Users' agencies : juxtaposing public portrayals and users' accounts of app-mediated cardiac arrest volunteer work in Sweden

Sammanfattning: This thesis embraces a social science research perspective to examine uses of the app SMSlivräddare (eng. SMSlifesaving), now Heartrunner, dedicated to alert volunteers nearby to assist people suspected to suffer from a cardiac arrest outside hospital. This case study of the uses of the health and medical app juxtaposes the public portrayals of the app, its prospective users, their agencies and use practices with the volunteer users’ own accounts. The analysis explores dimensions of the app’s and its users’ agencies as delegated by the technology’s portrayals and perceived by its users. It renders visible also possibly obscured aspects of the volunteer users’ agencies and practices at the time of the technology’s implementation in the two first regions, before its subsequent adoption in other Swedish regions and in Denmark. A medical research perspective has so far dominated the studies of lifesaving apps. Such research evaluates the patients’ health outcomes resulting from the app use by the volunteers and concentrates on the examination of the efficiency aspects of the app, such as how many users arrived and how many engaged in resuscitating the patients. At the same time, it contributes to the promissory discourses and instrumental approaches applied to understand the meanings and uses of health and medical apps. In contrast, building on the discourse and thematic analysis of the qualitative research material, this thesis seeks to highlight the users’ perspectives in their co-constructing of the SMSlifesaving technology through their app use practices; it embraces a socio-material theoretical approach and critically explores the users’ agencies as delegated by the discourses of the project developers, managers and evaluators of the medical technology and as negotiated by the users in their daily practices. This thesis, first, investigates the public portrayals of the app, its users and their agencies published online, in the user-recruiting practices, and in a medical research publication evaluating the SMSlifesaving technology. Next, it examines how the volunteers’ accounts describe the rationales of their entry into their SMSlifesaving app use practices, the social context embedding their entry and the meanings which they ascribe to their practices. Third, the study investigates how the volunteers’ accounts in juxtaposition to the online portrayals of the SMSlifesaving technology represent the volunteers’ app use before their receptions of the app’s notifications which inform them about cardiac-arrest cases nearby, at the time of reception of such notifications, and following acceptance of such notifications.Contributing to the field of critical social research on health and medical apps, the thesis identifies that both the SMSlifesaving app users and the technologies they co-construct have agencies. It illustrates the users’ agencies delegated and negotiated; the latter when they overcome the app everyday dependencies and judge the app-mediated volunteer work importance versus their paid work and private life commitments, develop dutiful engagement with the app and re-define the app’s medical promises for the patients and their families