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Sport, Education and Society

ISSN: 1357-3322 (Print) 1470-1243 (Online) Journal homepage: http://www.tandfonline.com/loi/cses20

‘Better understanding about what's going on’: young Australians’ use of digital technologies for health and fitness

Deborah Lupton

To cite this article: Deborah Lupton (2018): ‘Better understanding about what's going on’: young Australians’ use of digital technologies for health and fitness, Sport, Education and Society, DOI: 10.1080/13573322.2018.1555661

To link to this article: https://doi.org/10.1080/13573322.2018.1555661

Published online: 06 Dec 2018.

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‘Better understanding about what’s going on’: young Australians’ use of digital technologies for health and fitness Deborah Lupton

News & Media Research Centre, University of Canberra, Canberra, Australia

ABSTRACT Digital technologies such as websites, online discussion forums, social media, content-sharing platforms, mobile apps and wearable devices are now available as a means for young people to learn about and promote their health, physical fitness and wellbeing. This article provides findings from a qualitative interview-based study of young Australians (aged 16– 25 years) which explored their practices and understandings related to digital and non-digital sources of health and fitness information, advice and support. The interviews were analysed using a feminist new materialist theoretical framework, paying attention to the affordances, relational connections and affective forces gathering in human- nonhuman assemblages to create a set of key agential capacities. The agential capacities generated by the participants’ enactments of digital health included gaining a better knowledge of bodies, illness and healthcare and feeling more in control of health and wellbeing states. While the affordances of convenience, accessibility and detail and diversity of information offered by digital media and devices were valued by the participants, their accounts also highlighted the importance of face-to-face as well as online relationships and personal connections with other people for providing information and support, including family members and friends as well as medical professionals. The participants highly valued the agential capacity of digital technologies to generate detailed information about their bodies and health states and imagined new technologies that would be able to achieve even more detailed personalisation and customisation. However, they expressed little knowledge or concern about how their personal health data may be exploited by other actors or agencies. These insights go some way to recognising and acknowledging the embodied, affective and relational dimensions of living with, through and in the more-than-human worlds of digital health.

ARTICLE HISTORY Received 25 August 2018 Accepted 1 December 2018

KEYWORDS Digital health; digital technologies; feminist new materialism; young people; Australia

Introduction

A growing array of digital media and devices is currently available to people of all ages to find information, advice and support about health and illness, physical fitness and wellbeing (Lupton, 2017). These include older technologies such as online forums and websites and those emerging over the past two decades, such as apps, social media and wearable devices. Digital media can offer valuable opportunities for lay people to share health and fitness information and provide support to each other (Benetoli, Chen, & Aslani, 2017; Gonzalez-Polledo & Tarr, 2016; Lupton, 2018b). Digital technologies can also be used as pedagogical tools, helping people to learn about their bodies and health and illness states and act to improve their health, physical fitness

© 2018 Informa UK Limited, trading as Taylor & Francis Group

CONTACT Deborah Lupton deborah.lupton@canberra.edu.au

SPORT, EDUCATION AND SOCIETY https://doi.org/10.1080/13573322.2018.1555661

and wellbeing (Fullagar, Rich, Francombe-Webb, & Maturo, 2017; Goodyear, Armour, & Wood, 2018b; Lupton, 2018a; Rich, 2018).

Young people are often assumed to be ardent users of digital health technologies by virtue of having been born into the age of new digital media. This ‘digital natives’ discourse, however, has been subjected to critique by educational researchers who have pointed out the importance of acknowledging the complexities and nuances of young people’s use of digital media, including factors such as their age, socioeconomic status and access to technologies (S. Bennett & Maton, 2010). The broader, more-than-digital contexts of digital media use are also often neglected in research. Thus far, few social research studies have directed attention to the details of how and why young people use digital technologies for health-related purposes and how other, non-digital sources also contribute to the ways in which they learn about their bodies and health and engage in practices to support their health and wellbeing. In this article, I provide findings from the Young Australians and Digital Health Project, a qualitative interview-based study which was designed to address these issues. I used an approach that I have developed by ‘thinking with’ (Jackson & Mazzei, 2012) feminist new materialism that aligns with developments in post-qualitative inquiry (Fullagar, 2017; St Pierre, Jackson, & Mazzei, 2016).

