Empowerment through digital health trackers: an exploration of Indigenous Australian women and physical activity in leisure settings

Annals of Leisure Research ISSN: 1174-5398 (Print) 2159-6816 (Online) Journal homepage: https://www.tandfonline.com/loi/ranz20 Empowerment through digital health trackers: an exploration of Indigenous Australian women and physical activity in leisure settings Hazel Maxwell, Michelle O’Shea, Megan Stronach & Sonya Pearce To cite this article: Hazel Maxwell, Michelle O’Shea, Megan Stronach & Sonya Pearce (2019): Empowerment through digital health trackers: an exploration of Indigenous Australian women and physical activity in leisure settings, Annals of Leisure Research, DOI: 10.1080/11745398.2019.1674677 To link to this article: https://doi.org/10.1080/11745398.2019.1674677 Published online: 04 Oct 2019. Submit your article to this journal View related articles View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=ranz20 ANNALS OF LEISURE RESEARCH https://doi.org/10.1080/11745398.2019.1674677 Empowerment through digital health trackers: an exploration of Indigenous Australian women and physical activity in leisure settings Hazel Maxwell a , Michelle O’Sheab, Megan Stronach c and Sonya Pearcec a College of Health and Medicine, University of Tasmania, Sydney Campus, Australia; bSchool of Business, Western Sydney University, Sydney, Australia; cBusiness Faculty, University of Technology Sydney, Sydney, Australia ABSTRACT ARTICLE HISTORY Drawing on a strengths-based empowerment approach and Indigenous traditions of ‘yarning’, this research explores how digital health technologies might contribute to Indigenous Australian women’s increased participation in physical activity in leisure settings. While people have long controlled their bodies, conventionally through diaries and weight scales, digital selftracking of one’s bodily states and activities continues to expand. No previous studies have addressed how these technologies influence physical activity among this population and there is limited research about Indigenous Australian people’s leisure experiences and the meanings they attribute to them. Accordingly, this research contributes to an under researched area of health and leisure studies concerned with understanding the social, narrative and affective facets of individuals’ practices and experiences. Key findings from the pilot study include intersections between the use of health trackers and Indigenous women’s prioritizing time for leisure, increased physical activity, enhanced health literacy, and greater personal accountability for lifestyle choices. Received 18 March 2019 Accepted 27 September 2019 KEYWORDS Aboriginal; digital health trackers; leisure; physical activity; Indigenous women; self-tracking; yarning In recent years the growth and popularity of digital health technologies have received increased societal, governmental and academic attention (Lupton 2013; Patrick et al. 2016). Studying mHealth is fast becoming ‘a global priority, especially where resources are limited and where more people have access to a mobile device than a hospital or clinic’ (Rich and Miah 2017, 1). Wearable technologies are seen to be ‘key artefacts in a new cultural convergence of sensor technology and self-care’ (Schüll 2016, 1). While a standardized definition of mHealth is emerging, by drawing on World Health Organization research protocols, we understand that mHealth is a component of eHealth and is ‘a medical and public health practice supported by mobile devices’ including but not limited to ‘mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices’ (World Health Organization 2011, 6). CONTACT Hazel Maxwell Hazel.Maxwell@utas.edu.au © 2019 Australia and New Zealand Association of Leisure Studies 2 H. MAXWELL ET AL. The intersections between health technologies and self-care have particular relevance when addressing exercise, physical activity and health. While these technologies can help with the management of chronic conditions (Freid, Bernstein, and Bush 2012), disease management is not the only use. This research focuses on the maintenance of healthy habits, such as physical activity, through the use of wearable technologies. This is an increasingly pervasive manifestation of wellness management. Supporters of ‘health datafication’ such as healthcare or government organizations characteristically emphasize its potential to prevent and lessen the physical and economic problems of lifestyle diseases (Ruckenstein and Schüll 2017), such as obesity, diabetes, and cardiovascular disease (Hickey and Freedson 2016), pervasive contemporary health conditions that develop from daily behaviours of overeating, binge drinking (Crane et al. 2018), under exercising, and smoking (Khan et al. 2017). Wellness management technologies which help users track their health statuses by monitoring and recording ‘bites, sips, steps … minutes of sleep’, and other customizable measures have been conceptualized as ‘a digital compass’ providing users with ‘data for life’ (Schüll 2016, 1). In this way the quantified data produced through bodily tracking may enhance ‘self-knowledge through numbers’ (Bode and Kristensen 2016, 3). For example, sport wearables and trackers (e.g. Fitbit, Striiv, Jawbone Up) that use sensors to record data (Lunney, Cunningham, and Eastin 2016) are positioned and strategically marketed as providing consumers with information which will assist them to make better lifestyle choices. Accounts of self-tracking technologies for health and leisure, in both health promotion and lay self-tracking literatures, tend to emphasize their empowerment potential, together with the importance of taking responsibility for one’s health and wellbeing (Millington 2014). Drawing on Millington’s (2014) study and the work of Swan (2012) and Nelson, Verhagen, and Noordzij (2016), we consider that empowerment takes the form of an individual’s ability to influence an outcome. More recently Hardey (2019, 996) investigated selftracking among a group of runners. For high adopters of these technologies, self-tracking was found to encourage ‘introspection and enhanced self-awareness’. Digitally measuring and tracking meant that health was rendered more visible and in turn measurable. In this context the runners increased their desire and motivation to run each day. Thus, wellbeing and more philosophical conceptions of health were ‘woven into individual consciousness’ (Hardey 2019, 997) and prioritized. In the context of this research, we explore how optional activity monitoring, along with the corresponding collection of digitized data, shape Indigenous Australian women’s lifestyle choices for increased physical activity and improved health and wellbeing. Wellbeing is defined as a state in which a person is able to realize their potential, cope with normal stresses, and contribute to their household, community, and workplace. People with high levels of wellbeing have a higher quality of life, and more likely to cope with challenges and embrace change. Many things contribute to a person’s overall wellbeing. These include their safety and security, their physical and mental health, their relationships and social networks, their access to goods and services, and the fairness of the society they live in, amongst others (Garvey 2008). Thus, an increased level of physical activity may be a factor that enhances wellbeing of Indigenous women. Acknowledging the ubiquity of mHealth technologies and intersections with self-care, exercise and leisure activity, we ponder the potential affordances and limitations ANNALS OF LEISURE RESEARCH 3 associated with emerging digital health technologies, as well as dominant discourses and practices. Proceeding this discussion, by collaborating with women from the Tranby Indigenous College in Sydney, New South Wales, Australia, the paper unpacks how wearable technologies might enable Indigenous