The Assemblage and Dismantling of Access Barriers in Administrative Bureaucracies: Constructing the Problem of Diversity in the German Welfare State.

The article extends the literature on the construction of "diversity management" by personnel managers in corporate America. Such research has highlighted that Human Resource (HR) specialists draw heavily on social-scientific thinking in implementing various remedies against discrimination. However, it has paid less attention to how such esoteric views of reality, comprising such "things" as "structural barriers" impeding occupational advancement and "diversity sensitivity," have been successfully established as a self-evident reality in the workplace. In order to more thoroughly investigate how the world of diversity management is established outside the circle of academic specialists, the article employs perspectives from science and technology studies on the ways in which sociotechnical assemblages, i.e., networks of human actors and material devices, enact scientific ontologies. It applies such perspectives to a German case of diversity management, a program of "intercultural opening" that seeks to make bureaucracies of the welfare state more accessible to immigrants. The article delineates the specific ontology behind this version of diversity management, rooted in sociological perspectives on social mobility, and explores the various techniques and instruments through which officers of intercultural opening establish this ontology as a visible reality in municipal administrations.

The "UFO Taboo" Is What IR Theorists Make of It: "Sovereignty and the UFO" in Citational Perspective.

In 2008, Alexander Wendt and Raymond Duvall published an article titled "Sovereignty and the UFO," which demonstrated how a UFO taboo in international relations theory upheld an anthropocentric model of sovereignty. At a distance of a decade and a half, this review evaluates the validity of the claim that a UFO taboo exists in international relations, and explores the citational practices that influence the prestige economy of the field. The article employs a methodology of interpretive scientometrics informed by methodological debates in political science and international, as well as theoretical debates in actor-network theory. After testing the claim of the UFO taboo in a comparative perspective, the article investigates the strategies of association (weak and strong) present in the citations of "Sovereignty and the UFO." In addition to a revaluation of core claims in an often-read but less-often-cited article in international relations theory, this article provides important insights into how citation works in the discipline of international relations.

'Engaging on a slightly more human level': A qualitative study exploring the care of individuals with back pain in a multidisciplinary pain clinic.

Chronic low back pain is characterised by multiple and overlapping biological, psychological, social and broader dimensions, affecting individuals' lives. Multidisciplinary pain services have been considered optimal settings to account for the multidimensionality of chronic low back pain but have largely focused on cognitive and behavioural aspects of individuals' pain. Social dimensions are usually underexplored, considered outside or beyond healthcare professionals' scope of practice. Employing Actor Network Theorist Mol's concept multiplicity, our aim in this paper is to explore how a pain service's practices bring to the fore the social dimensions of individuals living with low back pain. Drawing on 32 ethnographic observations and four group exchanges with the service's clinicians, findings suggest that practices produced multiple enactments of an individual with low back pain. Although individuals' social context was present and manifested during consultations at the pain service (first enactment: 'the person'), it was often disconnected from care and overlooked in 'treatment/management' (second enactment: 'the patient'). In contrast, certain practices at the pain service not only provided acknowledgement of, but actions towards enhancing, individuals' social contexts by adapting rules and habits, providing assistance outside the service and shifting power relations during consultations (third enactment: 'the patient-person'). We therefore argue that different practices enact different versions of an individual with low back pain in pain services, and that engagement with individuals' social contexts can be part of a service's agenda.

Opening up conversations: Collaborative working across sociomaterial contexts in nursing in London.

