Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review.

BACKGROUND: The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups). OBJECTIVE: We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance. METHODS: Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. RESULTS: We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability. CONCLUSIONS: A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-https://doi.org/10.1136/bmjopen-2021-053962.

Understanding the Tensions of "Good Motherhood" Through Women's Digital Technology Use: Descriptive Qualitative Study.

BACKGROUND: Research suggests that expectant and new mothers consult and value information gathered from digital technologies, such as pregnancy-specific mobile apps and social media platforms, to support their transition to parenting. Notably, this transitional context can be rich with profound physiological, psychological, and emotional fluctuation for women as they cope with the demands of new parenting and navigate the cultural expectations of "good motherhood." Given the ways in which digital technologies can both support and hinder women's perceptions of their parenting abilities, understanding expectant and new mothers' experiences using digital technologies and the tensions that may arise from such use during the transition to parenting period warrants nuanced exploration. OBJECTIVE: This study aims to understand mothers' use of digital technologies during the transition to parenting period. METHODS: A descriptive qualitative study was conducted in a predominantly urban region of Southwestern Ontario, Canada. Purposive and snowball sampling strategies were implemented to recruit participants who had become a parent within the previous 24 months. Researchers conducted focus groups using a semistructured interview guide with 26 women. The interviews were audio recorded, transcribed, and thematically analyzed. RESULTS: Participants' experiences of using digital technologies in the transition to parenting period were captured within the overarching theme "balancing the tensions of digital technology use in the transition to parenting" and 4 subthemes: self-comparison on social media, second-guessing parenting practices, communities of support, and trusting intuition over technology. Although digital technologies purportedly offered "in-the-moment" access to community support and health information, this came at a cost to mothers, as they described feelings of guilt, shame, and self-doubt that provoked them to question and hold in contention whether they were a good mother and using technology in a morally upright manner. CONCLUSIONS: These findings raise critical questions concerning the promotion and commercialization of digital technologies and the ways in which they can further push the boundaries of hegemonic parenting practices, provoke feelings of inadequacy, and compromise well-being among expectant and new mothers.

'Putting all my eggs into the app': Self, relational and systemic surveillance of mothers' use of digital technologies during the transition to parenting.

This paper builds on thematic findings from a larger study that explored how digital technologies (e.g. smartphones, apps, search engines) shape expectant and new mothers' early parenting practices. An overarching theme that arose across these mothers' experiences which deserved deeper exploration was relational digital surveillance. In the context of this paper, relational digital surveillance describes how mothers evaluate their sense of preparedness, goodness or suitability for motherhood as they transition into parenting in relation to: their own use of digital technologies when caring for their pregnant bodies (self-surveillance), partners' and family members' commentary and/or judgement regarding their use of digital technologies to support their parenting and decision-making (familial surveillance) in addition to service/health care providers' commentary and/or judgement concerning their technology use (systemic surveillance). Mothers' use of digital technologies in this study not only provided others (partners, family members, health care providers) with means to watch over their actions and bodies as they transitioned into motherhood but offered a new evaluative dimension for others to scrutinize their behaviour as a new mother. Such understandings of relational digital surveillance within the transition to parenting context raise critical questions concerning the promotion and commercialization of digital self-surveillance technologies among expectant/new parents given the ways these technologies can further push the boundaries of hegemonic mothering practices and contribute to feelings of inadequacy and self-doubt. Alternatively, these insights offer avenues where health care providers can intervene to facilitate activities that enhance digital health literacy skills and mitigate parents' exposure to platforms that amplify anxieties.

Responding to COVID-19 with integrative health and sheltering models for persons experiencing homelessness in Southern Ontario, Canada: protocol for a qualitative study exploring implementation and sustainability.

