that might be promoted by using a phone
application to transform eating habits into a photo journal, attention
is paid to forms of knowledge production that underline and shape
care practices, suggesting that self-tracking offers new modes of
understanding and promoting health by uncovering visual and
temporal patterns in people’s lives. The focus on visibility and
temporality points towards a well-established research tradition that
explores modern notions of control and governmentality, the idea
being that by making unknown aspects of bodies, minds, events, or
temporalities detectable, we can gain more control over processes
and entities concerning human lives. Within the health care context,
patient care can still be defined by what Michel Foucault described
as the ‘clinical gaze’, the dominant medical mode of knowing that
came into being in the early-nineteenth century [7], one that is firmly
rooted in the externalization of ‘nature’ as something that people are
able to control and transform [8].
The discussion that follows, however, recognizes that visibility
is not only formative for the clinical gaze and related attempts to
diagnose and measure patients, but is also an essential aspect of
everyday care encounters with important links to ways in which
temporality is taken into account. Thus, rather than taking these
themes – visibility and temporality – for granted, the aim is to
explore how they are played out and practiced in relation to self-
tracking within health care, in this instance, by demonstrating how
self-tracking practices might unsettle current work practices,
primarily because they promote a new way of seeing and treating
the patient. In order to engage with the processes connected with
visibility and temporality in a more detailed and reflexive manner,
it is crucial to understand how temporality is materialized in care
and how the practices and aims of visibility and invisibility offer
vistas and visualizations of people’s lives, professional knowledge,
or technological systems. From this perspective, visibility is
regarded as an active and collaborative process, rather than a static
quality of presence or absence.
MealLogger was finally selected because of the knowledge that had already been gained of its uses in health
care.
Tracing connections
In ethnography, qualitative and quantitative research methods are
applied to produce empirical material about what people say and do
in particular situations. Even if the aim is that of developing skills
for more short-term and goal-oriented ethnography’, it is still useful
to engage in longer-term ethnographic projects as part of training in
Techno-Anthropology whereby an appreciation of the craft of
ethnography and a better understanding of the limitations of short-
term fieldwork could be developed. Typically an ethnographic study
involves a continuous effort to develop and refine the research
approach in the course of an assignment. An experienced
ethnographer can conduct projects that aim to highlight particular
aspects of everyday phenomena by adopting a creative, flexible, and
even somewhat eclectic research approach that is adjusted and
modified as the study proceeds, rather than being pre-planned. As I
hope to demonstrate, this kind of research attitude is an advantage
when studying emerging technologies, because it addresses the
complex nature of techno-encounters, including the perspectives of
various stakeholders.
Rather than producing ‘a thick description’ [9] of the ideology
and history of self-tracking practices, the goal of this discussion is
to highlight one particular aspect of self-tracking interactions:
namely, the kinds of issues that emerge when health professionals
are presented with data that details people’s daily eating habits. The
account is produced as a part of ongoing research collaboration,
based at the University of Helsinki, which looks at practices of self-
tracking and developments in personal data collection and the data
economy. The research builds on literature that critically addresses
current health technologies’ hype which tends to portray the
relationship between people and technology in an over-simplified
manner: for instance, technologies are said to enable patients to
participate proactively in their care, thereby diminishing the cost of
health care delivery by reducing interactions with health care
providers [10]. The aim of this discussion is to document what is
being promoted by interactions between people, digital devices, and
the data they generate and it is thus an intentional intervention in
programmatic statements that represent self-tracking in a
decontextualized manner: as a solution rather than a starting point.
The assumption is that self-tracking acts as an intermediary in
improving health outcomes, but as long as we do not understand how
health technologies participate in, and contribute to, care encounters
contextually, the outcomes are difficult, if not impossible, to assess,
measure, and scale. In order to support and empower people in care
encounters it is also important to demonstrate that self-tracking is
not simply a crude cost-cutting exercise, but, rather, that the goal is
to deliver better health care [11].
The approach that I have used combines various methodological
premises, including a discourse-centered approach to culture, the
basic principle of which is that the discourses circulating in a social
entity constructs the world in which the entity is situated or situates
itself [12,13]. In concrete terms, I have focused on what receives the
greatest engaged attention from the interviewed health care
professionals in discussions concerning food tracking by means of a
visual journal. In other words, “talk” is an important key to what
people are interested in and what drives them and, therefore, a vital
element to be examined when researching any social phenomenon.