Donna Haraway, Karen Barad, Rosi Braidotti and Jane Bennett are among the most influential scholars in new feminist materialism. Their scholarship focuses on understanding and mapping ontol- ogies of the ‘human’ (understood as a category that is difficult to define and may include ‘more-than- human’, ‘posthuman’, ‘transhuman’ and other varieties). A series of propositions are expounded in their work. These include the following: human subjects are unstable and emergent knowing, sensing, embodied, affective assemblages of matter, thought and language; humans are part of and inseparable from more-than-human worlds; humans come together/gather with nonhumans to configure constantly changing assemblages; these assemblages generate relational connections and affective forces which together create agential capacities; and because of the constantly chan- ging nature of these assemblages, there are possibilities for change, resistances or improvisations, or for thinking otherwise (Barad, 2003, 2014; J. Bennett, 2001, 2010; Braidotti, 2016, 2018; Haraway, 2008, 2016).

My reading of feminist new materialism theory identified a series of concepts that I wanted to explore in this project: namely, affordances, relational connections, affective forces and agential capacities. The interview questions were designed to draw attention to these features of digital and non-digital health support by asking the participants to describe their use of these resources in detail and to give examples where possible.

The affordances of fleshly human bodies include their sensory perceptions, emotional respon- siveness, embodied expertise, memory and the ability to learn and to move in certain ways. The affordances of nonhuman objects such as digital technologies relate to the design features of these technologies and what they potentially allow people to do with them. Relational connections include the ways in which humans interact with and respond to other humans, as well as with non- humans, and how these relationships contribute to or generate bonds and affects. The concept of affective forces as I use it here draws on the interpretation of Spinoza’s and Deleuze’s notions of affect by feminist new materialism scholars (for example, J. Bennett, 2010). Affects are understood as distributed forces that are shared between members of human-nonhuman assemblages, working to impel action and responses. Complex engagements of actors in these assemblages gen- erate agential forces and relational connections that are always contingent and dynamic, depend- ing on the actors that enter or leave assemblages and on time, space and place. Together, these elements contribute to the agential capacities and ‘thing-power’ (J. Bennett, 2010) of human-non- human assemblages that gather when people are trying to make sense of their bodies and health and illness states and promote their health and wellbeing. This approach is able to site digital tech- nologies and their affordances into the more-than-human worlds in which people come to under- stand and perform health and illness.

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Previous research on young people’s use of digital health technologies

Most previous studies of young people’s use of digital health technologies have employed quantitat- ive questionnaire-based methods in European countries. A Belgian study of adolescent school stu- dents (De Cock et al., 2017) found that a quarter used nutrition or fitness apps or both. A French survey (Beck et al., 2014) found that almost half of young internet users (aged 15–30 years) searched for health information. Another French study (Montagni, Cariou, Feuillet, Langlois, & Tzourio, 2018) surveyed students aged 18–24 years to identify their use and opinions concerning digital technol- ogies for health. Results showed that 35% had used at least one health app, mostly for physical activity and general health monitoring but only 4% used a wearable device. Almost all of the students had searched on the internet for health-related information in the past 12 months. In a Finnish project (Ng, Tynjälä, & Kokko, 2017), adolescents were surveyed about their use of physical activity trackers (apps and wearables). Half of the respondents had these apps but only 16% reported using them, while 17% owned wearables and 9% used them.

A small number of qualitative or mixed-methods approaches have been employed to research young people’s use of digital health in the social sciences. An English-based project (Goodyear et al., 2018b; Goodyear, Armour, & Wood, 2018a) used participatory class activities, interviews, focus group discussions and an online survey to elicit the experiences of school students (aged 11–15 years) relating to their engagement with health-related social media. The researchers found that just over half of the survey respondents actively used social media to search for health infor- mation: predominantly for physical activity, diet/nutrition and body image. In another English study (Goodyear, Kerner, & Quennerstedt, 2017; Kerner & Goodyear, 2017) school students aged 13–14 years were invited to try using a Fitbit wearable self-tracker for eight weeks. The students com- pleted questionnaires and engaged in focus group discussions about their experiences. The findings showed that the devices gave only short-term motivation to their users to increase their activity levels, and that their use engendered feelings of guilt, competition and internal pressure. A third English study (Depper & Howe, 2017) recruited adolescent girls who were sports leaders to take part in focus groups to explore the ways in which they understood concepts of ‘health’ as they were promoted by health and fitness apps. The girls were mostly positive about the self-tracking and motivational affordances offered by these apps. However, they demonstrated a critical under- standing of the body ideals promoted by the apps. These participants did not think the apps would work well in physical education classes as they had too individualistic an orientation and detracted from the social benefits of exercising together.

