Access and triage in contemporary general practice

A novel theory of digital candidacy

Bibliographic Data

ID4596723
AuthorsFrancesca H Dakin (0000-0002-4105-4617, University of Oxford, corresponding author), Sarah Rybczynska‐bunt (0000-0002-4284-1081, University of Plymouth), Sarah Rybczynska-Bunt, Rebecca Rosen (0000-0001-6580-8324, Nuffield Trust), Aileen Clarke (0000-0001-8299-3146, University of Oxford), Trisha Greenhalgh (0000-0003-2369-8088, University of Oxford)
Year2024
Volume349
Pages116885
Publication date2024-05-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2024.116885
PMID38640742
OpenAlexW4394761670
LanguageEN
Citations received7
References cited30

To access contemporary healthcare, patients must find and navigate a complex socio-technical network of human and digital actors linked in multi-modal pathways. Asynchronous, digitally-mediated triage decisions have largely replaced synchronous conversations between humans. In this paper, we draw on a large qualitative dataset from a multi-site study of remote and digital technologies in general practice to understand widening inequities of access. We theorise our data by bringing together traditional candidacy theory (in particular, concepts of self-assessment, help-seeking, adjudication and negotiation) and socio-technical and technology structuration theories (in particular, concepts of user configuration, articulation, distanciation, disembedding, and recursivity), thus producing a novel theory of digital candidacy. We propose that both human and technological actors (in different ways) embody social structures which affect how they 'act' in social situations. Digital technologies contain inbuilt assumptions about users' capabilities, needs, rights, and skills. Patients' ability to self-assess as sick, access digital platforms, self-advocate, and navigate multiple stages in the pathway, including adapting to and compensating for limitations in the technology, vary widely and are markedly patterned by disadvantage. Not every patient can craft an accurate digital facsimile on which the subsequent adjudication decision will be made; those who create incomplete, flawed or unpersuasive digital facsimiles may be deprioritised or misdirected. Staff who know about such patients may use articulation measures to ensure a personalised and appropriate access package, but they cannot identify or fully mitigate all such cases. The decisions and actions of human and technological agents at the time of an attempt to access care can significantly influence, disrupt, and reconstitute candidacy both immediately and recursively over time, and also recursively shape the system itself. These findings underscore the need for services to be (co-)designed with attention to the exclusionary tendencies of digital technologies and technology-supported processes and pathways

Actor–network theory · Adjudication · Digital health · Health care · Internet privacy · Knowledge management · Negotiation · Network theory · Political science · Sociology · Triage · Computer Science · Law · Mental Health and Patient Involvement · Mobile Health and mHealth Applications · Psychology · Telemedicine and Telehealth Implementation

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