women’s increased involvement in exercise and leisure activity, resulting in improved health and wellness outcomes. In so doing this research addresses the question: How can wearable technologies enhance experiences and outcomes of physical activity among Indigenous women in leisure settings? While self-tracking and the production of digital data are transforming health provision and consumption, little is known about the subjective meanings that are ascribed to selfmonitoring practices (Smith and Vonthethoff 2017). In spite of the enhanced centrality of digital data in everyday life, few empirical studies have explored the habitual use of commercial mHealth technology as a context for realizing a healthy body (Hardey 2019). This is a noteworthy knowledge gap. Although the datafication of health is proliferating governmental health promotion, policy and practice, its influence remains ‘mostly speculative, promissory’ and so ‘what is needed … are accounts of the actual reality of datafication as it takes shape in diverse practices’ (Ruckenstein and Schüll 2017, 262). By exploring engagement with self-tracking technologies and their potential implications, we address the particularities and nuances of an (at present) neglected group, that of Indigenous Australian women – women who are characteristically less physically active than other Australians (Maxwell et al. 2017; Stronach, Maxwell, and Taylor 2016). While historical, biographical, health promotion and community research is increasingly being undertaken to understand the significance of sport and physical activity to Indigenous Australians (see for examples Edwards 2009; Hayward 2006; Ryan 2012), the presence and voice of Indigenous women are mostly absent. This is of concern, as Indigenous Australians are active users of mobile technology and access social media at a higher rate than other Australians (Callinan 2014). Furthermore, mobile devices can assist traditionally underserved populations such as Indigenous Australians by ‘leapfrogging economic and infrastructural bottlenecks’ connecting individuals in isolated and ‘underserved communities without having to wait for access to more traditional (and expensive) residential Internet or computer use’ (Brusse et al. 2014, 3). Thus the present research contributes to illuminating and exploring ‘the less prominent voices’ and ‘subjugated knowledges’ (Fullagar 2019, 65) of Indigenous Australian women. The research also responds to the Australian Government’s 2013 House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs which reported on the contribution of sport to Aboriginal and Torres Strait Islander peoples’ wellbeing (House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs 2013). The Committee concluded that sport and physical activity had enormous potential to improve Indigenous wellbeing and mentoring, calling for an increase in programmes and funding to address the low physical activity participation rates of Indigenous women (House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs 2013). Similarly, empirical research by Stronach, Maxwell, and Taylor (2016) has explored the role that physical activity plays in the lives of Indigenous women. Women in their research suggested that they wanted to be active role models for their families and for their children. However, they often adopted a role of ‘enabler’, facilitating sporting opportunities for their extended families, a role which detracted from their own leisure and physical activity. 4 H. MAXWELL ET AL. In this exploratory paper, we use a strengths perspective to identify potential strengths linked to Indigenous women’s physical activities in leisure settings in Australia. We draw on the principle that all individuals have strengths, and this becomes the starting point for our analysis. The strengths perspective originated in social work as an approach to working with clients focused on the possibilities evident in a situation, which builds on the assumption that transformation is possible (Paraschak and Thompson 2014). Working within this perspective means to promote the creation of words, concepts and principles that reproduce the lived experience of people, and embrace genuine possibility and hope, rather than fixating on difficulties reinforced through a deficit perspective. Accordingly, we reframe, rather than deny, that problems exist, by examining the situation in a manner that focuses on whatever is going well – the strengths already demonstrated by the individuals involved and the available resources they can draw upon to enhance their situation (Paraschak and Thompson 2014). Positioning wearable technologies, health and physical activity The measurement, monitoring and recording of bodily function and movement is not a new phenomenon (Duus, Cooray, and Page 2018; Schüll 2016). Traditional self-tracking practices such as journaling and diary-keeping together with analogue devices (i.e. scales, wristwatches and thermometers) have long provided people with the means to record, reflect upon and in turn regulate their bodily states and processes (Schüll 2016). Today ‘in an increasingly technology-textured environment’ (Duus, Cooray, and Page 2018, 1), tracking devices are making their way onto – and in some cases into – the human body (Rich and Miah 2017). Correspondingly, we are witnessing significant changes in the availability, variety and sophistication of digital technologies for monitoring, pushing, nudging and guiding aspects of our lives (Ruckenstein and Schüll 2017). Yet, as an emerging field of academic enquiry, there is presently little uniformity in how these technologies and corresponding leisure, sport and health practices are defined and theorized. The digitization of bodily monitoring for health and wellbeing and the devices enabling body tracking have been conceptualized as ‘mHealth’, ‘Health 2.0’, ‘wearable technologies’, ‘smart health’, ‘datafication of health’ and ‘digitized health’ (Ruckenstein and Schüll 2017). Despite this divergence, several key themes and ideas underpin recent theorizing. Namely, these devices are easily portable and provide real-time data about bodily processes and states via digitized interfaces. Consequently, wearable devices are defined as ‘wearable computers with a mobile internet connection that are worn … and display information for users intelligently and efficiently’ (Liu and Guo 2017, 43). According to their functionality, device wearables can be further categorized (Lunney, Cunningham, and Eastin 2016). Characteristically, activity trackers take the form of wristbands, watches and clip-ons, are targeted at lay users, and offer objective feedback about the user’s level of bodily activity, most often expressed as step counts, distance walked and calories burnt (Meyer and Boll 2014). The devices usually have functionalities and associated applications that allow users to upload activity data, together with goal setting and training plan development (Lee et al. 2016). Their mobility and size mean they provide the potential for continuous and interactive communication. ANNALS OF LEISURE RESEARCH 5 Tracking practices and allied platforms have been described as companion structures which make ‘surveillance pleasurable’ (French and Smith 2013b, 384) and allow people to carve their personal health, activity or fitness biographies. From a health and wellness perspective for many people, tracking their bodily states and processes is not just a medical activity, but increasingly a voluntary activity engaged in for enjoyment (Nelson, Verhagen, and Noordzij 2016). In this way, contemporary digital media and devices construct diverse and multifaceted surveillance practices and spaces where individuals can share their exercise, leisure experiences and health promoting activity. They are able to ‘actively represent themselves, share their body metrics and experiences and find likeminded others for