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Short abstract:

We draw attention to participation in mundane routinized healthcare, considering how home blood pressure self-monitoring is incorporated into clinical care. Drawing on ideas about un/invited and material participation, we consider how participation might be characterised in this context.

Long abstract:

STS scholarship concerning the ‘participatory turn’ in healthcare has extended beyond formal, discrete and invited forms of participation to consider new forms of patient collectives and patient-driven innovations. By contrast, this paper looks at participation in mundane, routinized healthcare. It focuses on blood pressure self-monitoring, understanding this as a form of patient participation at the level of individual care.

Drawing on a UK study involving people who self-monitor blood pressure, and primary care professionals, we examine how home blood pressure self-monitoring is incorporated into clinical care. The research suggests that clinicians may invite their patients to self-monitor in circumscribed ways in order to make this manageable within the constraints of the clinic. In this way, patient participation is ‘made easy’ (Marres, 2012) for both patients and clinicians, containing the investments required of both. Yet, through these practices, some patient concerns get lost. By contrast, sometimes patients’ participation is uninvited in the context of the clinic, when people use their self-monitoring as a way to raise their own concerns. This involved delicate and sometimes invisible patient work to pursue these concerns within the constraints of clinical consultations.

Our analysis illustrates how materials are mobilised to facilitate or constrain participation. It also suggests that invited and uninvited participation are not always distinct and separate, as we observed movement between these. Ultimately, in the context of policy imaginaries about the transformative potential of patient participation, the study raises questions about the scope for and practices of patient participation in routine healthcare.