INTRODUCTION: COVID-19 has disproportionately impacted persons experiencing homelessness in Canada, who are at an increased risk of infection and severe outcomes. In response to the pandemic, several regions have adopted programmes that aim to address the intersecting nature of health and social challenges faced by persons facing homelessness. These programmes adopted during the pandemic may contribute to broader health and social impacts beyond limiting COVID-19 transmission, but the processes involved in developing and implementing these types of programmes and their sustainability after the pandemic are unknown. Our overall goal is to understand the processes of developing and implementing integrative health and sheltering initiatives in Ontario during COVID-19, as well as their sustainability post-pandemic. METHODS AND ANALYSIS: This study will use a multiple case study design-two cases over 1 year-enabling us to investigate how integrative health and sheltering approaches have been implemented in two mid-sized cities in Ontario, Canada. Each case will offer a unique narrative; through cross-case analysis, the cases will highlight programme operations, successes and challenges. Data will be collected using semi-structured interviews with programme staff and managers, and document analysis. Project partners will be brought together to further explore and interpret findings, along with co-creating a sustainability action plan and policy documents. ETHICS AND DISSEMINATION: Ethics clearance was obtained through the Western University Research Ethics Board and the University of Waterloo Office of Research Ethics. Findings will be disseminated through publications, conference presentations and lay summary reports.

"Let me know when I'm needed": Exploring the gendered nature of digital technology use for health information seeking during the transition to parenting.

This paper presents results of a qualitative descriptive study conducted to understand parents' experiences with digital technologies during their transition to parenting (i.e. the period from pre-conception through postpartum). Individuals in southwest Ontario who had become a new parent within the previous 24 months were recruited to participate in a focus group or individual interview. Participants were asked to describe the type of technologies they/their partner used during their transition to parenthood, and how such technologies were used to support their own and their family's health. Focus group and interview transcripts were then subjected to thematic analysis using inductive coding. Ten focus groups and three individual interviews were conducted with 26 heterosexual female participants. Participants primarily used digital technologies to: (1) seek health information for a variety of reproductive health issues, and (2) establish social and emotional connections. The nature of such health information work was markedly gendered and was categorized by 2 dominant themes. First, "'Let me know when I'm needed'", characterizes fathers' apparent avoidance of health information seeking and resultant creation of mothers as lay information mediaries. Second, "Information Curation", captures participants' belief that gender biases built-in to popular parenting apps and resources reified the gendered nature of health and health information work during the transition to parenting. Overall, findings indicate that digital technology tailored to new and expecting parents actively reinforced gender norms regarding health information seeking, which creates undue burden on new mothers to become the sole health information seeker and interpreter for their family.

Health service experiences and preferences of frail home care clients and their family and friend caregivers during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic has brought about a major upheaval in the lives of older adults and their family/friend caregivers, including those utilizing home care services. In this article, we focus on results from a qualitative component added to a pragmatic randomized controlled trial that focuses on the experiences of our study participants during COVID-19. A total of 29 participants responded to the COVID-19 related questions focused on their health services experiences and preferences from March-June 2020 including 10 home care clients and 19 family/friend caregivers in the provinces of Ontario and Nova Scotia, Canada. RESULTS: Many participants were affected drastically by the elimination or reduction of access to services, highlighting the vulnerability of home care clients and their caregivers during COVID-19. This took an emotional toll on home care clients and increased the need for family/friend caregiver support. While many participants expressed reduced desire to utilize residential long-term care homes, some caregivers found that passive remote monitoring technology was particularly useful within the COVID-19 context. Our results provide important insights into the ways the older adults and their caregivers have been affected during the COVID-19 context and how to better support them in the future.

Exploring Canadian Children's Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study.

BACKGROUND: Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. OBJECTIVE: The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. METHODS: We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. RESULTS: Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside. CONCLUSIONS: Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends.

Investigation of Digital Technology Use in the Transition to Parenting: Qualitative Study.