Significantly, health care and wellness professionals who are
enthusiastic about the possibilities of engaging and involving people
by using self-tracking devices position themselves as being part of a
more patient-centric approach to health. They see themselves as
being part of a culture of health care that uses digital devices in the
better treatment of people, though the perspective is firmly focused
on the ways self-tracking devices could promote and improve the
work of care rather than being treated instrumentally as ‘care
solutions’.
The interviewed health care professionals had used photo-
journaling that focused on food via a smart phone application for
treating people with eating disorders, stomach discomforts, weight
problems, and mental health issues. Most of them had taken part in
explorative pilot studies that took advantage of MealLogger in care
work. The findings of these pilots, mainly in the form of narrative
evidence and anecdotes, have been publicly presented in research
seminars and workshops,
2
and have also been used for product
development and as promotional material for the Wellness Foundry,
the start-up company that developed MealLogger. By relying on
outcomes that are also used for marketing tracking devices, this
research is part of a collaborative economy wherein market agents
promote research that takes advantage of their devices, in order to
reinforce the credibility and reliability of their offerings. This
association means that our research has an inbuilt tension. One way
to deal with this dilemma is to maintain a reflexive and inquisitive
attitude to what is being promoted when people interact with self-
tracking devices and the data they generate. From this perspective,
the working method is a critical and open-ended conversation about
personal data streams and their effects.
Much of the output of self-monitoring devices and mobile health
applications fails to engage people, and it cannot be taken for
granted that the data flows produced by health and wellness
applications and devices are useful and of interest to all. Since this
research follows the perspective of early-adopters or lead-users, who
have found value in visual food-journaling in terms of promoting
health, this discussion has an obvious bias. Self-tracking within
health care is described from the perspective of professionals who
see great promise in developing a form of care work that is assisted
by data flows; they are not bothered by the persuasive powers and
interventionist forces inscribed in measuring devices, but, rather,
treat them as a welcome addition to health promotion. “I have a little
engineer inside of me,” is how one of the nutritionists explained her
enthusiastic and fearless attitude to self-monitoring technologies.
Yet the interviewed professionals do not treat food tracking
uncritically as a universally appealing alternative. Various reasons
are listed in discussions as to why people do not adopt visual food-
journaling: they might not have a smart phone that supports the
application and their technology skills might be modest, in which
case a traditional pen and paper version of food tracking might work
better; photographing meals can be socially awkward; tracking can
be interpreted as emotionally too confrontational to adopt; or
2
A seminar on visual methods in food tracking, for instance, gathered together practitioners from the fields
of nutrition and public health at the University of Helsinki in March 2015 to share their findings and insights.
After the seminar a Facebook group was formed for disseminating knowledge and exchanging ideas.
motivation may simply be absent. Potentially negative or even
harmful results of food tracking were also mentioned by the
professionals who noted that it can encourage behavior that fails to
promote health: the anorectics participating in pro-ana communities,
for example, share weight-loss tips that take advantage of various
forms of self-tracking [14,15]. In terms of health a key to successful
self-tracking is the need and the will to address the current state of
affairs. “Either there is a need for change, or a felt discomfort or
disorder,” as one of the nurses put it. Nevertheless, with all its
limitations, self-tracking is an inspiring aid in care work, according
to interviewed health care professionals, who have identified a new
kind of view provided of what and how people eat: the subject that
receives particular attention here.
Enacting care
In terms of highlighting emerging practices of care, it is important
to focus on how self-tracking aids, supports, and obstructs relations
between people: in this case, between the professionals and the cared
for. Technologies offer new opportunities for these relations, but
also disrupt them and direct their course, an insight that resonates
with the insistence on the indivisibility of human and nonhuman
agents and forces in actor-network theory [16]. When people do
things, they are not subjects separate from objects, but part of chains
that distribute competences and actions [17]. In the case of self-
tracking practices within health care, personal data streams, data
visualizations, and communication concerning the data become an
active part of enacting care [2]. Self-tracking technologies permit
the people involved to assess and expand their sphere of influence
and activity, with the technologies becoming an inherent part of how
people see, treat, and communicate with each other.