support’ (Lupton 2017, 120). For example, ‘The Quantified Self’ (QS) movement was initiated in 2007 by Gary Wolf and Kevin Kelly. Since its inception the group has grown to in excess of 60,000 members globally, with 200 groups that meet regularly (Sharon 2017; Smith and Vonthethoff 2017). Self-tracking technologies contribute to a context in which subjects can craft and manage their bodily activity and processes. In the context of disease prevention, physical activity and wellbeing, these technologies offer a unique and emerging platform for empowerment and tangible individual and collective health benefits. Agency, autonomy, enhanced self-knowledge and participatory healthcare further underpin the affordances associated with self-tracking (Sharon 2017). Understood from a commercial perspective through advertisements and wearable app websites, consumers are constructed as needing to ‘take charge’ over ‘unruly things’ like chronic diseases, inactivity and unhealthy lifestyle choices (Sharon 2017, 97). Self-tracking practices can be thought of as ‘soft resistance’ to dominant modes of being and doing (Nafus and Sherman 2014). In the context of exercise, leisure activity and health, self-tracking practices can assist in authoritative, idealized and generalized definitions of health, allowing more nuanced understandings, expressed, for example, as, ‘what is healthy for me’ (Nafus and Sherman 2014, 1785). However, and in context to the present research dominant western biomedical health models do not necessarily align with how indigenous people interpret and experience health. Traditional indigenous perspectives of health are typically more holistic – that is, ‘encompassing everything important in a person’s life’ such as land, environment, relationships and community (Burns et al. 2013, 2). Values like these are more aligned with the social determinants model of health and therefore can conflict with the biomedical health interventions that characteristically underpin governmental health initiatives (Burns et al. 2013). Privileging good health as the reason for using fitness trackers and allied devices, can act to reify and normalize a discourse of healthism. The notion of healthism tends to be embraced by the socio-economically privileged, who are more easily able to position health and wellbeing as a priority in their lives because they are more likely to have access to the economic and educational resources to do so (Lupton 2013). The healthism discourse can obscure the social and economic determinants of health for a focus on taking charge of one’s own wellbeing. For example, Millington (2014) problematizes how this type of health and fitness ‘responsibilization’ … tends to abstract the body from its social context (490). As part of preventative healthcare, the adoption of commercial tracking devices can construct and reproduce neoliberal concerns, which transfer the responsibility of wellbeing onto the self-monitoring individual and emphasize market orientated solutions 6 H. MAXWELL ET AL. for health and illness (French and Smith 2013a). Similarly, through an analysis of past Australian public health policy Fullagar (2002) has questioned the way in which normative discourses about leisure and healthy living are constructed and reproduced. Characteristically the individual and how they manage their bodies through active leisure practices is centrally important to the production of ‘good healthy citizens’ (p. 71). Increased physical activity is seen to be one of the best ways to reduce the economic and other costs of ill health because ‘it costs the government little and locates responsibility for health with the individual and how they manage their bodies through leisure practices to reduce risk’ (p. 71). Accordingly, in the context of leisure, physical activity and health, Fullagar (2019) calls for a more reflexive dialogue around the questions of power and knowledge, i.e. how healthy living is defined. This dialogue is important given the heightened legitimacy of neoliberal health discourses which privilege individual responsibility and motivation for health and wellbeing. The concern here links with the present study’s focus on Indigenous Australian women’s health, leisure and activity. This is the implicit assumption that people universally have the resources, skills and literacy needed to access and operate these technologies. Rather, the present study illuminates how meanings about leisure, health and (in)activity are ‘culturally constructed and produced within a contemporary ‘biopolitics’ (Fullagar 2019, 65). While the emergence of digital social inequalities has received attention, there continues to be little acknowledgement or understanding of the diverse implications for people’s access to and use of digital health technologies (Lupton 2013). Neither is there an acknowledgement or critical discussion of the intersections between active embodiment, health and the historical, sociocultural, political and economic power relations that shape everyday life (Fullagar 2019). Those who espouse healthist discourses, therefore, value those who take such responsibility and construct them as ideal citizens, while people who are viewed as lacking selfresponsibility or who are ill can be inaccurately positioned as inferior and morally deficient (Fotopoulou and O’Riordan 2017). For example, in discussing non-communicable diseases such as obesity, Fullagar (2019) deliberates how obesity policies which aim to reduce the health effects of overweight on the biological body can also construct damaging discourses and practices. While urging individuals to be responsible for weight loss there is also the potential for negative effects in terms of ‘the shaming practices that occur’ (p. 67). For example, ‘associations of weight with attractiveness, bodily control – self-discipline or laziness’ (p. 67). These negative effectives are further illuminated as overweight and obese bodies do not accord with ‘the fetishized heteronormative female body that is stereotypically young, slender and white’ (p. 67). ‘While wearable technologies afford the quantification of self for some … other selves simply do not count’ (Teston 2016, 252). It is these ‘other selves’ that the present research scrutinizes. In short, the research addresses how trackers that use sensors to record data – commonly labelled fitness trackers – shape exercise, leisure activity and health outcomes among Indigenous Australian women. Empowerment framework The empowerment concept (Wilkinson 1998) was utilized to frame the study’s theoretical and material context. With its origins in the social sciences and while most widely applied ANNALS OF LEISURE RESEARCH 7 in the organizational studies literature, the empowerment concept has utility for health, exercise and leisure studies. Connecting with the present study’s methodological approach, empowerment interventions minimize external influences through empowering individuals and/or groups who are in need of support (Nelson, Verhagen, and Noordzij 2016). Accordingly, the present research examines how self-tracking practices might shape Indigenous Australian women’s increased physical and leisure activity and improved health and wellbeing. We extend this framework because of a conceptual shift proposed by Swan (2009). This is the movement toward person centrality. The individual becomes the nexus of actiontaking and empowerment. The lay user, through quantified self-tracking has tools which will assist them to understand, manage and take greater control over their own health (Sharon 2017). For Swan (2009), empowerment through bodily tracking data underpins a revolutionary shift from paternalistic to partnership health care. From being minimally informed advice recipients, citizens are instead active participants and collaborators who through self-tracking can realize improved personal health and wellbeing. While drawing on this