Several qualitative digital health-related projects have been conducted in the USA with young people. One study employed qualitative interviews with participants aged 13–18 years about their use of digital health technologies (Radovic, McCarty, Katzman, & Richardson, 2018). There were three main uses of digital technology for this group: (1) to gather information (medical websites and social media like Facebook and Pinterest, exercise apps and YouTube for workout information); (2) to share experiences and view others’ experiences to gain social support or inspiration; and (3) to engage in self-tracking (apps and wearables). Online media and apps were considered by the young people to be easy to use, always available, non-judgemental and with options to share information and experiences anonymously. The negative aspects identified by the participants were that online information was not always credible, apps and wearables can be unaffordable, the burden of entering information into apps, the temptation of always having the phone on, some technology was not designed for teenagers’ use, and peers sometimes shared information that may be inaccurate or encourage risk-taking.

Another USA-based qualitative study involving interviews with college students who used health and fitness apps (Gowin, Cheney, Gwin, & Franklin Wann, 2015) found that most had downloaded the app to help with meeting goals: supporting an established behaviour or adopting a new behaviour. In a project on wearable devices (Schaefer, Ching, Breen, & German, 2016), young people enrolled in an after-school programme in California were provided with Fitbits over six months. They took part in

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focus groups and their Fitbit activity data were reviewed. Data logs revealed low continuous engage- ment that declined over time. The design of the Fitbit, environmental constraints and motivation were barriers to continuous engagement.

Little is known about young Australians’ use of digital health technologies. Surveys routinely demonstrate that Australians as a population are among the highest users of digital technologies worldwide. A 2018 representative consumer survey of adult Australians (Yellow, 2018) found that 87% of respondents owned a smartphone and just over one-fifth (21%) owned a wearable device such as a smartwatch or fitness band. Young Australians (18–29 years) differed from older Australians in several key aspects of digital use. They were much more likely to own a smartphone and far less likely to own a desktop computer. Young Australians were also more likely to frequently access the internet and social media (five times or more per day) compared with other age groups. They were among the highest owners of wearable devices: the highest use was found among the 30–39 years group, followed by the 18–29 years group.

Only a small number of Australian-based studies specifically about digital health use have been conducted involving young people. A large survey of Australian young women aged 18–24 con- ducted in 2012–2013 found that 43% had used the internet to search for health information. Those experiencing stigmatised conditions or symptoms (such as mental health problems) were more likely to have searched online (Rowlands, Loxton, Dobson, & Mishra, 2015). In another Austra- lian-based study (Ridgers et al., 2018) similar to the American and English Fitbit studies discussed above, the researchers provided participants aged 13–14 years with a Fitbit and asked them to use the devices for six weeks. These young people then took part in focus groups to discuss how they found the wristband. The participants reported finding the device easy for tracking physical activity, but not as useful for sleep tracking. Barriers to use included problems with the Fitbit’s comfort and design, lack of specific feedback about activity levels and the difficulty of using it to track water-based sporting activities. A project focusing on mental health information online (Chan, Farrer, Gulliver, Bennett, & Griffiths, 2016) involved Australian university students aged 19–24 year in focus groups. The students said that they were concerned about privacy and confidentiality and the quality of web-based resources. Potential benefits they identified were anon- ymity, avoidance of stigma and accessibility. In another study, the researchers interviewed health and physical education students at an Australian university about their perceptions and use of digital technology use for health and fitness (Pang, Varea, Cavallin, & Cupac, 2018). While these participants enjoyed the benefits of being able to monitor their bodies with apps or wearable devices, the researchers also identified a sense of ambivalence in many of their participants, centring on not wanting to ‘miss out’ on the benefits of these technologies but also not finding much value in using them.

