Revisiting agency and medical health technology: actor network theory and breast cancer survivors' perspectives on an adherence tool

Mark L Cabling; Fabrizio Drago; Jeanine Turner; Alejandra Hurtado-de-Mendoza; Vanessa B Sheppard

doi:10.1007/s12553-022-00707-1

Revisiting agency and medical health technology: actor network theory and breast cancer survivors' perspectives on an adherence tool

Health Technol (Berl). 2022;12(6):1071-1084. doi: 10.1007/s12553-022-00707-1. Epub 2022 Nov 13.

Authors

Mark L Cabling¹, Fabrizio Drago², Jeanine Turner³, Alejandra Hurtado-de-Mendoza¹, Vanessa B Sheppard⁴

Affiliations

¹ Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 3300 Whitehaven Street, NW, Ste. 4100, 20007 Washington DC, USA.
² Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854 USA.
³ Communication, Culture & Technology Program, Graduate School of Arts and Sciences, Georgetown University Car Barn, Suite 311, 3520 Prospect Street, Washington DC , N.W. 20057 USA.
⁴ Massey Cancer Center, School of Medicine, Virginia Commonwealth University, 401 College Street, Box 980037, Richmond, VA 23298-0037 USA.

Abstract

Purpose: Optimal treatment adherence is critical in the management of breast cancer patients/survivors taking hormonal therapy. However, lack of adherence is common. Many technologies have been developed to encourage medication intake, such as reminders on phones or digital pills, with varying degrees of success.

Methods: To explore the role of technology in medical adherence requires a framework that considers all complexities of technology, from software to the end user's beliefs. Actor Network Theory (ANT) defines technology based on its technical, social, and abstract components. We conducted three focus groups, which we analyzed using a thematic analysis to determine topics in breast cancer survivors' discussions of these technologies. We also conducted a deductive content analysis using ANT concepts as codes.

Results: In discussing the use of technology to improve medical adherence, participants had an empowering view of technology (48.8%) a neutral one (41.5%) or a disempowering view (9.8%). When it comes to their medication adherence, breast cancer survivors taking hormonal therapy perceived technology as something on which they could assert agency while their own agency dictated their adherence behaviors.

Conclusions: In line with a non-technologically deterministic view of medical technologies, this finding shows that technology can be both constraining and enabling, depending on the specific context of human use. This networked understanding of technology in terms of social dynamics has relevant implications in designing interventions that use technology to improve adherence.

Keywords: Actor Network Theory; Adherence; Breast Cancer; Hormonal therapy; Medical Technology.

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