AIM: To discuss nurses' use of networks to address nursing recruitment and retention in London, UK. DESIGN: Qualitative evaluation of the Capital Nurse programme reporting on 30 narrative interviews with executive, clinical and student nurses in 2019. RESULTS: Executive nurses within the Capital Nurse programme recognized the importance of sociomaterial contexts in the health and social care system in London and worked strategically across these contexts to achieve change. Supported through the Capital Nurse programme, executive nurses from health organizations across London initiated collaborative working to improve recruitment and retention. Primarily by designing and delivering sociomaterial products (organizational and educational) to support nurses to build a career in London. Drawing on ideas from actor network theory, in particular sociomaterial contexts, nurses' actions at all levels to develop and sustain networks to address nursing recruitment and retention across the NHS in London are described. CONCLUSIONS: Capital Nurse supported collaborative working both within single organizations and across organizations in London. There is evidence of change in how nurses across the capital work together to improve patient care, improve recruitment and retention. Findings may resonate with nurses in other settings who seek to address the problem of recruitment and retention. They show how nurses coming together in networks to effect changes in practice can work successfully. IMPACT: Nurses' use of networks led to novel models of communication and action to address the problems of recruitment and retention in London. We argue that sociomateriality should be considered outside the clinical practice setting, as part of nurses' professional development and organizational practice, that is how they plan their career, how they address recruitment and retention, how they communicate across organizations about nursing issues. NO PATIENT OR PUBLIC CONTRIBUTION: This was an evaluation of a staff development project in London, which sought to elicit nurses' experiences of participation in Capital Nurse.

Value-based health care in translation: From global popularity to primary care for Dutch elderly patients.

In this article we examine the fragmented interpretation and implementation of a remarkably popular concept, value-based health care (VBHC). By building on a case study of a project team working on the development of value-based primary care services for elderly patients, we shed new light on the way in which VBHC transitions from theory to practice. The concept of 'translation' is used to theoretically frame our analysis. Between June 2021 and May 2022, we gathered data through participant observation (50 h), semi-structured interviews (n = 20) and document analysis (n = 16). Our findings show how VBHC inspired new ways of working, and that, in line with previous studies, parts of the original concept have been neglected, while others have been modified. We identified three reasons for VBHC's locally varied applications: VBHC transforms to enable a growing support base, the originally radical idea is applied conservatively and the concept tends to get mixed up with other policy objectives. In all, VBHC appears to be successful in catalysing cross-disciplinary interaction aimed at improving value for patients.

Distributed age(ing): Features of a material gerontology.

In this paper, I develop features of a material gerontology which are summarised in the concept of "distributed age(ing);" that is, age(ing) that is distributed across and co-constituted through meanings, roles, and identities, as well as human and non-human forms of materiality, their productive dimensions and their relations to each other. The starting point is the critique of the human-centredness of gerontological approaches and, thus, the lack of a systematic conceptual consideration of non-human forms of materiality and agency in the context of age(ing). To overcome this problem, I propose the following shifts in perspective that are inspired by actor-network theory: from human-centredness to the recognition and consideration of the material diversity of age(ing); from the critique of subject/object dualism to the symmetrisation of materialities; from the seemingly given ontology of the ageing body to the re-ontologisation of age(ing); from the critique of intentional and causal determinants to embodiment and relationality; from linearity and chronology to the plural temporalities of age(ing). I will explain these features in more detail by using breathing as an example. I will show that the concept of distributed age(ing) allows for both the generation of new insights on age(ing) by asking how, where and when age(ing) takes place and reflection on presumptions, determinants and reductions of approaches belonging to social and cultural gerontology.

Knowledge Translation as Cultural and Epistemic Translation Comment on "Sustaining Knowledge Translation Practices: A Critical Interpretative Synthesis".

This commentary examines the claim made by Borst et al that knowledge translation (KT) should look to Science and Technology Studies (STS), the sociology of translation, and constructionist views on knowledge, and begin to think of the sustainability of a certain practice as construction work in continuous progress, and not as states to be reached once and for all. While endorsing this claim, the present commentary also argues that what it calls the "epistemic reframing" behind the new construal of KT in Borst must be supplemented with approaches that goes beyond the sociology of translation. The commentary claims that this epistemic shift hinges upon a shift in the narrative framing of KT, and that we need to consider the broader narrative and historical ideology of knowledge dissemination behind KT, and that a failure to do so, leaves us with KT seen as a linear transmission of "true" knowledge to peoples and places lacking such knowledge.