Methods

The Young Australians and Digital Health Project was designed to engender further insights into how and why this demographic group use digital technologies for health and medical purposes, building on a previous study I conducted asking similar questions of Australian adult women from a range of age groups (Lupton & Maslen, in press). It aimed to investigate the following research questions: What digital technologies do the participants use regularly for health-related purposes? Which do they find most and least helpful and useful? What other kinds of information and support sources do they use? What kinds of digital health technologies would they like to see developed in the future? A qualitative method – semi-structured telephone interviews – was chosen to shed light on the situated complex- ities of the participants’ encounters with digital health technologies.

A market research company was briefed to recruit 30 young Australians aged 16–25 years from its panels of research volunteers. Once a participant had agreed to take part, a telephone interview was conducted by the company’s interviewers at a time chosen by the participant, and was audio- recorded and then professionally transcribed. Participants were provided with an AU$50 gift card

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as compensation for their time. The project was approved by the University of Canberra Human Research Ethics Committee.

The interviews took place in April-May 2018. Participants were asked a series of questions relating to how and why they sourced health and medical information and support, including non-digital and digital sources, and which of these they found most and least useful and helpful. They were asked if anyone had recommended that they use digital health technologies and whether they had any con- cerns about their personal health data privacy and security. The final question had a future-oriented perspective, asking participants to imagine and describe an ideal digital health technology for their everyday needs.

The participants were recruited to ensure equal numbers of female and male participants and a spread of ages. Seventeen participants were aged 16–20 years and 13 were aged 21–25 years. Most of the participants (22) had completed at least some university education, while five were still at school and three had finished or were currently in post-school technical training. In terms of ethnic background, this was quite a diverse group of young Australians, reflecting the multi- ethnic nature of the Australian population more generally (Australian Bureau of Statistics, 2018). Almost half (14) the participants identified as Anglo-Celtic, eight as Asian, two as European and six as other (Anglo-Indigenous, Middle-Eastern, Anglo/Armenian, Asian/Pacific-Islander and two as Eur- asian). Ten of the participants lived in New South Wales, ten in Victoria, five in Queensland, two in South Australia and one each in Western Australia, Tasmania and the Australian Capital Territory. Twenty-one participants lived in cities and nine lived in rural areas.

I designed the interview schedule and conducted all the analysis of the transcripts. I read through the transcripts repeatedly, looking for how the participants described their experiences and practices in relation to the following dimensions drawn from thinking with feminist new materialism theory: affordances, relational connections, affective forces and agential capacities. In alignment with post-qualitative perspectives on research (Fullagar, 2017; St Pierre et al., 2016), I acknowledge that my interpretation, as in any analysis of research materials, is situated and partial. In what follows, I first discuss affordances, relational connections and affective forces (acknowledging that these are inevitably interconnected, but working to build on each section to create a sense of the complexities involved in these human-nonhuman assemblages). The discussion section examines how these dimensions gather to generate agential capacities, working to make things happen or make things matter.

Findings

Sources used and their affordances

The interview began with some questions designed to determine which information sources were used by the participants for health and medical topics and issues. Table 1 shows responses to a list of non-digital and digital sources that was provided to the participants. For each source, they were asked if they currently used them. Subsequent questions asked the participants to provide further details about their use.

As shown in the table, all participants said that they sought information from doctors and other healthcare providers, and most also turned to advice from friends and family members. Very few young people used books for health information, but pamphlets were still read by around a third of participants (usually picked up in doctors’ surgeries while waiting for a consultation). In terms of digital tools and resources, search engines were used by everyone, with health websites a close second. All the participants said that they were routinely online throughout the day and were accus- tomed to searching the internet as a habitual practice for various purposes. They generally searched between once or twice a week or once a month for health-related topics. Youtube, online discussion groups and social media groups were fairly well-used, but by less than half of the participants. Par- ticipants noted that these sources were often found from an initial search using Google Search. Only

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five of the 30 participants said that they had signed up to My Health Record (Australia’s nationwide patient electronic medical record), with the remainder noting that they had not heard of it. This response suggests that the affordances of this digital health technology were opaque or unknown to most of this group of young people.

The young people explained that the affordances offered by search engines and online sources were predominantly convenience, ease of use and ready access to instant information from a wide variety of sources. Searching online was typically used by young people as a first step in a process of deciding whether their symptoms or concerns required medical attention.

