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From screens to sensors: a contextual integrity approach to understanding privacy norms across mobile health contexts
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DOI：10.1093/jcmc/zmaf022.png)
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Abstract
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The increasing reliance on digital technologies in health care brings unique privacy risks to individual users. Guided by the framework of contextual integrity (CI), this study examined how privacy norms compare across four mobile health technological contexts: telehealth, online patient portals, mobile health applications, and wearable devices. Analysis of 34 semi-structured interviews revealed context-specific actors, information types, and transmission principles, and identified instances that represent points of departure from entrenched privacy norms. In addition, we found that people use privacy heuristics-evoked by CI parameters-to guide their privacy evaluations. Findings theoretically contribute to CI by identifying parameters in the novel context of mobile health and by proposing privacy heuristics as the explanatory mechanism underlying the evaluation of privacy norms. Practically, findings can inform more user-centered mobile health design and communication practices. As health care becomes more digital, new privacy concerns are emerging for everyday users. This study explores people's privacy responses toward four types of mobile health technologies: telehealth, online patient portals, mobile health applications, and wearable devices. Interviews with 34 mobile health users showed that their privacy attitudes and behaviors differed across these technologies and were guided by factors such as the actors involved in the use of mHealth technologies, the types of information being collected and shared, and the platforms' privacy protection mechanisms and policies. Users also employed various mental shortcuts (e.g., if the platform is transparent about their data collection practices, it is safe to share my personal information) to help guide their privacy decisions. Our findings can help inform health care professionals and mHealth designers of factors that shape users' privacy decisions, thus facilitating more effective patient-provider communication and more user-centered technology design.
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