Students' and Instructors' Perspectives on Learning and Professional Development in the Context of Interprofessional Simulation.

Phenomenon: Simulation-enhanced interprofessional education is a potentially valuable pedagogical approach in health professional education. Simulation-enhanced interprofessional education merits more empirical exploration particularly in terms of experiences from different perspectives. Approach: The study aims to provide a multi-perspective in-depth understanding of students' engagement in a simulation-based interprofessional learning environment. Ninety students and thirteen facilitators participated. We analyzed data from examination sheets of medical and nursing students in a simulation-enhanced interprofessional education course and from a facilitator survey, using manifest inductive content analysis. The analysis was informed by actor network theory and Schön's reflection on action model. Findings: Students reflected on their performance in relation to (1) personal attributes, such as systemization skills; (2) other team members, such as communication skills; and (3) the surrounding environment, such as efficient employment of resources. They also reflected on the consequences of their actions and future professional growth. We observed group differences in conceptualizations of performance and knowledge enactment. Facilitators' and students' perceptions of performance were mostly aligned. Leadership enactment in the learning environment was problematic for students as well as facilitators. Insights: Students' engagement in the learning environment helped them develop a prototype of their professional identity and explore potential domains or tools for further learning and professional growth. Features of the learning environment fostered teamwork skills and allowed students to learn from each other, thus improving performance. Our findings have several implications for education, and professional practice, including the need for meticulous planning of learning environments and the importance of more intensive pedagogical efforts for soon-to-be health professionals regarding workplace dynamics and potential conflicts. It is also important to consider that an interactive learning environment can invoke reflection on action not only among students but also among facilitators and that this can contribute to the development of clinical praxis.

Understand, track and develop enterprise workplace safety, and sustainability in the industrial park.

Industrial parks make great contributions to the local economy, society, and culture, but they have also encountered many problems, such as limited resources, the longevity of ecological restoration, and the contagion of safety accidents. As a socioeconomic and ecological composite system formed by the interaction of multiple stakeholders, the solutions to succeed in workplace sustainability in industrial parks are still not known. The purpose of this study is to explore how to integrate existing resources to achieve a win-win situation in industrial park safety and environmental protection issues. According to Actor-network Theory and a systematic search, this study identifies the relevant subjects from selected 24 studies and clarifies the interactions made by these subjects. In sum, this study concludes two main modes of developing workplace sustainability in the park from multiple actors' perspectives: self-regulation of inner park subjects and the driving force of exterior park subjects.

Mapping an online production network: The field of 'actual play' media.

This article maps out and analyzes relationships shaping production in a growing cultural field of online gaming media production called 'Actual Play' (AP). AP occupies an ambiguous economic space between fan production and professional media and is marked by widespread monetization. Drawing on qualitative semi-structured interviews with 24 AP producers, this article uses actor-network theory and the concept of cultural fields to understand that space through an account of the actors constituting it. This maps the how AP producers develop their practices through complex relational networks. The analysis identifies 'key actor types' - the varieties of technological, human and corporate actors whose activities give shape to producers' practices. The article concludes that despite pervasive pressures to professionalize, the field offers limited pathways to vocational sustainability.

Intersectoral Collaboration to Promote Child Development: The Contributions of the Actor-Network Theory.