So I would initially just google my query and do a little bit of research on my own but then I would take my problems to a doctor and they would have more detail and more answers for me. I like going online for the ease of use, ease of access, variety of information available, all that kind of stuff. (male, 24 years)

For some participants, the opportunity to save time and money by avoiding a doctor’s consultation were further factors in their preference to go online as a first mode of action.

I guess another factor is probably cost as well; because typically if you want to get information seeing a doctor to get information, it is helpful but sometimes I can’t afford it. So that’s why I go online, because if you go online it’s free to get information. (male, 24 years)

Other affordances of the digital technologies used by participants included their visual formats. YouTube, in particular, offered explanatory videos which were valued by the participants who used this medium for health-related topics. They said that they were able to view videos to learn about how to successfully engage in practices such as exercises for recovering from injuries or for improving physical fitness.

I tend to find it better to listen to someone speaking about a health issue rather than just reading about it. Sometimes they have diagrams that are quite useful and even show remedies. So that’s helpful. (female, 23 years)

Apps and wearable devices (mostly Fitbits) were used for mental health and wellbeing and booking medical appointments, as well as for self-tracking sleep, heart rate, steps and other physical activities, and menstrual cycles. The users of wearable devices and apps tended to use them on a daily basis. The main affordances offered by these apps and devices were the opportunity to monitor bodily functions and activities and to do so easily and in detail.

I find the Fitbit is the most useful, because it’s pretty portable. It goes on my wrist for most of the day, I take it off at night, and I can pretty much sync it with my phone and get all the data. I guess overall probably the functions are the most useful part. It tracks your sleep patterns, tracks your steps, and also tells you your heart rate. And all this stuff, you can monitor on the go. (male, 23 years)

Table 1. Sources of health and medical information used currently.

SOURCES Number of respondents (n = 30)

Non-digital sources doctors and other health care providers 30 friends and family 21 pamphlets 11 books 5 Digital sources search engines 30 health websites 26 YouTube 13 online discussion forums 12 wearable devices 12 social media groups 10 apps 9 digital exercise games (e.g. Wii Fit) 8 electronic medical record (My Health Record) 5 physical activity platforms (e.g. Strava) 6

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Digital exercise games such as Wii Fit and physical activity platforms like Strava were the least used of all the technologies listed. Few participants who did use them did so regularly, with several partici- pants noting that exercise games were too time-consuming to set up.

When the young people were asked to imagine the ideal digital health technology for their needs, features of convenience, diversity of information and access were again to the fore. The participants often imagined an app, website or device that could do everything in one place.

A lot of that kind of stuff, you have to download all these separate apps, and everything, to do what you want. You have to find the ones that work for you. It would be great to just have it all there, to just make it easier. (male, 16 years)

According to the participants’ accounts, doctors offered different affordances from online sources. They were highly valued as the pre-eminent source of health information authority because of their training and expertise. Young people noted that it could be difficult to distinguish between different opinions and details about health and illness expressed online, requiring them to assess which sources were most valid and reliable. By comparison, a doctor’s expertise was individualised to patients’ specific needs and they could offer knowledgeable interpretations based on their train- ing. Young people could then defer to this expertise.

I guess online there’s a lot of different opinions on what something – like, if you think you’ve got a cold or something like that then you go online and I guess you’re not really qualified yourself to go, this is actually what symptoms I’m experiencing and this is what it actually is. Whereas I feel like if you go to a doctor, they’re able to pinpoint it quite well. (female, 22 years)

For some participants, their imagined ideal digital health technology involved better access to medical expertise online, thereby combining the affordances of digital technology with those offered by experiential and personalised medical expertise.

So my ideal would be – like, if you have a physical problem and you can actually see it, you’ll be able to take a photo of it, then can put it up online. And online doctors or something, they could help you out with it, like tell you what you have. (female, 18 years)

Relational connections

As suggested above, the importance of face-to-face encounters was evident in the participants’ accounts. Part of the value of these encounters were the relational connections that could be estab- lished between the participants and other people in their lives, including medical professionals, friends and family members. One of the key values expressed by the young people was the role played by the intimate knowledge of their health held by their parents or regular doctor, developed through their regular in-person interactions over time.

