10.6092/issn.2038-3460/17478
This study analyzes the co-production of peer-to-peer interactions as a social innovation that utilizes older people’s resources as a means for providing public care. We ethnographically explore an initiative named Give&amp;Take that aims to establish peer-to-peer care among older people. We draw on a practice perspective with respect to care and its organization while also being influenced by the conceptualization of sociomateriality. The study illustrates the co-production of peer-to-peer care within a social innovation at the intersection of formal and informal care. We show how care practices and their specificities clash with institutionalized logics in the co-production of care. In conclusion, we argue that considering how care practices are shaped by a set of institutionalized logics in public innovations enhances our understanding of the coproduction of care that draws on older people’s resources. These findings are of importance to innovations following EU policies on co-production and active aging.
application/pdf
2038-3460
17478
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en
Axel Wolf
https://creativecommons.org/licenses/by-nc-sa/2.5/
Tecnoscienza – Italian Journal of Science & Technology Studies
sociomateriality
Co-production of Peer-to-Peer Care Practices. The Case of a Social Innovation in Elderly Care
Text.Serial.Journal
https://tecnoscienza.unibo.it/
11
Essays
2021-03-09
2023-06-27
2021-03-09
2023-10-16
73-92
TS
Axel Wolf
2020
10.6092/issn.2038-3460/17478
73
Gothenburg University
2038-3460
2
sociomateriality
en
92
Co-production of Peer-to-Peer Care Practices. The Case of a Social Innovation in Elderly Care
https://tecnoscienza.unibo.it/article/download/17478/16327
11
                                                                                                  Essay
                                                                                                      73




Co-production of Peer-to-Peer Care
Practices
The Case of a Social Innovation in Elderly Care

                  Elin Siira                                          Signe Yndigegn
            Gothenburg University, SE                                     IT University, DK


          Bertil Rolandsson                                              Helle Wijk
            Gothenburg University, SE                                 Gothenburg University, SE


                                               Axel Wolf
                                          Gothenburg University, SE



     Abstract: This study analyzes the co-production of peer-to-peer
     interactions as a social innovation that utilizes older people’s resources as a
     means for providing public care. We ethnographically explore an initiative
     named Give&Take that aims to establish peer-to-peer care among older
     people. We draw on a practice perspective with respect to care and its
     organization while also being influenced by the conceptualization of
     sociomateriality. The study illustrates the co-production of peer-to-peer
     care within a social innovation at the intersection of formal and informal
     care. We show how care practices and their specificities clash with
     institutionalized logics in the co-production of care. In conclusion, we argue
     that considering how care practices are shaped by a set of institutionalized
     logics in public innovations enhances our understanding of the co-
     production of care that draws on older people’s resources. These findings
     are of importance to innovations following EU policies on co-production
     and active aging.

     Keywords: care practices; peer-to-peer care; ethnography; aging;
     sociomateriality.

     Submitted: May 21, 2020 – Accepted: October 10, 2020

     Corresponding author: Elin Siira, Institute of Health and Care Sciences,
     Gothenburg University, Box 457, 405 30, Gothenburg, Sweden. Email:
     elin.siira@gu.se




TECNOSCIENZA
Italian Journal of Science and Technology Studies
11 (2) pp. 73-92 - ISSN 2038-3460
www.tecnoscienza.net                                    2020                                        73
74                                                          Tecnoscienza – 11 (2)