An integrated intersectoral care model promises to meet complex needs to promote early child development and address health determinants and inequities. Nevertheless, there is a lack of understanding of actors' interactions in producing intersectoral collaboration networks. The present study aimed to analyze the intersectoral collaboration in the social protection network involved in promoting early child growth and development in Brazilian municipalities. Underpinned by the tenets of actor-network theory, a case study was conducted with data produced from an educational intervention, entitled "Projeto Nascente." Through document analysis (ecomaps), participant observation (in Projeto Nascente seminars), and interviews (with municipal management representatives), our study explored and captured links among actors; controversies and resolution mechanisms; the presence of mediators and intermediaries; and an alignment of actors, resources, and support. The qualitative analysis of these materials identified three main themes: (1) agency fragility for intersectoral collaboration, (2) attempt to form networks, and (3) incorporation of fields of possibilities. Our findings revealed that intersectoral collaboration for promoting child growth and development is virtually non-existent or fragile, and local potential is missed or underused. These results emphasized the scarcity of action by mediators and intermediaries to promote enrollment processes to intersectoral collaboration. Likewise, existing controversies were not used as a mechanism for triggering changes. Our research supports the need to mobilize actors, resources, management, and communication tools that promote processes of interessement and enrollment in favor of intersectoral collaboration policies and practices for child development.

Normative puzzles for local government: Managing the introduction of single-handed care in England.

A crisis in social care is apparent across the developed world as ageing populations put unprecedented demand on understaffed social care workforces. A recent popular response to this 'care crisis' within the UK involves the 'innovation' of single-handed care (SHC). SHC involves a care package with two or more homecare workers being reduced to one worker using advanced equipment and new moving and handling techniques. In this article, we explore how SHC is rendered in 245 documents from 52 local authorities in England. Using Actor Network Theory as an interpretative lens, we suggest documents attempt to satisfy three 'duties of care': to the individual wellbeing of citizens, morally and fiscally to the collective and to innovation. Each appeal to different stakeholder groups necessary for SHC to work, but the combination of duties can pose problems in enabling coherent stories of SHC. Duties can be kept apart in different documents, but at times they must be brought together in certain textual spaces to enact SHC as a coherent enterprise. Here, the potential tensions that emerge are routinely orientated to as (merely) problems of process that can and should be managed in and through a more refined approach to change management.

Dialectic narratives, hostile actors, and Earth's resources in Saskatchewan, Canada.

This paper uses networks of action situations (NAS) together with actor network theory (ANT) to identify the decisions that were made in Saskatchewan regarding power production and explore what future choices are available in the context of climate change. A theoretical and methodological contribution to NAS literature is made with focus on interconnected human and non-human objects (carbon, hydro, and uranium) or 'actants' and the development of discourses supporting or opposing their development. Actants provide the nodes of focus, while discourses explain the development of actants and their links. Identification and explanation of the emergence and recession of actants on the Saskatchewan landscape are analyzed with diagnostics of telecoupled systems, polycentric governance, and flows of faction situations. Focus group and survey data are used to identify future pathways and imaginaries of power production and the actants of carbon, hydro and uranium. Actants of carbon (coal) and hydro are possibly kept alive with carbon capture and storage and import of hydro-electricity from the distant action situation in a neighboring province (if the necessary infrastructure is built). While actants of renewables are strongly emerging, uranium currently mined on the Saskatchewan landscape is receiving strong support by government due to the possibility of small modular reactors (SMRs). This expanded theoretical conception of NAS illustrates distant action situations impact on local narratives and decision-making and dynamics of polycentric governance that are neither top down nor collaborative. Supplementary Information: The online version contains supplementary material available at 10.1007/s11625-022-01214-y.

Automated news in practice: a cross-national exploratory study.

Background: This article provides a comprehensive picture of the current state of automated news-understood here as the auto-generation of journalistic text through software and algorithms-as well as to where it is headed. For this, I look at 18 news organisations in Europe, North America and Australia, following a strategic sample inspired by Hallin and Mancini's (2004) media system typology. Methods: To conduct this cross-national exploratory study, I made use of semi-structured interviews with editorial staff, executives and technologists. I also rely on Actor-network theory (ANT) to tell when an interference is made to an otherwise linear situation, thus endowing automated news with a sense of agency. Results: Overall, my findings show that the main interferences concern alternate data sources (e.g., news organisations' internal feeds, crowdsourced material), in-house interfaces that allow for more journalistic participation (e.g., internal self-editing tools, notification streams) and output other than text (e.g., automated audio summaries for voice assistants). Conclusions: Although these changes lead to greater journalistic professionalisation, they could also make news organisations become too dependent on Big Tech companies for data acquisition and dissemination of automated news products. That said, mutual negotiations and a re-alignment of interests may occur as platforms increasingly face journalistic challenges.