framework we are also cognizant of a growing body of critical health and allied leisure and sport studies (see for examples Fullagar 2019; Sharon 2017), which reflects on some of the narratives underpinning the empowerment discourses and strategies of contemporary leisure, sport and health promotion policy and practice. For example, active living policies advocated by governments frequently focus on individual behaviour and choice. By positioning behavioural change as a solution for inactivity, the complex intersections within and between ‘the material, discursive and affective conditions that shape embodiment’ (Fullagar 2019, 69) are overlooked. These conditions are especially relevant to Indigenous Australian women who, as a group, are characteristically less active than other Australians (Maxwell et al. 2017; Stronach, Maxwell, and Taylor 2016). Attracting attention to the social relations that shape (in)activity and the everyday practices that Indigenous Australian women negotiate, might contribute to counter-narratives that give voice and agency to marginalized groups and inform future policy. Drawing on Foucauldian scholarship, tracking of bodies via wearable technologies can be thought of as ‘an explanatory device for understanding how control and discipline are articulated together through the conduit of subjectivity’ (French and Smith 2013a, 87). The tracking of bodily states and activities can become a ubiquitous form of individual and societal surveillance. For instance, mobile self-tracking can be an important means through which people manage health risks associated with inactivity. At the same time, it can ‘create a documentary history that puts those same persons at risk of sanction by organizations, like insurers or employers, who could penalize them for their excessive or indolent habits’ (French and Smith 2013b, 387). In contemporary societies that are ‘robustly digitally networked’, the data generated through self-tracking technologies constructs a means through which power ‘permeate [s] and exert[s] power on all manner of forms of life’ (Ruckenstein and Schüll 2017, 263). Such a digitally networked context can construct a divide between the ‘data rich’ – characteristically governments, large institutions and commercial enterprise – and individual citizens who are ‘data poor’ (Ruckenstein and Schüll 2017, 263). Companies such as Nike and Fitbit provide platforms where users can store their activity data while simultaneously sharing this information with affiliated commercial agencies such as insurers, marketers and pharmaceutical companies (Ruckenstein and Schüll 8 H. MAXWELL ET AL. 2017). Consequently, users and the bodily data they upload to sharing platforms become ‘bio-capital’ (Rose 2006), that can be commodified. The sale of this data to marketers can, for example, inform the advertising /positioning of exercise, leisure and wellness products and services. Consequently, data streaming from Fitbits can be further harnessed and potentially exploited. While a more complete discussion of these ideas is beyond the scope of this research, we have highlighted emerging critical perspectives as they underpin the preliminary nature of the present study, mediate our research conclusions and provide a context for our future empirical research and conceptual frameworks. As Ruckenstein and Schüll (2017, 262) remark, ‘an important starting place for social-scientific scholarship on the datafication of health is … it takes shape in diverse practices and, quite often, twists in unforeseen directions’. Methodology Participants The study was a small pilot programme conducted in Australia from July to October 2018. The research team consisted of both Indigenous and non-Indigenous members who worked with a group of Indigenous women from the Tranby Indigenous College in Glebe (Sydney, Australia) during that timeframe. The women were students and staff from across NSW and lived in both urban and rural settings. The women [n = 8, consisting of four women in the 18–30 age range, two in the 21–50 age range and two in the 50+ range] designed and followed their own exercise and leisure activity programme. Following the study’s theoretical and methodological framework, the practice of self-designed activity programmes was employed. Individualized activity and health goals underpinned the study’s approach. Each participant would subsequently decide how best to achieve her goals with the assistance of the digital health tracker. The participants self-managed their experience in a culturally safe and appropriate manner. They tracked their activity levels by wearing a digital health tracker and diarizing their activity types, amounts, experiences and thoughts across an eight-week period. Specifically, the study involved: (a) An initial introductory session, second information session and focus group. During the second session participants were provided with a digital health tracker and coached on how to use the device. (b) Participants then tracked their activity levels for a total of eight weeks. (c) Researchers met with participants for a progress session and focus group after four weeks; a further focus group and a final participant debriefing session was held after eight weeks. Three participants also took up the option of individual interviews with the researchers after four and eight weeks to share their experiences in a one to one setting. Ethics Before data collection, Ethics approval was obtained from the UTS Ethics Committee (UTS HREC REF No. ETH16-0873). Pseudonyms were used at the request of participants as this ANNALS OF LEISURE RESEARCH 9 would allow them to be frank in their assessments. The participants were all interviewed either at the College or in public places of their choosing and they were each given a digital health tracker to keep at the end of the eight-week activity programme. Interview protocols The women both in the focus groups and in individual interviews were given the opportunity to express their opinions through conversations or ‘yarning circles’ (Fredericks et al. 2011; Leeson, Smith, and Rynne 2016), either individually with the researcher or as part of a group of like-minded people. For Indigenous Australians, yarning is a timeless way of learning, which simply means sitting down and sharing stories (Dunleavy 2013). Thus, yarning is a loose, fluid, and flexible means to share information by personal narratives or story-telling. In a yarning circle, all participants have the opportunity to speak in a safe non-judgmental place and to share their strengths in an inclusive and collaborative environment. In keeping with our strengths approach to research, yarning is always focused on strengths, not problem solving or criticism (Dunleavy 2013). Given the strong oral and story-telling traditions of Indigenous peoples, and indeed, the empowerment potential of story-telling (Williams, Labonte, and O’Brien 2003), we considered a strategy to allow the women to provide information by yarning circles most appropriate, and more effective than standard question and answer sessions (Leeson, Smith, and Rynne 2016; Ralph 1997). This approach has the potential to uncover, from an inside perspective, a broad range of topics, including what the women liked to do, and what they would like to do in the future, how they could integrate their exercise and leisure activities with their academic studies and work, and their future goals. In the focus group/ yarning sessions, women considered ‘invisible’ activities which they could now include in their daily planning, such as walking to college or the bus-stop, walking the dog, or doing the shopping, the importance of recovery and relaxation, and how to maintain better balance in their lives. This balancing act was heightened for many participants given their work, study and family commitments. Researchers helped stimulate yarning by urging participants to speak freely about their feelings, frustrations and most importantly by celebrating their achievements. Data analysis Focus group/ yarning sessions were digitally recorded, transcribed and spot checked for accuracy. The transcripts were then analyzed with Nvivo (v9). To create the typological analysis, researchers first read transcripts for keywords, phrases and concepts, at the same time creating categories or groups on ‘the basis of some canon for disaggregating a whole phenomenon’ (Howe and Brainerd 1988, 201). The transcripts were electronically coded and textually analyzed. The research team then used constant comparison to look for similarities or differences (Miles and Huberman 1994). Findings After the analysis of the focus groups/ yarning transcripts, a number of key themes emerged. There were substantial links between and across themes, which are illustrated in Table 1. The key themes from the findings are now presented and discussed. 