With an eye to examining the enabling forces of personal data
streams, I gathered reflections on food tracking from health care
professionals who included a general practitioner, a public health
nurse, and a nutritionist. In the analysis of enacting care, I
contextualized these reflections in relation to earlier research on
self-tracking, and soon after the first interviews, I started to pay
more systematic attention to features that have been described as
formative for self-tracking in previous research: namely, visibility
and temporality [4,5]. It appeared that these two qualities offer
insights into both the facilitating and unsettling powers of self-
tracking within health care. At least in Finland, the new forms of
visibility and temporality enabled by personal data streams do not
fit comfortably into customary care practices. I address this unease
by focusing on the particular qualities of food tracking and by
describing how approaches to health, intertwining with tracking
technologies, are generating new modes of interaction and
communication. With the goal of further illuminating visibility and
temporality, I also researched the perspectives of users of food
tracking devices, and the active and dynamic relationship between
people and self-tracking devices more generally. Thus, while the
focus of this account is firmly on health care professionals, I offer
some details of how people have been incorporated into care
situations as users of food tracking applications. The perspective
chosen offers important clues as to why personal data streams are
enthusiastically, or not so enthusiastically, received within current
health care practices; when people introduce self-tracking data about
mundane everyday practices like eating or sleeping in the care
context, they reveal intimate aspects of their daily routines that allow
health care professionals to witness their lives from an angle that is
not typical for clinical work.
Beyond the clinical gaze
As I have already pointed out, the ‘clinical gaze’ is the dominant
medical mode of knowing, that is, of detecting pathologies and
abnormalities by localizing them; the doctor is in charge of the gaze
and assisted by medical technologies that are used in the diagnosis
of the patient [7], thereby positioning the physician firmly as active
and in control of the situation in relation to the patient. I suggest that
one of the discomforts connected with personal data has to do with
unsettling and disturbing the clinical gaze; the element of personal
visual mediation inherent to self-tracking applications, like the food
tracking application discussed in this chapter, confronts the clinical
gaze and introduces new modes of relating, classification, and
ordering to the care situation, as I will demonstrate. Moreover, self-
tracking advances practices that visually and temporally document,
retrieve, communicate, and provide understanding of physical and
mental processes. On the other hand, while food tracking through
photo-journaling involves bodily, emotional, spatial, and temporal
aspects, it raises questions about these aspects rather than aiming to
diagnose them. From this perspective, self-tracking does not create
a closed-off situation or rigid doctor-patient positions, but, rather,
opens up the patient’s everyday life for guidance and negotiation,
allowing health professionals to participate and intervene in the
daily lives of people more than providing knowledge purely in order
to form a diagnosis.
It is also true, however, that self-tracking technologies are used
in health care to record aspects of people’s daily lives in an attempt
to target unhealthy behavioral patterns and lifestyles and, from this
perspective, rather than evading the clinical gaze, self-tracking
practices are spreading it beyond the clinic into people’s daily lives,
their kitchens, and their bedrooms [18]. As sociologist Deborah
Lupton [10,18], reminds us, mobile and wireless health technologies
are part of the same continuum as medical technologies that have for
centuries been employed to render the body visible and to direct the
clinical gaze upon it. By promoting processes that abstract and slice
everyday activities into various kinds of data flows, self-monitoring
offers vistas of people’s lives which health care professionals can
examine and react to. Tracking technologies record information
about exercise, dietary patterns, and hours slept and can use software
to communicate with professionals regardless of the patient’s
location or participation.
Following Lupton’s [6] definition, the mode of self-tracking
discussed in this chapter is ‘pushed’, referring to the fact that the
impulse for engaging in self-tracking is not self-generated and
privately initiated, but comes from an external agent. Advocates for
pushed self-tracking promote, for instance, persuasive design
systems for behavioral change, patient self-care in case of chronic
illnesses, and wellness programs within workplaces. Self-tracking
must be approved by the subject, but if it is taken up in response to
external encouragement, it may be used as a means of encouraging
health and wellness awareness and for configuring a more digitally
engaged patient or worker [19]. For instance, a young woman who
used a food tracking application explained to me that a nurse had
suggested it when her eating disorder worsened. At first the patient
declined the offer: she thought that the tracking would make her
control her food intake even more frantically. After some
consideration, however, she decided to try it in order to make her
eating more observable and to provide a more realistic view of how
she ate. Thus an explicit aim of food tracking within the health care
context is to engage people in following their eating patterns in order
to nudge them towards health-related goals. Unquestionably, this
activates and expands the clinical gaze.
