The reflexive imperative in the digital age: Using Archer’s ‘fractured reflexivity’ to theorise widening inequities in UK general practice

‘Reflexivity’, as used by Margaret Archer, means creative self‐mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperat...

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Bibliographic Details
Published in:Sociology of health & illness 2024-11, Vol.46 (8), p.1772-1791
Main Authors: Rybczynska‐Bunt, Sarah, Byng, Richard, Spitters, Sophie, Shaw, Sara E., Jameson, Ben, Greenhalgh, Trisha
Format: Article
Language:English
Subjects:
Anthropology, Cultural
Digital Age
digital healthcare
disadvantage
Disadvantaged
Female
Fractured
fractured reflexivity
General Practice
Health disparities
Health services
Healthcare Disparities
Humans
Inequality
inequities
Longitudinal Studies
Male
Past experiences
Patients
reflexive imperative
Reflexivity
remote healthcare
Social situations
United Kingdom
Workforce
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Summary:‘Reflexivity’, as used by Margaret Archer, means creative self‐mastery that enables individuals to evaluate their social situation and act purposively within it. People with complex health and social needs may be less able to reflect on their predicament and act to address it. Reflexivity is imperative in complex and changing social situations. The substantial widening of health inequities since the introduction of remote and digital modalities in health care has been well‐documented but inadequately theorised. In this article, we use Archer’s theory of fractured reflexivity to understand digital disparities in data from a 28‐month longitudinal ethnographic study of 12 UK general practices and a sample of in‐depth clinical cases from ‘Deep End’ practices serving highly deprived populations. Through four composite patient cases crafted to illustrate different dimensions of disadvantage, we show how adverse past experiences and structural inequities intersect with patients’ reflexive capacity to self‐advocate and act strategically. In some cases, staff were able to use creative workarounds to compensate for patients’ fractured reflexivity, but such actions were limited by workforce capacity and staff awareness. Unless a more systematic safety net is introduced and resourced, people with complex needs are likely to remain multiply disadvantaged by remote and digital health care.
ISSN:0141-9889
1467-9566
1467-9566
DOI:10.1111/1467-9566.13811