A cross-level, intersectional feminist perspective of patient empowerment through mobile health applications: a case study on the app ‘RheumaBuddy’ for rheumatoid arthritis.

Abstract

The importance of patient empowerment has emerged as a key dimension of contemporary healthcare policy and delivery under the paradigm of the democratisation of healthcare. This thesis focuses on digital health (DH) interventions, particularly mobile health applications, and their role in patient empowerment. The aim of this research was to highlight the importance of a multi-level analysis of empowerment through DH, which takes place on micro (intrapersonal), meso (interpersonal) and macro (structural) levels. Qualitative research through interviewing was conducted alongside Daman, a digital healthcare partner, in relation to their app ’RheumaBuddy’ for rheumatoid arthritis (RA). This study utilises a multi-level analysis of empowerment under intersectional feminist theory, illuminated through a case study on the mobile health app ’RheumaBuddy’. A multi-level analysis is imperative when considering empowerment due to issues associated with a single level analysis which often forgoes the nuances associated with the true lived patient experience. This affectively ties in with an intersectional feminist perspective, which argues that power and identity intertwine to impact the oppression of marginalized individuals. Aspects related to power and identity as associated with intersectional feminism heavily influence patient outcomes on micro, meso and macro levels. The results of this study align with the hypothesis that a patient experience of (dis)empowerment is conducive to their position in the social world and interwoven between the three ecological levels. Therefore, we should consider all three levels and a patient’s social position when considering patient empowerment through DH, as opposed to heavily relying on the micro-level which privileges neoliberalist ideals. This study shows how mobile health applications can be dualistically empowering and disempowering, affecting participants situated on different intersections of the social world in a distinct way. Going forward, DH interventions must be designed with an intersectional framework in mind. The utilization of DH which is grounded in cross-level analyses and intersectional feminism can help alleviate health inequalities and bolster inclusion – but if not addressed, the health disparities we already see in our social world will only be amplified further through DH.