What emerged from the empirical material, however, was not
only evidence for the expansion of the clinical gaze, but also
indications of at least a partial dissolving of it. As has also been
noted by other researchers, while technologies extend the clinical
gaze into the home, for instance in the form of telehealth, they may
also offer patients the opportunity to avoid the gaze [see, 10]. Indeed,
I suggest that its observable dissolving has to do with the possibility
of enacting technology-aided care in a manner that affects the parties
involved; the professional is still in charge of the situation, but self-
tracking introduces elements that distribute the agency of care to the
patient and the technology involved. In terms of Techno-
Anthropology, the participation of all these agencies in enacting care
is particularly thought provoking, because it underlines the
indivisibility of human and nonhuman agents and forces in care
work, and offers empirical support for exploring the enabling
powers of personal data. In the following, I open a window onto
these powers by demonstrating how health professionals might learn
– through self-tracking data – about aspects of people’s lives that
they have previously been unable to see. This might seem trivial, but
is in fact no minor detail, because it frames the care work in a manner
that promotes a new kind of structured uncertainty: the health
professional is thrown out of the comfort zone of the clinical gaze
into a world of negotiation, participation, and exploration.
Witnessing everyday eating patterns
A powerful and engaging aspect of self-tracking is that it seeks to
make visible something that is typically not a subject of reflection,
with the aim of converting previously undetected bodily reactions
and behavioral clues into traceable information. Consequently, the
design and technical specifications of tracking devices build on the
notion that visibility is a key for understanding bodies, minds, and
daily lives. The goal of food tracking is to simplify and summarize
people’s relationship to food on the basis of certain pre-defined
assumptions. Many existing forms of food tracking depend on
numbers, calories, and grams, but applications like the MealLogger
rely on visual estimates: one cannot see from the photographs taken
what kind of oil has been used in the salad, for example, or how
many grams the steak weighs. The application is built on the
assumption that the visual journal is sufficiently communicative,
and that there is no need to unpack meals into numerical evidence.
The communicative aspect is enriched by the possibility of sharing
the visual diary with others. As is typical for mobile health
applications, the sharing is made easy in the MealLogger
application: the expert can see the pictures taken, evaluate the food
eaten with a star system, and write posts about meals.
When confronted with the food journal the health professional
will search for clues, categories, and patterns in the visual
information. For instance, interviewees describe how they learn
from the pictures about people’s definitions of categories of food:
thus a salad for some might consist of a can of tuna and a can of
pineapple, while for others it might be something rather different.
The health professional adopts a particular stance in relation to the
patient by aiming to uncover and highlight aspects of eating
behavior and food consumption that are important in terms of
understanding the everyday life and discomforts of the patient. From
the perspective of the clinical gaze, this is radical: the physician is
operating in a field that is not bound by the clinical mode of knowing.
The focus is on everyday patterns such as the overview of the meals,
which also includes their coloring and variety. One of the physicians
explained that it was impossible to imagine beforehand how much
the coloring of the food could reveal, such as the fact that somebody
eats only beige food. Other people, the photographs reveal, are
extremely repetitious in their daily habits: they eat the same thing at
every single meal. Of diagnostic value is the fact that the
photographs might reveal how one-sided the diet is in terms of
nutrition, or how out of touch people are with their eating: one of the
nurses described, for example, how her patient produced beautiful
portrayals of miniature portions of food, indicating serious problems
with eating. Thus the value of a visual food diary lies in its precise
re-presentation of patterns and details of everyday life that might
also become significant in terms of clinical work. The diagnostic
work is not, however, what drives the enactment of care, which is
more about witnessing and reacting to the patient’s relationship to
food, and possible harmful consequences of that relationship, in the
context of daily life.