10 H. MAXWELL ET AL. Table 1. Key themes. Surveillance device Wearable technology Themes Evidence Discussion points Levels and nature of adoption Increased health literacy High, medium, or low uptake. Individual/ family/ group activity. Increased knowledge of sleep requirements, anxiety, diabetes, weight management, general wellbeing To be more active and to participate more. Shown by increasing steps, swimming, walking, ‘more drive’, feeling competitive Conscious or unconscious factors altered personal perceptions. The quantified self (self as database) Increased motivation for activity Increased accountability to self Barriers Governance by micronudge Increased agency and empowerment Time poor due to family, work and/or study commitments, ‘laziness’, problems with technology Adoption of the digital health trackers To provide a more nuanced understanding of individual experience within the adoption of the digital health trackers, a typology was adopted. The characteristics of the participants are presented in Table 2. Table 2 shows three user typologies: high adopters, mid-range adopters and low adopters. The high adopters were extremely enthusiastic digital health technology users who continued with their use after the research was completed. Three of the four high adopters (Ash, Cathy and Freda) were students or on work experience and under 30 years of age with minimal caring responsibilities which may have given them more time to focus on using the technology. The medium adopters (Betty and Glenda) were happy to try something new and interested in continuing use of the trackers after the research but needed more time, training and support to maximize the potential health and wellbeing benefits that they could see emerging from their experience. These women were both over 30 years of age. The low adopters (Heather and Denise) began to use the technology but withdrew and ceased altogether during the study period. For example, Heather explained, ‘The band gave me a rash, so I would prefer another style I can tolerate’. Again, these women were over 30 years of age. It is important to understand that the positioning of the women in these typologies was the result of several key influences. They included each individual participant’s personal circumstances, their activity interests, the people with whom they exercised, their motivation and their ability to use the technology. These factors are overlaid by socioeconomic, Table 2. Participant characteristics. Typology Participant Age range Individual characteristics High adopters Ash Cathy Freda Emma Betty Glenda Heather Denise 18–30 18–30 18–30 50+ 18–30 31–50 31–50 50+ Work experience Student Student Student Student Student Student Student Mid-range adopters Low adopters ANNALS OF LEISURE RESEARCH 11 education, employment, housing and the gendered expectations that these women face from their families and the wider community. The types of leisure activities that the participants used the wearable technology to measure included: pole dancing, walking and shopping, as well as exercises such as running, rowing, swimming, martial arts, gym classes, fitness classes, treadmill and netball. Activity types were predominantly individual experiences with the exception of walking with family and friends and playing netball. Walking was the most popular activity and counting steps was the most widely used tracker function. In particular, pole dancing, group walking, and shopping were adopted by the women to increase their daily step count and perceived by them as contributing to their personal activity goals. Increased health literacy Increased health knowledge and understanding of daily activity levels (in particular by measuring step count) was frequently discussed. Freda explained, ‘the tracker provided education, it increased my knowledge. Before I started, I was only averaging around 6000 steps per day and I thought I was doing more’. Through daily walks in her local park, often with or ‘competing’ with her partner, Freda used the trackers to count her steps. She became more aware of her activity levels, increased her health literacy and managed to increase her step count to 10,000 steps a day, thereby reaching her daily goal. Weight management and diabetes were also considerations for some participants. ‘It helps me with losing weight and with my diabetes … my doctor is happy that I am more active and losing weight’ (Emma, high adopter). So too was the concept of sufficient sleep, which lead to discussion around optimal rest and sleep levels. Glenda stated, ‘I enjoyed using the sleep function and the heart rate function. It was useful in gauging if I had had enough sleep’. Furthermore, she added, ‘I suffer from anxiety and it changed my thinking about anxiety and self-perception … the increased walking helped to relieve my anxiety and stress. It was social and therapeutic; it did improve my participation in physical activity’. Increased motivation for activity All the participants, even low adopters, interpreted that the activity tracker was a motivational tool. They all believed that the data generated through self-tracking improved their involvement in active leisure. For example, Glenda suggested that it encouraged ‘walking rather than going in the car’. Ash stated that it provided ‘more drive to do personal exercise’. Heather found it was ‘an incentive to be active … it inspired me to achieve’. For high adopters such as Emma it was ‘highly motivating … I love it’. This concurs with Hardey (2019) who found that among high adopters of self-tracking there was an increased desire and motivation to run each day. There was also a relationship between increased personal motivation for activity and the active leisure of family and friends. For example, Emma remarked how she ‘enjoyed using [the digital tracker] and now my Grandson wants one as well’. Similarly, Cathy discussed being motivated to continue exercising and tracking her activity levels. Her cousin has ‘now got one as well’ and so they ‘walk and exercise together’. A focus on competition was evident both with themselves as participants in the study and others such as partners, family members and friends. Cathy said that it made her ‘feel 12 H. MAXWELL ET AL. competitive … I enjoyed using the band to compete with my partner and this motivated me to increase my daily step count’. Freda stated that it ‘provided an opportunity for me to be competitive with myself’. So, whether it was a drive to increase daily step count, swim or walk further or compete against themselves or others, the digital tracker and associated data motivated all the participants to some degree. Increased accountability to self Participant comments suggest that both conscious and unconscious factors altered personal perceptions around active leisure and improved health. For example, Heather discussed how ‘the tracker got her active in an unconscious way’. It encouraged and ‘helped her’ integrate ‘exercise in [her] daily