Healthcare

My new project on digital inequality in healthcare applies my empirical and theoretical findings from education to the study of how organizations shape the unequal allocation and use of medical devices by race/ethnicity and social class, using the case of youth with Type 1 diabetes (T1D) and Type 2 diabetes (T2D). Overall, the project seeks to understand how organizational systems (clinics, device companies, schools) shape inequities in device use by race and social class, described in a series of articles that will culminate in my second book project.

In my first article from the project in Social Science & Medicine entitled, “How Organizations Shape Medical Technology Allocation: Insulin Pumps and Pediatric Patients with Type 1 Diabetes,” looks at differences in how pediatric endocrinology clinics allocate insulin pumps. Using an organizational lens, my coauthors and I find allocation is shaped by 1) the extent to which patient cultural health capital is tied to pump eligibility, 2) how clinics frame and support medical technology use overall (e.g., “pro-tech” practices such as provider and patient education to support new devices), and 3) how clinics organize decision making processes (e.g., professional opinion vs. use of metrics by lower status providers).

Two other papers that also investigate inequities in the use of medical devices are in progress. One describes findings from a pilot study where my collaborators provided continuous glucose monitoring (CGM) devices to young adults with T2D to see how healthcare organizations can improve equity in device use. These patients are not commonly prescribed CGM, largely due to providers’ biased assumptions about deficits in their digital and health literacy. Instead, we find these teens are able to consistently use CGM and that device use significantly increases their self-rated quality-of-life.

The other paper in progress examines how schools are part of organizational systems that shape medical device use. Drawing upon data from focus groups with children and adolescents with T1D, we find that conflicts caused by a misalignment in institutional demands, particularly with regard to device use, elicit negative responses from teachers and other students and stigmatize youth with T1D in schools. Ultimately, children and teens must manage day-to-day institutional conflicts and experiences of stigma. Overall, the paper contributes to research on the health of children and adolescents by pointing to the central role institutional entanglements play in health management and illuminates how conflicts between the demands of healthcare institutions and schools requires the ongoing labor of patients.