BACKGROUND: The transition to parenting-that is, the journey from preconception through pregnancy and postpartum periods-is one of the most emotionally charged and information-intense times for individuals and families. While there is a developing body of literature on the use and impact of digital technology on the information behaviors of children, adolescents, and young adults, personal use of digital technology during the transition to parenting and in support of infants to 2 years of age is relatively understudied. OBJECTIVE: The purpose of this study was to enhance our understanding of the ways digital technologies contribute to the experience of the transition to parenting, particularly the role these technologies play in organizing and structuring emerging pregnancy and early parenting practices. METHODS: A qualitative descriptive study was conducted to understand new parents' experiences with and uses of digital technology during 4 stages-prenatal, pregnancy, labor, and postpartum-of their transition to becoming a new parent. A purposive sampling strategy was implemented using snowball sampling techniques to recruit participants who had become a parent within the previous 24 months. Focus groups and follow-up interviews were conducted using semistructured interview guides that inquired about parents' type and use of technologies for self and family health. Transcribed audio recordings were thematically analyzed. RESULTS: A total of 10 focus groups and 3 individual interviews were completed with 26 participants. While recruitment efforts targeted parents of all genders and sexual orientations, all participants identified as heterosexual women. Participants reported prolific use of digital technologies to direct fertility (eg, ovulation timing), for information seeking regarding development of their fetus, to prepare for labor and delivery, and in searching for a sense of community during postpartum. Participants expressed their need for these technologies to assist them in the day-to-day demands of preparing for and undertaking parenting, yet expressed concerns about their personal patterns of use and the potential negative impacts of their use. The 3 themes generated from the data included: "Is this normal; is this happening to you?!", "Am I having a heart attack; what is this?", and "Anyone can put anything on Wikipedia": Managing the Negative Impacts of Digital Information. CONCLUSIONS: Digital technologies were used by mothers to track menstrual cycles during preconception; monitor, document, and announce a pregnancy during the prenatal stage; prepare for delivery during labor/birth stage; and to help babies sleep, document/announce their birth, and connect to parenting resources during the postpartum stage. Mothers used digital technologies to reassure themselves that their experiences were normal or to seek help when they were abnormal. Digital technologies provided mothers with convenient means to access health information from a range of sources, yet mothers were apprehensive about the credibility and trustworthiness of the information they retrieved. Further research should seek to understand how men and fathers use digital technologies during their transition to parenting. Additionally, further research should critically examine how constant access to information affects mothers' perceived need to self-monitor and further understand the unintended health consequences of constant surveillance on new parents.

Tokenism and Mending Fences: How Rural Male Farmers and Their Health Needs Are Discussed in Health Policy and Planning Documents.

Rural male farmers (RMFs) are an understudied population with high mortality, morbidity and co-morbidities due to preventable injury, most of which occur on-farm. This study examines how RMFs and their health needs are discussed in Ontario rural health policy documents. A retrospective analysis of policy was conducted to analyze the content of Ontario rural healthcare policy documents published since 2006. Discussions of RMFs were categorized by two themes: tokenism and mending fences. Tokenism refers to RMFs' invisibility, except when farming stereotypes were used to describe rural areas. Mending fences captures the desire of rural communities to be included in healthcare decisions, and to position RMFs as key stakeholders for healthcare organizations to engage with to improve how they are perceived by rural communities. This study asserts that including RMFs in health policy formation can improve rural healthcare delivery and relationships between rural healthcare organizations and the communities they serve.

Rural Men's Health, Health Information Seeking, and Gender Identities: A Conceptual Theoretical Review of the Literature.

Beginning as early as 2009, recent shifts in Canadian health care delivery indicate that access to health information is essential to promote and maintain a healthy population. It is important to understand how and where various populations, such as underresourced rural populations, access health information so that public health agencies can develop and deliver appropriate information with, for, and in these contexts. There is a paucity of research that specifically examines how rural Canadian men seek health information; therefore, this review aimed to conceptualize this process based on three dynamic key constructs: health patterns of rural Canadians, health information-seeking behaviors, and rural gender identities. This conceptual theoretical literature review included 91 articles at the intersection of these three constructs. Discussion focuses on how residing in a rural region influences men's health and health care access. Health information-seeking behaviors are discussed in terms of social networks and framed with a rural context. Connell's theory of masculinity provides a useful approach to dissecting how rural men's gender identities influence their health attitudes, and how such attitudes are embedded in rural social and cultural norms. Each major construct-health in rural Canada, health information seeking, and rural gender identities-is discussed to highlight how specific embodiments of masculinity may promote and inhibit men's health information-seeking and positive health behaviors.