Rhythms of eating
The visual patterns of food consumption, revealed by the
photographs, are closely linked to the temporalities of eating. Once
a picture of the food to be eaten has been taken, the MealLogger
application generates a time stamp which offers further evidence of
daily eating patterns. The aggregated photographs record that some
people eat very regularly, while others only now and then; some eat
all through the day, others mainly late at night. In terms of Techno-
Anthropology, the everyday temporalities that the self-tracking
applications make detectable and observable are no minor point.
Self-tracking offers methodological support for uncovering how
daily practices condition, and are conditioned by, temporal orders of
the everyday. Evidence of the rhythmic order of weekly events can
be found in people’s eating, sleeping, working, online behavior, or
in the ways they socialize: Saturday night in particular is dedicated
to meeting friends [20]. Despite detailed time-use studies, relatively
little is known of the rhythmic ordering of people’s lives in terms of
health and wellbeing. From this perspective it is not surprising how
illuminating it was for the interviewed professionals to start
witnessing how eating patterns are temporally ordered. The daily
rhythms of eating reveal how people position themselves in relation
to food: food might be a regular or irregular element in their life;
eating might start the morning vigorously, or provide comfort late at
night. One of the interviewed nutritionists talks about how
unconscious the rhythmic ordering of eating might be: she tried the
MealLogger before she started using it with her customers and
discovered that she was a ‘nibbler’, easily taking nine pictures a day
of food ingested, with the typical number of her customers’ meals
being five or six. The main revelation for her was that she did not
expect this kind of finding.
The health care establishment is not trained to approach health
and wellbeing in terms of everyday temporalities: the clinical gaze
is characteristically atemporal. A focus on the daily rhythms of
people’s lives opens an alternative view to health by drawing
attention to the temporal nature of disorders in daily lives. For
instance, addictive behaviors, such as drinking or gambling, are
characteristically time-consuming; in terms of diagnosing an
addiction, one could concentrate on time use and treat addictions as
repeated practices that have damaging consequences in terms of
health and wellbeing [21]. Empirical studies offer support for the
temporal character of addictive behaviors by offering testimonials
of addiction that replicate notions of circularity and lost time
horizons [22,23]. Compulsive behavior becomes visible and
identifiable through repetition as everyday practices start to center
and focus on certain activities, though the unsuccessful balancing of
temporal orders is not a cause or effect of individual health
disturbances; rather, these two aspects co-create and support each
other.
By paying attention to the timing of eating, food tracking offers
the possibility of examining the temporal foundations of health.
Various health complaints, including stress, anxiety, sleep
deprivation, depression, or substance abuse, are connected to
irregular and damaging time use: people do not have enough
physiological regularity and recovery in their lives. A visual journal
of daily eating patterns acts as a mediator and a translator,
highlighting problems in the daily balancing of everyday rhythms.
For instance, students who live alone for the first time in their lives
might eat irregularly: with no parental guidance and assistance their
diet deteriorates. Their stomach discomforts are not necessarily a
sign of illness or food allergies, however, but probably a
consequence of irregular and erratic eating. A simple food tracking
application can reveal the origin of their disorders without clinical
tests or medical imaging technologies. This suggests that if used for
enacting care in a manner that takes the everyday circumstances of
people into account, self-tracking technologies are more likely to
deliver on their promise of supplying health care at a lower cost [24].
The coaching health professional
I have argued that self-tracking technologies aid in bypassing and
even dissolving the clinical gaze. A further indication of this lies in
the reflexive attitude outlined by a public health nurse that offers
concrete evidence for rethinking diagnostic practices. She has
actively used food tracking in her care work and explained how she
no longer thinks or cares about whether a person has an eating
disorder, or a metabolic syndrome: she is only interested in healthy
eating. This approach connects with processes of health making,
suggesting that rather than seeing health as a bounded entity with a
preordained ontology and categorical grounding, it should be
regarded as a constant movement towards becoming healthy. The
role of food tracking is to aid, direct, and guide this undertaking;
while it does not produce health by itself, it becomes part of an
alliance for generating health. Significantly, however, whether the
tracking application will fulfill this aim might not be known
beforehand: thus, by using self-tracking technologies in care work
the health professional’s role becomes more explorative. Only by
experimenting with self-tracking technologies can one discover
exactly what each device promotes in terms of health making and
what it requires from patients and professionals [24].