The doctor’s better than online sources, because they’ve got all the knowledge. You know, they know what they’re doing and they’ve got a better grasp of medical history – they have known you for years. (male, 20 years)

It was common for participants to recount asking family members for advice about a health issue (particularly their parents). Here again, they noted that their family members knew them very well, and therefore could provide help or advice that was more personalised and effective.

If it’s a family member that actually knows the information that I’m seeking, that’s probably the most help I’m getting, because it’s close to home. (female, 19 years)

Advice from family members and friends was also commonly sought by the participants when they were considering which digital health technologies were the best to use. Some young people recounted how friends and family members had recommended websites, apps or wearable devices. They explained that they valued the embodied experience-based knowledges that these people could provide.

I know when my little brother got his Fitbit originally and he was all rage on it and I was, like, okay, maybe this is something that I need to look into. That’s when I ended up getting my Bellabeat tracker after I researched into

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them. My mum’s always looking up stuff on the internet about health. It sort of showed me that there is a platform that I can use that is a bit more discreet and more accessible. (female, 20 years)

Digitally-mediated human contact on online discussion forums and social media groups was another important relational connection according to the participants’ accounts. The young people who engaged with these forums and groups noted that they appreciated accessing other people’s experi- ences with health issues. They explained that these platforms offered a more personal perspective than websites which simply provided information about health and illness, incorporating other people’s narratives of illness and their responses to therapies and medications. Most of the partici- pants tended to observe others’ contributions rather than actively contribute content to these platforms.

I guess I’m always looking for other people and what they are experiencing within the websites, so I guess it kind of serves that purpose of just providing a community as well as further information. It’s helpful to know other people’s experiences and what they ended up being diagnosed with or if they weren’t diagnosed with anything. So it also assists me in that level of comfort. I never post anything, I just consume. (male, 22 years)

The participants also appreciated being able to view videos on YouTube featuring people who were going through similar experiences.

In general, I am on YouTube pretty often – like two hours maybe before bed and stuff, so every day. For health stuff probably like a few times a week, just because I’m subscribed to interesting people who talk about psychology stuff. It just teaches me – I mean, if I’m searching on how to get better and stuff, I guess I use it to see people talk about what they’ve been through. (male, 20 years)

Self-tracking apps and wearable devices generated relational connections between users and their bodies and mental states. They helped users to see patterns in or causes of the bodily sensations and signs they were able to discern that otherwise would be hidden.

The apps I use is a period tracker, so I use that every day and it kind of tracks your mood and everything as well so I use that one daily. And then I also have the Apple Health app which tracks how many steps I do. I think I use it, like, if my feet or legs or anything are in pain I normally look it up and see, did I do a lot of steps today or something like that. To, kind of, go, oh, okay, well, that’s understandable. Like, I guess it helps me find a reason as to why and when my legs and feet hurt. (female, 22 years)

One of the potential affordances participants imagined in an ideal digital health technology was the opportunity to generate better relational connections between digital technologies and bodies/ selves so that the technologies could respond more intimately and effectively to their needs.

I think it would need to be sort of some type of fitness device, but I think it would also have to have access to - it would have to be very personalised. You’d have to be able to put in everything about yourself. I think it would also have to have articles on search engines, then it can connect to the internet and have all this information ready for you to type it in. And I guess because then it’s got all your personal information, it can sort of narrow down the ones that are actually relevant to you. (female, 20 years)

At its most extreme, the imagined ideal technology was one that could be permanently placed on or inserted into the body.

If I was able to design something, I’m thinking of a chip that is put on to any part of your body, that monitors you throughout the whole day, that will monitor everything from heart rate to high blood pressure, low blood pressure, and all the health monitoring. (male, 23 years)

Affective forces

The ways in which the young people described their experiences of seeking health information and support frequently described affective forces that either moved them to act or had direct impacts on their health and wellbeing. These affects included trust, reassurance, quelling fears, feeling less alone, feelings of achievement and motivation. The impetus to seek information and advice itself stemmed from concern or worry about unusual bodily signs and symptoms or a desire to achieve a better state

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of health and wellbeing. Initial bodily sensory experiences and observations, a feeling that something was not quite right, impelled the participants to seek out information or advice.

