Digital Health Communications

It is clear that in 2020, it is deeply illusory to want to dissociate “digital health communication” from a hypothetical “non-digital health communication”. As in all fields of human activity, digital communication is embedded in all forms of interaction and relationships. Nevertheless, it still seems relevant to us to question the specifically digital part of health info-communication issues. Quite simply because we have not yet exhausted our understanding of the consequences of digitization on all of our activities, and particularly in the health sector.

The experience of the Covid-19 health crisis makes this analytical process all the more important since a multitude of supporting discourses are opposed to a no less significant volume of analyses pointing out all the risks inherent in the socio-technical ecosystem. On the one hand, we can identify prescription discourses aimed at the rapid adoption of digital tools facilitating access to information, reducing opportunities for interaction with caregivers or other patients ready to discuss their care pathway, enabling remote medical monitoring or improving the coordination of the action of medical teams [DUP 10, VAL 15]. On the other hand, we can also observe alarmist points of view that indicate the harmful effects of the massive implementation of digital information and communication technologies (DICTs) in terms of the remote monitoring of inhabitants, the development of teleworking that alienates people under the guise of economic optimization, or the future dehumanization of patient care by seeking to digitally compensate for the problem of territorial inequalities in access to care.

The positioning of information and communication sciences in the concert of human and social sciences must allow for relevant, current and heuristic clarifications of approaches to understanding the mechanisms of insertion and, we should also say, of the social insemination of ICT.

Our perspective is anti-deterministic. However, it can well be about the very mechanisms of a deterministic technological thinking at work among critics and promoters of an ever more digital society, increasing or even preserving humanity for some, enslaving it for others. It is at the heart of this tension that the info-communication processes are deployed, between cure and care, which we propose to study in this book. The research carried out for more than 30 years on the specific stakes of the social insertion of DICTs has made it possible to build an active community of researchers who, between the sociology of uses [JAU 11, JOU 00, PER 89], the digital communication of organizations [DUR 09, LEP 02], the new creative and digital industries [BOU 12, MIE 17], the semiotics or semiology of the digital world [BAD 15, BON 13, PIG 09], design [CAR 17b, LEL 02], changes in public debate, the digital mediation of knowledge [JAC 02, MOE 10, PER 12, PER 14] and the challenges of electronic socialization [GAL 05, PRO 00, PRO 06], provide a solid foundation for the identification, analysis and understanding of a digital health society in the making.

The scientific work that gives substance to this approach is located territorially. We question identifiable institutional contexts that, though they are limited to France and Quebec, bring to the forefront issues which, we believe, common to all communities involved in the digitization of health care. However, the health culture is not the same in Canada and France. For example, it is very much marked by the centralizing power of the State in France, and it seems much more imbued with the commitment of healthcare actors in Quebec. The various works presented here will be concerned with showing this context, which seems to us to be rich in similarities, as well as in differences, if only because of their distinct reactions to the logic of the new public management [DEG 14].

Indeed, the idea that corporate management can be applied to all forms of organizations, especially those focused on the common good, such as health organizations, now conditions all activities in the health sector. The logic of efficiency, whose limits are becoming apparent in this period of Covid-19 crisis (e.g. a lack of beds in intensive care units because they are not useful in normal times, a lack of nursing staff because of a decrease in the number of personnel owing to the neoliberal dogma of cost reduction, and a lack of masks, a consequence of the precepts of lean management [BOU 15b], etc.), is predominant in all countries, but with forms of acceptance or resistance that may prove to be different.

It is, of course, the case with regard to the French and Quebec cultural contexts which we focus on here. Similarly, for these two territories, acceptance and resistance to the digitization of care may be similar in many respects, but more specific in others. It seems certain to us, however, that Quebec society and French society can show some form of relevance to reflections on a global health system in crisis; this is a health system in which the care actors, in a form of consensus, question liberal strategic-economic precepts that until now seemed to be the fruit of “vulgar” managerial common sense, despite the exhaustion and repeated alerts of the care workers, particularly in France where half of the emergency services were on strike in September 2019 to demand more resources.

Without claiming to be exhaustive here, we wish to propose a significant state of the art of digital communication approaches in health led by researchers related or connected to information and communication sciences (ICS).

Numerous works are now available in many HSS disciplines dealing with the analysis of info-communication processes that cross the field of health. In sociology, psycho-sociology, economics and management sciences, researchers are studying the sociotechnical changes that are taking place and that are effective in the mediation between actors and organizations involved in health care. Nevertheless, it seems to us that ICS, because of the elements put forward previously, constitute a very relevant and already rich interdisciplinary base. Indeed, the work presented in this book can draw on a set of empirically proven hypotheses and theories, which are constantly being updated, concerning all the issues of the digital society.

Moreover, the interest in understanding the strategies of actors, which is a key feature of ICS, allows us to take into account macro-social tensions, be they economic or cultural, by linking them, at a meso-level, to individual action logics. In addition, the proximity of ICS research to empirical reality, validated in particular by the numerous partnership research contracts between our laboratories and institutions/organizations in the health sector, testifies to a dynamism in the renewal of problems directly related to the field.

In the same way, the methodological apparatus mobilized can be nourished by various approaches, articulated according to the interdisciplinary affiliations claimed by researchers concerned with not locking their questioning into an overly rigid conceptual straitjacket. As a result, cross methodologies, mainly articulating qualitative approaches in a comprehensive perspective, are deployed. This will be a question of finely perceiving the logics of actions via semi-directed interviews, as well as of strongly mobilizing ethnographic approaches of the Internet [JOU 13]; the semio-pragmatic analysis of site design can also be used [ODI 11], as can the analysis of online discourse [MAR 16].

While we do not wish to further evoke here the multiplicity of empirical approaches practiced in digital communication, it seems to us necessary to mention the main currents of communicational thinking in health. We believe that all of them are defined by a critical distance towards supporting discourses or organizational projects that aim to make ICTs the all-encompassing solutions to most, if not all, of the health sector problems. This critical distance, the result of observations made as closely as possible to the uses and info-communication practices of patients and caregivers, never precludes an increase in generality involving a systemic questioning of the dominant neoliberal perspectives.