The explorative role of the professional introduces elements of
uncertainty and openness to processes of enacting care as the health
care professional bypasses familiar ways of approaching potential
illness, thereby raising new kinds of questions and perspectives for
inspection. An obvious problem for validating the clinical utility of
self-tracking applications, however, is the difficulty of determining
a baseline: for instance, it is questionable whether self-reported data
on eating is a valid baseline for measuring the efficacy of using a
visual food journal in an intervention [25]. Once people start
tracking themselves, they also begin to use the tracking as
behavioral and emotional guidance: photographing one’s meals has
an effect on what one eats and, consequently, the visual record. In
other words, self-tracking is an intervention in itself [4].
Documenting the contents of a meal, or the rhythms of eating, might
be so revealing of the everyday that people might stop
photographing all the food they ingest, or start adding healthy things
to their plates to please the health care provider. Unconsciously, the
self-tracker might want to upgrade, through photographs, how she is
perceived by an outsider. For instance, one woman in her twenties
described how keeping the visual food journal made her invest in
her meals, both in terms of nutrition and aesthetics.
Discussing what people do not photograph, and how they add
vegetables to their plates and stylize their meals for the visual
journal, is an important part of enacting care. Photographs taken are
not treated as authentic evidence of people’s eating, but they do offer
a communicative route to an area of life in which people might need
support. The pictures, and talk about the pictures, address the
intimate and emotional nature of people’s relationship to food: how
they might not be able to control how they eat, or how they might
be ashamed of the contents of their meals and the times when they
eat. The interviewed nurse had treated people who were so
embarrassed and guilty about their eating that they only ate alone;
they had no model of how to eat properly and in front of others. They
could, for instance, eat without a plate and drink milk directly from
the carton. For them, documenting their meals and making their
eating patterns visible to an outsider is already a major
accomplishment in terms of the care process, even if the
documenting is partial and incomplete.
Food tracking might offer a less invasive and threatening way of
portraying lives than verbalizing problems of eating: one can take a
picture alone, and only the care professional has access to it.
Relevant to the latter process, one of the interviewed nutritionists
notes that she sees little value in food tracking in connection with
eating-related issues and problems without professional support: for
her the relationship between the expert and the user is the most vital
element of enacting care. Interestingly, the relationship can be
geographically distant and intimate at the same time, and she has
supported people who live in different parts of Finland, although
they might have only met face-to-face once or twice. Still, these
meetings are crucial: “I need to see how the person gestures, talks,
and sits.” She talked about the importance of the overview that she
gets by observing the person and “by using my antennae and relying
on intuition”, and underlined an aspect of food tracking that comes
out repeatedly in discussions about its use: eating is such a personal
and sensitive matter that the guidance offered needs to be subtle and
discreet, although once the nutritionist learns how to address the
client, she might be bolder and more demanding. She also mentioned
the importance of humor in these encounters. The playfulness and
creativity of people interacting with tracking devices has been
recognized: what is significant in her account is that the playfulness
might be an important part of enacting care. She described, for
example, how men she has coached took photographs for their visual
journals of their restaurant bills, or of apples carved with emoticons.
The empirical material suggests that in terms of food tracking
that aims to have a positive impact on people’s health, personal data
streams should not be taken at face value or treated as uncomplicated
externalizations of people’s interiors. A competent health
professional sees beyond the promises of the apparently rational and
motivated self-tracker who claims to control his or her life and
destiny with data streams. The goal is much more modest; rather one
of using self-tracking data as part of the effort to identify harmful
patterns in daily lives and to address them in conversation. Time and
again the interviewees talk about how keeping a visual food journal
and sharing it with an outsider make people more conscious of their
choices and practices; people become more aware of not only what
they eat and when, but of how they place the food on the plate.
Mothers of young children, for instance, often begin to think about
the meal as a clearly defined item, meaning that they are less likely
to eat half their portion while they are cooking, or consume leftovers
from children’s plates. Food tracking, based on a visual journal,
enacts care in a manner that involves people and pushes them to
reflect on and change their behavior. By doing so, this form of
tracking develops self-awareness and produces everyday
transformations that have been identified as crucial for patient
empowerment and self-management of health [24].