Trust was an important element in how the participants evaluated the validity, accuracy and support offered by information sources. The participants discussed how important it was to them to be able to trust the information they found online, and how face-to-face interactions as part of established social networks with doctors, friends and family members were often the most trust- worthy interactions. The relational connections they had established with these other people were central to trust.

I think it’s similar to word of mouth, when someone close to you tells you something you’re going to believe them more, because you know them personally. Whereas if you find things on the internet it might not be true. I think even if you ask a professional if it’s seconded by someone close to you, you tend to believe it more. (female, 23 years)

These kinds of affective forces could also be generated through online interactions and networks. Reas- surance was another affective force that these sources of information and advice could offer the young people. Finding information quickly meant that anxieties or concerns could be quickly dispelled.

Going online gives you like a first opinion. So, if it’s something that you are worried about but don’t think is too serious, then it’s easy to quell your fears, or think I need to take another step. (male, 24 years)

So too, the desire to feel as if they were not alone in experiencing bodily feelings and sensations was met by going online and accessing Youtube videos, online discussion forums and social media groups. As noted earlier, YouTube, online discussion forums and social media groups were viewed by the young people as more personal and experiential sources of information, advice and support for health-related matters compared with health information websites. They felt connected to the physically distant others they encountered online through their sharing of experiences and affective responses on these platforms.

Well, probably I just read forums to find information on the forums, the one thing I find useful is that they have allowed people to express their own feelings with different kinds of diseases. And I find that if it relates to me, then I guess it doesn’t make me feel so alone – knowing that what I’m going through, someone else is going through it with it. (male, 24 years)

The affective forces driving the regular use self-tracking apps and wearable devices were motivation and feeling of achievement engendered by setting and reaching goals.

I like the wearable’s ability to actually make you want to set goals and you can see just at a glance your progress and it’s just that little bit of extra motivation that would otherwise never really exist without having a wearable. (male, 22 years)

The participants did not spontaneously refer to privacy or security issues when they were outlining their use of digital health. When they were asked specific questions about whether they ever thought about where the personal health data they generated by their use of online media, apps or wearable devices went and who else may access and use their data, the participants for the most part expressed little or no concern. This lack of concern is particularly notable given that their interviews had taken place around the time that the Facebook/Cambridge Analytica scandal had received high levels of media attention in Australia, drawing attention to the secondary use of personal details pro- vided to companies such as Facebook.

The participants’ accounts suggested that they were still willing to invest trust in the platforms and companies involved to protect the security and privacy of their personal data. They had difficulty explaining who might use their personal health data and for what purpose.

I feel like there’s a lot of people using the internet, and I don’t think they’ll have very much interest in my information. Yeah, I don’t really see it as an issue (female, 19 years)

Several participants said that they had noticed that companies like Facebook and Google were moni- toring their online searches and content for advertising purposes, but these practices were accepted as the norm for online engagement.

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Obviously, Google, because they’re finding ways to link to merchandise, or that’s what I believe, personally. If I look up fitness they’ll say, “Oh look at this fitness gear; why don’t you buy it?” I think it’s just society today – I can’t really stop it. (female, 18 years)

Some young people also identified the government as one of the agencies potentially acces- sing their health data, but again, they expressed little concern about this secondary use of their details.

I’d probably say the government because if I ever submit any information for myself the government probably has access to it. It doesn’t bother me too much. (male, 20 years)

Even the participants who made direct mention of data breaches or the Facebook/Cambridge Ana- lytica scandal said that they were not highly concerned.

There has been a lot of data breaches and they do tend to be growing. But no, it doesn’t really worry me once I’ve done my research. I think it’s just companies and third-party companies trying to target things specific to me that I would like to buy. (male, 22 years)

Discussion

The findings from the Young People and Digital Health Project complement and build on previous research on young people’s use of digital health technologies by including young people across Aus- tralia, exploring how and why the participants used the range of devices and software currently avail- able to them rather than focusing on specific technologies, addressing health data privacy and security issues, contextualising their enactments of digital health in their broader sociocultural environment (including their face-to-face encounters with other people) and adopting a feminist new materialism theoretical perspective to draw attention to the gathering of affordances, relational connections and affective forces in generating agential capacities. This group of young participants were even higher users of search engines and websites than those in the studies conducted both in Australia and in other wealthy countries reviewed earlier, but were roughly similar in the extent to which they used online discussion groups and newer digital media such as social media platforms, apps or wearable devices.