Brincar nas, com e apesar das telas / Playing with, on and in spite of the screens / Jugar con, en y a pesar de las pantallas / Jouer avec, dans et malgré les écrans

Este trabalho está inserido em uma pesquisa que buscou explorar as articulações forjadas entre crianças e telas durante o isolamento físico imposto pela pandemia da COVID-19. O objetivo aqui foi analisar como as brincadeiras se desenrolaram nesse momento tão especial, levando em conta a presença das telas. Nossos principais referenciais teóricos foram a psicanálise e a Teoria Ator-Rede e adotamos a cartografia como metodologia, a fim de explorar o campo em toda sua fluidez e complexidade. Utilizamos questionários online e entrevistas com responsáveis e crianças. Foi possível observar que as crianças não deixaram de brincar por causa das telas, mas puderam construir múltiplas e singulares articulações, brincaram nas, com e apesar das telas

This article is part of a piece of research that sought to explore the articulations forged between children and screens during the physical isolation imposed by the COVID-19 pandemic. The goal was to analyse how children's games developed in this particular moment, taking into account the presence of digital screens. In order to explore the research field in all its fluidity and complexity, our main theoretical references were psychoanalysis and Actor-Network Theory. Besides this, we adopted cartography as a methodology where online questionnaires and interviews with parents and children were carried out. It was possible to observe that the children didn't stop playing because of the screens but were able to build multiple and unique articulations, playing on, with and in spite of the screens

Este trabajo es parte de una investigación que buscó explorar las articulaciones entre los niños y las pantallas durante el aislamiento físico impuesto por la pandemia del COVID-19. El objetivo aquí fue analizar cómo se desarrollaron los juegos en este momento tan especial, teniendo en cuenta la presencia de las pantallas. Nuestros principales referentes teóricos fueron el psicoanálisis y la Teoría del Actor-Red y adoptamos la cartografía como metodología para explorar el campo en toda su fluidez y complejidad. Utilizamos encuestas virtuales y entrevistas con responsables y niños. Se pudo observar que los niños no dejaron de jugar por causa de las pantallas, sino que lograron construir múltiples y singulares articulaciones, jugaron en, com y a pesar de las pantallas

Ce travail s'inscrit dans une recherche qui visait à explorer les articulations forgées entre les enfants et les écrans lors de l'isolement physique imposé par la pandémie de COVID-19. L'objectif était d'analyser le déroulement des jeux dans ce moment particulier, en tenant compte de la présence des écrans. Nos principales références théoriques étaient la psychanalyse et la théorie de l'acteur-réseau et nous avons adopté la cartographie comme méthodologie afin d'explorer le domaine dans toute sa fluidité et complexité. Nous utilisons des questionnaires en ligne et des entretiens avec les parents et les enfants. Il a été possible de constater que les enfants n'ont pas arrêté de jouer à cause des écrans, mais ils ont su construire des articulations multiples et uniques, ils ont joué dans, avec et malgré les écrans

Práticas cotidianas constituindo múltiplas versões da criança com comportamentos externalizantes: um estudo de caso / Prácticas cotidianas constituyendo múltiples versiones del niño con comportamientos externalizantes: un estudio de caso / Everyday practices constituting multiple versions of children with externalizing behaviors: a case study