Conclusions
This chapter has argued that by introducing new modes of relating,
classification, and ordering to the care situation, self-tracking
applications aid in disrupting dominant ways of seeing and treating
the patient. Self-tracking opens for observation something that is
typically not a subject of reflection: the tracker converts meals and
eating times into traceable and actionable evidence, and the data thus
generated is used as a communicative aid in treating people. Self-
tracking can assist, for instance, in reaching the goal of balancing
eating, sleeping, or overall time use in an approach that is preventive
and supportive rather than reactive; it actively avoids trivializing
people’s experiences. In fact, the interviewed professionals
emphasized the need for a more mediated and socially responsive
definition of health.
The research agenda outlined in this chapter is particularly
productive when the objective is to learn how technologies become
intimately involved in knowledge formation, including that
generated by experiencing ourselves and others through new visual
and communicative devices. In terms of Techno-Anthropology, this
kind of approach emphasizes the need for interactional experts who
know how to combine and balance the user’s perspective with those
of professionals, or provide a bridge between the two positions [26].
I have described how food tracking offers visual mediation that
supports health care by unpacking a patient’s everyday life for
inspection, guidance, and negotiation, but in order to promote the
successful integration of self-tracking with care work, one needs to
understand how tracking devices become part of enacting care and
how they shape their users, whether health care professionals, or
people with health problems. In other words, insights produced
through ethnographically-oriented research offer the possibility of
learning how emerging technology, in this case self-tracking, can
strengthen or block developments that people see as valuable and
worth pursuing.
Various methods are useful in ethnographically-oriented efforts
in Techno-Anthropology. A discourse-centered perspective is
valuable in exploring, through speech, what drives people in their
everyday actions and aims, whereas the focus on the dynamics of
human and nonhuman relations informed by actor-network theory
assists in the study of the material, social, and technological
underpinnings of people’s encounters. Throughout the research
reported here, the aim has been to understand how self-tracking
discursively and practically promotes and accelerates changes in the
health field. It must be remembered that numerous practical barriers
exist to using even fairly simple self-tracking applications, like the
one discussed in this chapter, in established health care institutions.
Some of these have to do with the ownership of tracking data: health
care institutions might not be comfortable using data that is
generated and stored by another company, for instance, because of
issues related to data privacy and security. Another barrier to
adoption is the incorporation of self-tracking applications into the
work flow of a health care organization. One of the interviewees
described, for example, how the health care institution wanted the
log-in page to the food tracking application to be on the
organization’s website, but that was complicated by the number of
existing phone models and relentlessly updated software. Payments
are a further unresolved area, raising the question of what the
tracking device users should be billed for: the use of the application,
or the professional’s comments on the patient’s meals?
Some health care organizations in Finland have found workable
solutions to such issues, but for the most part they are still largely
unresolved. Companies promoting self-tracking applications, and
health care professionals who share an interest in developing their
expertise and institutional practices, are working together with the
conviction that they will produce better care. Techno-Anthropology
can address these efforts in order to promote mutual learning and
interactions with various stakeholders in the health field. More
generally, health care is developing and changing in reaction to
specific situations or circumstances including technological and
economic developments, as well as in more encompassing ways by
shaping and transforming what it means to be a doctor, a patient, or
to enact care. This chapter has outlined some developments that
appear important and disruptive in terms of care work, but it also
serves as a reminder of the contextual nature of research findings:
self-tracking is characterized by processes that are distributed across
many kinds of locations and power networks, and it is important not
to assume that these technologies work in a straight-forward and
uncomplicated manner. This account has particularly emphasized
the role of self-tracking in uncovering visual and temporal patterns
in people’s lives in order to promote health. From this perspective,
self-tracking can be adopted as part of a new way to enact care and
to experiment, connect, and learn, gaining value in relation to the
social and communicative processes that it promotes, and adding to
the possibilities of rethinking and re-enacting health.
Acknowledgement
I thank Nina Honkela for contributing to this study and Marie-
Louise Karttunen, Mikko Lehtovirta, Mika Pantzar, Michael
Quarshie and Sanna Vellava for supporting it. The research on self-
tracking is conducted in the Digital Health Revolution programme,
funded by Tekes, the Finnish Funding Agency for innovation.
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