routine’. Similarly, while describing herself as very active, Ash mentioned how the activity tracker made her more conscious of increasing her ‘personal exercise’. Ash recalled how ‘it makes you want to get the step count up, it definitely gives you an incentive to do more’. Similarly, Glenda found that, the ‘Buzz’ made me get up from my desk. I often walked the dog or walked with friends to increase my daily steps and walked between meetings, there is no doubt that the reminders motivate me to be more active and move more. These findings support observations that self-tracking encourages ‘introspection and enhanced self-awareness’ (Hardey 2019, 996). Barriers The group identified several constraints and barriers to being active. These included the women being time-poor, characteristically due to family, work and/or study commitments. Some participants also described themselves as ‘lazy’ and others experienced challenges with the tracker technologies. Betty, who has family responsibilities and works six days a week explained that ‘I know I need to do more but time is a big barrier as I work from seven am to seem pm’. Betty’s concerns around long working hours and the resulting lack of time for physical activity are interesting in the light of the often implicit assumption mentioned earlier that people have the same universal resources to access and operate technologies (Lupton 2013). Similarly, Denise’s experiences of significant ‘issues’ with downloading, coping with the activity tracker and managing the phone charger are another example of a lack of commonly assumed technological ability. Denise also struggled with a lack of social interaction, explaining ‘not being able to do it with friends made me lazy and I didn’t do enough exercise’. Ultimately these problems caused her to withdraw from the programme. These constraining factors (time, education, family and care responsibilities) appear to be linked to the wider social and economic context of the study participants. Discussion Despite the barriers, the findings indicate that in a range of ways wearable technologies can enhance the experiences and outcomes of being active for Indigenous women. These are discussed through the key themes of: the quantified self, governance by micro-nudge and increased agency and empowerment. These themes are next presented and discussed. ANNALS OF LEISURE RESEARCH 13 The quantified self We use this phrase to refer to the cultural phenomenon of self-tracking with technology. Quantified Self practices overlap with the practice of lifelogging and allied trends that incorporate technology and data acquisition into daily life, often with the goal of improving physical, mental, and/or emotional performance (Sharon 2017). The widespread adoption in recent years of wearable fitness and sleep trackers such as the Fitbit or the Apple Watch, have made self-tracking accessible to a large segment of the population, as apparent in this study. The quantified data produced through bodily tracking by participants was evidenced with the enhanced self-knowledge that the Indigenous women developed through counting steps, timing their activity levels, monitoring heart rate and sleep patterns. This ‘enhanced self-knowledge through numbers’ (Bode and Kristensen 2016, 3) provides ‘data for life’ (Schüll 2016, 1). In particular, the data the women collected from the trackers facilitated their understanding of their sleep patterns and sleep requirements, their daily step count and the extent to which they were elevating their heart rate during active leisure. In this way the fitness tracker became a ‘a digital compass’ (Schüll 2016, 1), a material and digital reference point for checking, and increasing, for example, the number of steps they had walked or ensuring they had adequate sleep and rest. The findings allow researchers to comprehend practices of self-tracking and the production of digital data and the importance and meaning that this data can have for Indigenous Australian women. The increased self-efficacy noted in this population alongside the enthusiasm for the adoption of the health trackers by most of the participants suggests that mHealth technologies have the potential to increase Indigenous health and wellbeing and increase participation rates of Indigenous women in active leisure in this country (Maxwell et al. 2017). These results also help us understand datafication as it occurs within and through diverse practice, a knowledge gap highlighted by Ruckenstein and Schüll (2017). Governance by micro-nudge A nudge is a concept in behavioural science, political theory, and behavioural economics which proposes positive reinforcement and indirect suggestions as ways to influence the behaviour and decision making of groups or individuals. Nudging contrasts with other ways to achieve compliance, such as education, legislation or enforcement. A micronudge is a micro animation for behavioural change, or a well-timed small animation that prompts the user to do a ‘small’ task that they may have otherwise forgotten or not have taken notice of (Ruckenstein and Schüll 2017). The digital health trackers in this research provided a micro-nudge in the form of a buzz to draw participants’ attention. The buzz function encouraged participants to be more active and in particular to increase their daily step count. This function operated by increasing the motivation of the Indigenous women be more physically active in their daily lives. Interestingly the reminder provided by the buzz was not experienced negatively, and it was not interpreted as a form of unwanted monitoring or surveillance. In fact, there was no mention of health trackers acting as an individual or societal surveillance mechanism as health sociologists such as Ruckenstein and Schüll (2017) have cautioned may occur. Rather, the micro-nudge appeared to guide the women to make healthier 14 H. MAXWELL ET AL. decisions by reframing rather than constraining their choices, thereby leveraging free choice through the use of ‘choice architecture’ (Thaler and Sunstein 2008). Increased agency and empowerment The women discussed their enjoyment in using the trackers. This experience concurs with French and Smith (2013b), who describe the adoption of health and wellness technologies in terms of making surveillance pleasurable. Furthermore, it is in accord with Nelson, Verhagen, and Noordzij (2016), who explain that tracking the body using these technologies is a voluntary activity engaged in for enjoyment rather a medically controlled process for prevention of poor health. Participants used self-tracking as a type of soft resistance to dominant discourses (Nafus and Sherman 2014) by challenging traditional approaches to health. Examples of this are adopting and recognizing individualized and nuanced forms of exercise and leisure activity, such as shopping, group walking and pole dancing, tackling lifestyle diseases by increasing activity levels, improving sleep, or counting calories, and developing new active ways of dealing with stress and anxiety. By choosing their own activities which suited their needs, the women challenged biomedical discourses and aligned their experiences with Indigenous ways of being and knowing in the world (Martin and Mirraboopa 2009). The women used the trackers in multiple ways to take responsibility for their good health (in particular in managing diabetes and mental health). This reflects the work of Sharon (2017) who explores how digital self-tracking can enhance agency, feelings of autonomy, and participatory self-care. The flexibility of the digital trackers allowing participants to choose when, where and how they became active helped them to overcome some of the barriers to being active identified in previous studies (Stronach, Maxwell, and Taylor 2016). For example, participating in tasks such as dog walking with a partner or family assisted the women to overcome the