Notably, although YouTube has received little attention as a health information source in previous research, it emerged as a quite popular source among this group of participants, offering the affor- dances of personal stories of health and visual formats. This finding may be related to the expansion of take-up of this platform among young people generally, as shown in Pew Research Center’s recent survey of social media use in the USA (Smith & Anderson, 2018). Even though this Pew study also demonstrated high use of social media such as Instagram, Snapchat and Twitter among young adult Americans, the Australian young people in my study did not report using these social media platforms for health- or fitness-related information purposes.

For those young people who used self-tracking wearable device or apps, the affordances of these technologies for coming together with their bodies was another relational connection. These tech- nologies provide more detailed insights than could be generated from fleshly sensory affordances. The human-nonhuman affordances came together to enhance people’s capacities to monitor and measure their bodies and their abilities to motivate themselves to achieve goals or aspirations. Affective forces, such as the need for reassurance and to be able to trust the providers of health infor- mation were also dominant in the participants’ accounts. The affordances of humans and nonhu- mans, relational connections and affective forces gathered to generate agential capacities. These capacities included finding an answer to and treatment for worrying symptoms, generating better knowledge of bodies and health states, feeling part of social or familial networks and improving health, fitness and mental wellbeing.

The participants’ accounts highlight the importance to this demographic group of the relational and affective dimensions of seeking health-related advice and information. While all the participants

10 D. LUPTON

went online routinely and regularly to find advice and information, particularly because the internet affords convenience, ready access and a wealth of diverse opinions, it was evident that their con- nections and relationships with other people, both face-to-face and digitally mediated, were very important. Other key affordances offered by digital technologies included offering material that could be viewed anonymously and unobtrusively. Feeling understood by and connected to other people was an agential capacity generated through various combinations of humans with each other and with technologies. The ideal digital health technologies that were imagined by the participants also evoked the affordances of convenience and accessibility. These imaginaries also suggested the importance to young people of technologies that could ‘know’ and ‘understand’ them better than those they had already tried. This suggests a relational connection generated by a human-nonhuman assemblage that is highly intimate, mimicking the relational knowledge that trusted people such as parents, other family members and long-term doctors may have about them.

Importantly, while participants highly valued the agential capacity of digital technologies to gen- erate detailed information about their bodies and health states, for the most part they did not recog- nise the capacities these very personal data offered to other actors and agencies. On the contrary, the most commonly imagined affordance of the idea digital health technology was a website or app which could collect even more detailed information about the user and bring these data together all in one place. This imagined device was valued for convenience, ease of use and the detailed infor- mation it could generate and curate. The potential for these data to be used or exploited by third parties was not considered.

The opportunities for connection, emotional support, interacting with and listening to others were the vibrancies that animated the participants’ enactments of seeking and finding health infor- mation and support, that kept them googling, reading the content of websites, social media plat- forms and online forums, watching videos and using apps and wearable devices. While the young people’s consumption of this content may overtly appear to be passive, given that they tended to view rather than create online content, the young people were actively making sense of the material they were accessing and gathering, deciding how relevant or valid it was for their needs, how they would respond to it and whether they needed to seek further advice from doctors or others.

To conclude, thinking with feminist new materialism to analyse empirical interview materials in this project facilitated an approach that acknowledges the complexities of the entanglements of technological and fleshly human affordances. The findings demonstrate ‘what a body can do’ (Fox, 2017) when coming together with digital health technologies as well as other sources of information and support. Digital technologies are important resources for young people as they learn about their bodies and health states, but they operate within the broader network of face-to-face relationships that young people have with family members, friends and healthcare professionals. The findings highlight that learning about health and embodiment is a distributed relational capacity between humans and nonhumans, and that connections with other people are crucial elements of these assemblages. These insights go some way to recognising and acknowledging the embodied, affective and relational dimensions of living with, through and in the more-than-human worlds of digital health.

Acknowledgements

Many thanks to the participants for their involvement in the project and the University of Canberra for providing funding support.

Disclosure statement

No potential conflict of interest was reported by the author.

SPORT, EDUCATION AND SOCIETY 11

ORCID

Deborah Lupton http://orcid.org/0000-0003-2658-4430

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