Resumo Visando compreender as múltiplas versões de realidade produzidas nas práticas cotidianas da rede relacional de uma criança à qual se referem problemas de comportamentos externalizantes, no campo da saúde mental, este artigo relata um estudo de caso, realizado em 2017, a partir das abordagens da Teoria Ator-Rede e das Práticas Discursivas e Produção de Sentidos no Cotidiano. O referente empírico da pesquisa é um menino com hipótese diagnóstica de TDAH e TOD, articulado com actantes humanos e não humanos em dimensões diversas de suas relações. Os resultados expõem as interatuações cotidianas, atravessadas por conflitos intergeracionais, produzindo realidades e sentidos heterogêneos, no trânsito entre ideias aparentemente antagônicas (angelical-diabólico/criança-adulto). A criança, com seus comportamentos diversos, tal qual os adultos, atua e é atuada em relações de poder, numa coprodução fluida de conflitos e entendimentos que expressam versões sempre incertas e localizadas do que seria "a criança com comportamentos externalizantes".

Resumen Con el objetivo de comprender las múltiples versiones de la realidad que se producen en las prácticas cotidianas de la red relacional de un niño a la que se refieren los problemas de comportamiento externalizante, en el campo de la salud mental, este artículo relata un estudio de caso, realizado en 2017, a partir de los enfoques de la Teoría Actor-Red y Prácticas Discursivas y Producción de Sentidos en la Vida Cotidiana. El referente empírico de la investigación es un niño con hipótesis diagnóstica de TDAH y TND, articulado con actantes humanos y no humanos en diferentes dimensiones de sus relaciones. Los resultados exponen las interacciones cotidianas, atravesadas por conflictos intergeneracionales, produciendo realidades y significados heterogéneos, en el tránsito entre ideas aparentemente antagónicas (angelical-diabólica/niño-adulto). Los niños, con sus diferentes conductas, al igual que los adultos, actúan y son actuados en relaciones de poder, en una fluida coproducción de conflictos y entendimientos que expresan versiones siempre inciertas y localizadas de lo que sería "el niño con conductas externalizantes".

Abstract Aiming to understand the multiple versions of reality produced in the daily practices of a child's relational network to which externalizing behavior problems refer, in the field of mental health, this article reports a case study, carried out in 2017, based on the approaches of the Actor-Network and Discursive Practices and Production of Meanings in Everyday Life. The empirical referent of the research is a boy with a diagnostic hypothesis of ADHD and ODD, articulated with human and non-human actants in different dimensions of their relationships. The results expose everyday interactions, crossed by intergenerational conflicts, producing heterogeneous realities and meanings, in the transit between apparently antagonistic ideas (angelic-diabolical/child-adult). Children, with ir different behaviors, just like adults, acts and are acted upon in power relations, in a fluid co-production of conflicts and understandings that express always uncertain and localized versions of what would be "the child with externalizing behaviors".

Actor-Network Theory: Insights into the Study of Social-Ecological Resilience.

Actor-network theory, which emerged from science and technology studies in the 1980s, regards everything in the social and ecological systems as a continuous result of the network of relations where they are located. Social-ecological resilience, with its origins in systems ecology, focuses on the non-linear changing dynamics of social-ecological systems and their governance. Among them, social-ecological resilience study integrates different disciplines, backgrounds, and themes, which inevitably leads to the vagueness of its concept. Both actor-network theory and social-ecological resilience emphasize human-nature relationships and view social-ecological systems as dynamic and unpredictable "networks". Therefore, this paper explored the potential conceptual or theoretical underpinnings that actor-network theory can provide in social-ecological resilience through interdisciplinary research. Specifically, a semi-structured interview was conducted with 30 fishing households from Chang-shan Archipelago in Northeastern China. The obtained interview data were analyzed through thematic analysis, and three main themes were generated, including "heterogeneous networks", "agency", and "translation", which facilitated a reconceptualization of the three components of social-ecological resilience, namely, "linked social-ecological systems", "changing dynamics" and "the ability to maintain resilience", and also provided a new theoretical perspective on the adaptive governance of social-ecological systems.