barrier of lack of time by combining exercise with a family chore. The micro-nudge function via the buzz was also mentioned as a way to overcome the personal constraint of laziness. The idea of laziness is interesting as it results from the individualized notion of health which places responsibility for lifestyle change in the hands of the individual (Bedini and Guinan 1996). According to Bedini and Guinan (1996), a focus on women’s self-management of health and wellbeing increases the burden of care that women already experience in regard to the health and leisure needs of partners, children and older people. We contend that the individual Indigenous women are at the nexus of action-taking and empowerment. This positionality underpins and encourages a conceptual shift towards person centrality and aligns with Swan’s (2012) focus on a shift from paternalistic to partnership health care. On the whole the self-trackers empowered the women to be active participants in their exercise and leisure activity choices, despite the constraints of time which was needed for the work, study and the care of others. In drawing these conclusions and offering associated discussions we are conscious of situating and acknowledge these women’s experiences and interpretations within a broader socio-political context. We note the continued struggle for Indigenous rights and meaningful reconciliatory activities. Programmes of restitution, reparation, and compensation, while widespread, have often reified the state surveillance of Indigenous Australians (Haebich 2015). ANNALS OF LEISURE RESEARCH 15 Limitations There are some limitations with this research as it reflects a neoliberal conceptualization of health which places responsibility for health and wellbeing to the self-monitoring individual rather than considering broad societal structures. The concern is that some participants taking part in the research may not have had the resources, skills or literacy to access and fully benefit from the digital health tracker’s functionality. There were also some technology usage issues which reduced the potential participation of two of the women who were otherwise well-motivated study participants. This experience accords with data which shows that Indigenous people often find themselves on the wrong side of the digital divide and despite increasing use of ICT there are continuing access and affordability issues (Eardley, Bruce, and Goggin 2009). Despite the limitations, it should be noted that the study was a small pilot project, and as such the findings may be transferable to other populations. In addition, the discussion with the participants were useful and did provide some insightful themes and ideas for future research Future research As an emerging and at present under researched area of leisure studies, the use and influence of digital trackers of themselves and within communities such as Indigenous Australian women warrants ongoing critical analysis. Building from the present study’s focus on a short participant-led activity programme, future research could extend for a longer period (i.e. 6–12 months). In combination with this time frame, intervention such as the development of a tailored programme of support negotiated between participants and Indigenous health and exercise workers could be trialled. In doing so this research can contribute to a more nuanced understanding of how these technologies might be incorporated into the everyday lives of both lay people and health and exercise professionals. Further extending the study’s empowerment framework, future research could more specifically explore how within a group of Indigenous Australian women the active sharing and comparing of digital activity data can be harnessed in ways which encourage among others the social facets of exercise and leisure activity. Conclusion Research with a group of Indigenous Australian women experimenting with digital health trackers has allowed an insight into a minority group. This builds on the health, sport and leisure literature, which for the most part considers Anglo-western women’s experiences and their interpretations. Our approach was shown to empower Indigenous Australian women to improve their activity levels in an innovative and modern manner, signifying a shift away from more traditional approaches which have been commonly adopted in the past with this cohort. The conversations and yarning circles with the women (around the use of digital health trackers) privileged their voices, experiences and interpretations. The research has shown that mobile self-tracking devices can be important tools to enable Indigenous Australian women to manage their exercise and leisure activity in an independent and empowering manner. 16 H. MAXWELL ET AL. Disclosure statement No potential conflict of interest was reported by the authors. Funding This work was supported by Australia and New Zealand Association of Leisure Studies. Notes on contributors Dr Hazel Maxwell has research and teaching interests in issues around health and well-being, physical activity, community sport, social impact, social inclusion and diversity management. Dr Michelle O’Shea is a Senior Lecturer at Western Sydney University and her research interests include gender and diversity in sport management. Dr Megan Stronach has research interests which focus on the experiences of Indigenous people in sport and leisure contexts. Dr Sonya Pearce is a Gooreng Gooreng woman with over 35 years in Indigenous education, employment, training and community development. Sonya continues to teach and research in the space of Indigenous Innovation and Entrepreneurship. ORCID Hazel Maxwell http://orcid.org/0000-0003-0610-4698 Megan Stronach http://orcid.org/0000-0002-5045-409X References Bedini, Leandra A., and Diane M. Guinan. 1996. “The Leisure of Caregivers of Older Adults: Implications for CTRS’s in Non-Traditional Settings.” Therapeutic Recreation Journal 30: 274–288. Bode, Matthias, and Dorthe Brogård Kristensen. 2016. “The Digital Doppelgänger Within. A Study on Self-Tracking and the Quantified Self Movement.” In Assembling Consumption: Researching Actors, Networks and Markets, edited by Btihaj Ajana, 119–134. London: Palgrave. Brusse, C., K. Gardner, D. McAullay, and M. Dowden. 2014. “Social Media and Mobile Apps for Health Promotion in Australian Indigenous Populations: Scoping Review.” Journal of Medical Internet Research 16 (12): e280–e288. Burns, J., A. MacRae, N. Thomson, Catto M. Anomie, C. Gray, L. Levitan, N. McLoughlin, et al. 2013. “Summary of Indigenous Women’s Health.” Australian Indigenous HealthInfoNet. Callinan, T. 2014. “Remote Indigenous Australians Rely on Facebook to Stay in Touch.” Social Media Mob: Being Indigenous Online. Crane, D., C. Garnett, S. Michie, R. West, and J. Brown. 2018. “A Smartphone App to Reduce Excessive Alcohol Consumption: Identifying the Effectiveness of Intervention Components in a Factorial Randomised Control Trial.” Scientific Reports 8 (1): 4384. Dunleavy, Janine. 2013. About Yarning Circles. Gold Coast: Southern Cross University. Duus, Rikke, Mike Cooray, and Nadine C. Page. 2018. “Exploring Human-Tech Hybridity at the Intersection of Extended Cognition and Distributed Agency: A Focus on Self-Tracking Devices.” Frontiers in Psychology 9: 1. Eardley, Tony, Jasmine Bruce, and Gerard Goggin. 2009. Telecommunications and Community Wellbeing: A Review of the Literature on Access and Affordability for Low-Income and Disadvantaged Groups. Sydney: Social Policy Research Centre. Edwards, Ken. 2009. “Traditional Games of a Timeless Land: Play Cultures in Aboriginal and Torres Strait Islander Communities.” Australian Aboriginal Studies 2: 32–44. ANNALS OF LEISURE RESEARCH 17 Fotopoulou, Aristea, and Kate O’Riordan. 