Could Smart Communities Improve theEfficiency of Cancer Services in Sheffield

This critical digital health study draws upon smart community and smart city literature to gain insights into how to address the practical and complex issue of improving healthcare, with a focus on cancer services in Sheffield. The study’s approach brought together ideas from literature and primary data through a process of theory informed critical reflexivity. It applied a critical systems heuristics methodology that included 3 workshops and 30 semi-structured interviews. Workshops focussed on creating rich pictures of what future systems might look like based on the smart community concept. The interpretation of data applied Bourdieu’s Practice Theory to help understand and highlight power dynamics in existing and proposed solutions. The three corners of the study’s sense making process were: expressed ideas of interviewees and workshop participants, reflections of the researcher, based on his life experience and ideas expressed in journals. By reflecting on opportunities and challenges within smart city, smart community and digital health literature, strengths and weaknesses of emergent ideas were identified. Theory emerged through the creation of a framework that maps out what a more efficient system of cancer services might look like based on the concept of smart community. Whilst smart city and community literature has acknowledged differences between top down and bottom up approaches the divisions within top down and bottom up approaches are rarely given much consideration. To address these limitations a framework was developed that subdivides top down into private vs government led and bottom up between individual and collective approaches. The study concludes that a new system based on smart community is only likely to improve efficiency without undesirable ethical consequences if applied in a specific way. New relationships with and through smart technology would be required as would greater consideration of the structural factors that impact on health outcomes.