Medida socioeducativa de liberdade assistida: cartografia de redes (sociotécnicas) / Socio-educational measure of assisted freedom: cartography of (sociotechnical) networks / Medida socioeducativa de libertad asistida: cartografía de las redes (sociotécnicas)

Este artigo propõe uma análise sobre a rede de políticas públicas envolvidas no atendimento de adolescentes em Medida Socioeducativa de Liberdade Assistida (LA), utilizando-se de uma análise a partir da Teoria-Ator-Rede (TAR) proposta por Latour (2006). Analisou-se que cada adolescente pesquisado produz e é produzido pela rede em que se conecta, em um jogo de força que estabiliza e desestabiliza configurações e situações e provoca movimentos. Essa rede é composta por atores humanos e não-humanos que os produzem enquanto sujeitos, destacando-se a LA, a qual tem um caráter socializador e de responsabilização e busca assegurar alguns direitos, o que demanda a implicação de outras políticas públicas. É no desabrochar de um trabalho interdisciplinar que se analisa o potencial para ampliação das experiências e a inserção de novos agentes para a emergência de novas tramas na rede de produção destes adolescentes.(AU)

The idea of this article is to discuss the network of public policies involved in the care of adolescents in Socio-educational Measures of Assisted Freedom (LA), using an analysis based on the Actor-Network Theory (ANT) proposed by Latour (2006). We analyzed that each researched adolescent produces and is produced by the network in which he is connected, in a game of force that stabilizes and destabilizes configurations and situations and causes movements. This network is composed of human and non-human actors that produce them as subjects, highlighting LA, which has a socializing character and also of responsibility, and seeks to ensure some rights, which demands the implication of other public policies. It is in the development of an interdisciplinary work that we analyze the potential for expansion of experiences and the insertion of new agents for the emergence of new plots in the production network of these adolescents.(AU)

La idea del artículo es discurrir sobre la red de políticas públicas involucradas en la atención de adolescentes en Medida Socioeducativa de Libertad Asistida (LA), utilizando un análisis a partir de la Teoría Actor-Red (TAR) propuesta por Latour (2006). Se analizó que cada adolescente investigado produce y es producido por la red en que se conecta, en un juego de fuerza que estabiliza y desestabiliza configuraciones y situaciones y provoca movimientos. Esta red se compone por actores humanos y no humanos que los producen como sujetos, destacándose la LA, la cual tiene un carácter socializador y de responsabilización y busca asegurar algunos derechos, lo que demanda la implicación de otras políticas públicas. Es en el desarrollo de un trabajo interdisciplinario que se analiza el potencial para ampliar las experiencias y la inserción de nuevos agentes para la emergencia de nuevas tramas en la red de producción de estos adolescentes.(AU)

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

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.

Black boxes and information pathways: An actor-network theory approach to breast cancer survivorship care.

Many women diagnosed with breast cancer today can expect to live long after completing their treatment. This growing population of survivors encounters distinct post-treatment health and information needs. Existing survivorship care models take information as a given, black boxing it. I use Actor-Network Theory to examine how information actually works for women after they complete breast cancer treatment, and how it shapes their understanding of survivorship. I draw on in-depth interviews with breast cancer survivors (n = 82) and a wide range of providers (n = 84) in a medically underserved region of Southern California. Black boxes and information pathways convey experiential dimensions of cancer care; they are also metaphoric constructs. The black box metaphor refers to the cancer experience as a container; the pathways metaphor refers to a journey. Each of these metaphors expresses salient dimensions of the cancer experience and has implications for post-treatment survivorship. When healthcare information flows smoothly and invisibly, its pathways become black boxed. Black boxes can be helpful when they function effectively. But since black boxes conceal their inner workings, it is challenging to intervene when difficulties arise. I provide three examples of difficulties that complicate women's transition to post-treatment survivorship: (1) when survivors fail to recognize treatment-related late effects, (2) do not understand they have a terminal diagnosis, or (3) worry that their treatment accomplished nothing. Contextualized within survivorship scholarship, this study recommends opening black boxes to examine how information pathways could connect women differently to improve survivorship care.