2017. “Training to Self-Care: Fitness Tracking, Biopedagogy and the Healthy Consumer.” Health Sociology Review 26 (1): 54–68. Fredericks, Bronwyn L., Karen Adams, Summer May Finlay, Gillian Fletcher, Simone Andy, Lyn Briggs, Lisa Briggs, and Robert Hall. 2011. “Engaging the Practice of Yarning in Action Research.” Action Learning and Action Research Journal 17 (2): 7–19. Freid, Virginia M., Amy B. Bernstein, and Mary Ann Bush. 2012. “Multiple Chronic Conditions among Adults Aged 45 and Over; Trends Over the Past 10 Years”. National Center for Health Statistics Data Brief 100: 1–8. French, Alan, and Gareth Smith. 2013a. “Measuring Brand Association Strength: A Consumer Based Brand Equity Approach.” European Journal of Marketing 47 (8): 1356–1367. French, Martin, and Gavin Smith. 2013b. “‘Health’ Surveillance: New Modes of Monitoring Bodies, Populations, and Polities.” Critical Public Health 23 (4): 383–392. Fullagar, Simone. 2002. “Governing the Healthy Body: Discourses of Leisure and Lifestyle within Australian Health Policy.” Health 6 (1): 69–84. Fullagar, Simone. 2019. “A Physical Cultural Studies Perspective on Physical (in) Activity and Health Inequalities: The Biopolitics of Body Practices and Embodied Movement.” Revista Tempos e Espaços em Educação 12 (28): 63–76. Garvey, Darren. 2008. “A Review of the Social and Emotional Wellbeing of Indigenous Australian Peoples – Considerations, Challenges and Opportunities.” Australian Indigenous HealthBulletin 8 (3): 1–22. Haebich, Anna. 2015. “Neoliberalism, Settler Colonialism and the History of Indigenous Child Removal in Australia.” Australian Indigenous Law Review 19 (1): 20–31. Hardey, Mariann. 2019. “On the Body of the Consumer: Performance-Seeking with Wearables and Health and Fitness Apps.” Sociology of Health and Illness 41 (6): 991–1004. Hayward, E. 2006. No Free Kicks: Family, Community and Football. Fremantle: Fremantle Arts Centre Press. Hickey, Amanda M., and Patty S. Freedson. 2016. “Utility of Consumer Physical Activity Trackers as an Intervention Tool in Cardiovascular Disease Prevention and Treatment.” Progress in Cardiovascular Diseases 58 (6): 613–619. House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs. 2013. Sport-More Than Just a Game: Contribution of Sport to Indigenous Wellbeing and Mentoring. Canberra: The Parliament of the Commonwealth of Australia. Howe, M. L., and C. J. Brainerd. 1988. Cognitive Development in Adulthood: Progress in Cognitive Development Research. New York: Springer-Verlag. Khan, Numan, Francoise A. Marvel, Jane Wang, and Seth S. Martin. 2017. “Digital Health Technologies to Promote Lifestyle Change and Adherence.” Current Treatment Options in Cardiovascular Medicine 19 (8): 60. Lee, Jae Hyun, Adam W. Davis, Seo Youn Yoon, and Konstadinos G. Goulias. 2016. “Activity Space Estimation with Longitudinal Observations of Social Media Data.” Transportation 43 (6): 955–977. Leeson, Sjharn, Catrin Smith, and John Rynne. 2016. “Yarning and Appreciative Inquiry: The use of Culturally Appropriate and Respectful Research Methods When Working with Aboriginal and Torres Strait Islander Women in Australian Prisons.” Methodological Innovations 9: 2059799116630660. Liu, Dawei, and Xiaohong Guo. 2017. “Can Trust and Social Benefit Really Help? Empirical Examination of Purchase Intentions for Wearable Devices.” Information Development 33 (1): 43–56. Lunney, Abbey, Nicole R. Cunningham, and Matthew S. Eastin. 2016. “Wearable Fitness Technology: A Structural Investigation Into Acceptance and Perceived Fitness Outcomes.” Computers in Human Behavior 65: 114–120. Lupton, Deborah. 2013. “Quantifying the Body: Monitoring and Measuring Health in the Age of mHealth Technologies.” Critical Public Health 23 (4): 393–403. Lupton, Deborah. 2017. “Digital Media and Body Weight, Shape, and Size: An Introduction and Review.” Fat Studies 6 (2): 119–134. Martin, Karen, and Booran Mirraboopa. 2009. “Ways of Knowing, Being and Doing: A Theoretical Framework and Methods for Indigenous and Indigenist Research.” Journal of Australian Studies 27 (76): 203–214. 18 H. MAXWELL ET AL. Maxwell, H., M. Stronach, D. Adair, and S. Pearce. 2017. “Indigenous Australian Women and Sport: Findings and Recommendations from a Parliamentary Inquiry.” Sport in Society 20 (11): 1500– 1529. doi:10.1080/17430437.2017.1284802. Meyer, Jochen, and Susanne Boll. 2014. “Digital Health Devices for Everyone!.” IEEE Pervasive Computing 13 (2): 10–13. Miles, Matthew, and Michael Huberman. 1994. Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks: Sage Publications. Millington, Brad. 2014. “Smartphone Apps and the Mobile Privatization of Health and Fitness.” Critical Studies in Media Communication 31 (5): 479–493. Nafus, Dawn, and Jamie Sherman. 2014. “Big Data, Big Questions This one Does Not go up to 11: The Quantified Self Movement as an Alternative Big Data Practice.” International Journal of Communication 8: 11. Nelson, Elizabeth C., Tibert Verhagen, and Matthijs L. Noordzij. 2016. “Health Empowerment Through Activity Trackers: An Empirical Smart Wristband Study.” Computers in Human Behavior 62: 364–374. Paraschak, Victoria, and Kristi Thompson. 2014. “Finding Strength(s): Insights on Canadian Aboriginal Physical Cultural Practices.” Sport in Society 17 (8): 1046–1060. Patrick, Kevin, Eric B. Hekler, Deborah Estrin, David C. Mohr, Heleen Riper, David Crane, Job Godino, and William T. Riley. 2016. “The Pace of Technologic Change: Implications for Digital Health Behavior Intervention Research.” American Journal of Preventive Medicine 51 (5): 816–824. Ralph, Stephen. 1997. “Working with Aboriginal Families: Issues and Guidelines for Family and Child Counsellors.” Australian Institute of Family Studies 46: 46–50. Rich, Emma, and Andy Miah. 2017. “Mobile, Wearable and Ingestible Health Technologies: Towards a Critical Research Agenda.” Health Sociology Review 26 (1): 84–97. Rose, Nikolas. 2006. The Politics of Life Itself: Biomedicine, Power and Subjectivity in the XXI Century. Princeton: Princeton University Press. Ruckenstein, Minna, and Natasha Dow Schüll. 2017. “The Datafication of Health.” Annual Review of Anthropology 46: 261–278. Ryan, Lyndall. 2012. Tasmanian Aborigines: A History Since 1803. Sydney: Allen & Unwin. Schüll, Natasha Dow. 2016. “Data for Life: Wearable Technology and the Design of Self-Care.” BioSocieties 11 (3): 317–333. Sharon, Tamar. 2017. “Self-tracking for Health and the Quantified Self: Re-Articulating Autonomy, Solidarity, and Authenticity in an Age of Personalized Healthcare.” Philosophy & Technology 30 (1): 93–121. Smith, Gavin J. D., and Ben Vonthethoff. 2017. “Health by Numbers? Exploring the Practice and Experience of Datafied Health.” Health Sociology Review 26 (1): 6–21. Stronach, M., H. Maxwell, and T. Taylor. 2016. “Sistas’ and Aunties: Sport, Physical Activity, and Indigenous Australian Women.” Annals of Leisure Research 19 (1): 7–26. doi:10.1080/11745398. 2015.1051067. Swan, M. 2009. “Emerging Patient-Driven Health Care Models: An Examination of Health Social Networks, Consumer Personalized Medicine and Quantified Self-Tracking.” International Journal of Environmental Research and Public Health 6 (2): 492–525. Swan, Melanie. 2012. “Health 2050: The Realization of Personalized Medicine Through Crowdsourcing, the Quantified Self, and the Participatory Biocitizen.” Journal of Personalized Medicine 2 (3): 93–118. Teston, Christa. 2016. “Rhetoric, Precarity, and mHealth Technologies.” Rhetoric Society Quarterly 46 (3): 251–268. Thaler, Richard H., and Cass R. Sunstein. 2008. Nudge: Improving Decisions About Health Wealth and Happiness. New Haven, CT: Yale University Press. Wilkinson, Adrian. 1998. “Empowerment: Theory and Practice.” Personnel Review 27 (1): 40–56. Williams, Lewis, Ronald Labonte, and Mike O’Brien. 2003. “Empowering Social Action Through Narratives of Identity and Culture.” Health Promotion International 18 (1): 33–40. World Health Organization. 2011. “mHealth New Horizons for Health Through Mobile Technologies.” Global Observatory for eHealth Series Volume 3. Accessed June 6, 2019.