1. Introduction

    Studies of innovation in public welfare often investigate digital means
used, for example, to register, store, and handle data. In contrast to these
studies, this article explores an initiative aiming to innovate older people’s
opportunities to socialize and care for each other (also called peer-to-peer
care) as a means of public care. The innovation in this study resembles
other Scandinavian innovations that aim to create specific active aging ac-
tivities through co-production involving both technology and older peo-
ple’s resources (see Lassen et al. 2015). These “welfare technologies”
(Östlund et al. 2015) resonate with the European Union’s (EU) active ag-
ing and welfare policy frameworks (see European Commission 2011).
    Concerning public services, co-production is a measure that involves
citizens in the design and implementation of services to enhance their de-
livery (Brandsen and Honingh 2018) by, for instance, tapping into users’
(or citizens’) expertise and pairing it with professionals’ competence (Os-
borne and Strokosch 2013). Hence, co-production contrasts to viewing
older people as passive receivers of public services.
    Innovations in elderly care aim to delay older people’s needs for for-
mal care by utilizing older people’s resources to self-care (Pols 2012).
Care solutions that delay such needs also have to be flexible and have the
ability to adjust to person-centered requirements, making co-production
involving both the public sector and older people crucial. Meanwhile, a
lack of understanding of the constitutive aspects of technology and aging
(Wanka and Gallistl 2018) and an emphasis on interventionist (Peine and
Neven 2019) instrumental logics (Cozza et al. 2020) often lead to the con-
struction of doable problems (Lassen et al. 2015, 17), which are said to
contribute to the failure of many innovations (see Peine and Neven 2019;
Wanka and Gallistl 2018; Östlund et al. 2015). Furthermore, older peo-
ples’ acts of resistance within and towards innovation projects are often
overlooked, creating tensions and paradoxes (Yndigegn 2016).
    Innovations in public care constitute specific arrangements that pro-
vide complex conditions for co-production where different interests (of-
ten involving both business and the common good) have to be reconciled.
Such innovations need to align with not only the economic values of effi-
ciency and effectiveness, but also the administrative values of the appro-
priateness underpinning legitimacy (Bekkers et al. 2011). In addition, if
we follow what may be referred to as the specificities of care practices
(Mol et al. 2010) and try to tap into citizens’ resources to care for them-
selves and others, it is easy to understand that innovations that submit the
care of older citizens to the rules and regulations of public discourse (in
line with the logics of effectiveness and appropriateness) risk losing the
efficiency and strength in the care they set out to utilize.
    Understandings of innovations in care are often based on evaluations
of single projects and pre-defined effects, which are produced by the out-
Siira et al.                                                            75
comes of an innovation itself (Mol et al. 2010). Less research has focused
on how this type of complex arrangement of material technologies, foster-
ing common good, shapes and diffuses into practice in social innovations.
Viewing innovations as specific arrangements, we may talk about them in
terms of “arenas” for wider interaction that co-produce practices (Peine
and Neven 2019). Our understanding of the conditions of co-production
of care in social innovations that link to broader policy arrangements and
the tensions that may emerge between different logics thus needs further
attention.
    A sociomaterial perspective allows us to better understand the co-
production of care for older people. For this purpose, we ethnographical-
ly explored one specific case: the EU-funded innovation project
Give&Take. Through social and digital innovation, this project aimed to
empower older people’s independence by helping them realize their un-
met potential to carry out tasks in the realm of public welfare. The
Give&Take project is, in many respects, a typical co-design innovation
following a Scandinavian political agenda of “welfare technology,” as de-
scribed by Östlund et al. (2015). Therefore, it is a good opportunity to
explore the constitution of care practices and what tensions occur in this
kind of social innovation. Our paper focuses on one of the project’s Dan-
ish sites.
    To develop the understanding of the sociomaterial arrangement of the
co-production of peer-to-peer care practices within social innovations,
this study had two main questions: (1) How do the sociomaterial ar-
rangement of the Give&Take innovation co-produce opportunities for
older people to care for each other?, and (2) What tensions emerge with-
in the co-production of peer-to-peer care, and how do actors navigate
these?
    This study illustrates the co-production of peer-to-peer care within a
social innovation at the intersection of formal and informal care. It em-
phasizes two actors within the social innovation: the digital technology (a
peer-to-peer platform) and the older people who participate in the inno-
vation. We postulate how theory regarding care practices may enhance
understandings of the co-production of care in social innovations linked
to broader policy arrangements concerning public care and the common
good.


2. Understanding the Co-production of Care in Social
Innovations

    To understand the constitution of (peer-to-peer) care in social innova-
tions, we draw on a practice-based perspective (Gherardi and Rodeschini
2016; Mol et al. 2010). Taking practices afforded by both human and ma-
terial actors as the central unit of analysis brings together traditions of
76                                                          Tecnoscienza – 11 (2)

Science and Technology Studies (STS), design (Shove 2014), and, we ar-
gue, studies on care practices. This enables us to understand how and
under what conditions care is enacted. We explore how the workings of
different logics enter the constitution of sociomaterial practice by creating
opportunities for action, and how these logics unfold in practice. With
logics, we refer to arrangements of norms and values that link institutions
and actions. In their practice, actors are able to enact and adapt institu-
tionalized logics to specific conditions (Boltanski and Thevenot 2006;
Rolandsson 2020).
    We are influenced by sociomaterial perspectives that recognize the
contribution of material artifacts on different types of interactions be-
tween an actor and material objects. That is, emerging sociomaterial ar-
rangements involve different affordances that precondition activity (Gib-
son 1977). These affordances are not the outcome of the artifact alone
nor of the actor alone; they are part of a broader sociomaterial construc-
tion both shaping and being shaped in complex interactions between
multiple social actors and material objects (Orlikowski and Scott 2008).
Our focus has thus been broadened to include both things and humans as
part of the care arrangements that make up social innovations. To under-
stand the constitution of peer-to-peer care, we consider the sociomaterial
arrangement that arise as part of a broader policy dimension related to
the public good and public care (for further discussion, see Hultin and
Mähring 2014). In this view, the healthcare organization, a specific tech-
nology (in this case, the Give&Take peer-to-peer platform), and users
(here, older citizens) are three dimensions of a broader interaction of
things and humans that constitute possibilities for the enactment of care.
    Innovations aim to find solutions through new ways of organizing,
which involves making use of new ideas or inventions in practice (see
Sørensen and Torfing 2011). Innovations are arenas for the creation of
shared definitions of phenomena and practices linked to aging, thereby
reframing the norms and practices of aging (Peine and Neven 2019). In
the public sector, innovations attempt to overcome different logics and
provide conditions for actors to co-produce network arrangements that
may pick up “wicked policy problems” (Bekkers et al. 2011, 8). The
Give&Take platform exemplifies the reframing of norms and practices in
conjunction with digital technology in public care services, intending to
activate older citizens to co-produce solutions to welfare problems.
    Social innovations aim to achieve socially recognized goals in innova-
tive ways (Manzini 2013). The empirical case in this study aimed to de-
sign co-production between older people and care professionals. Bringing
the expertise of service users and professionals together is a common goal
in co-production to enhance the delivery of public services (Osborne and
Strokosch 2013). Further, this study assesses co-production at the inter-
section of formal and informal care that involves professionals and en-
courages older people to participate in public care delivery.
    Such innovating has been portrayed as problematic by, for example,
Siira et al.                                                                 77
Brandsen et al. (2017), who argue that governments encouraging citizens
to participate through, for instance, self-organization of spontaneous citi-
zen initiatives, easily manufacture conditions that undermine the essence
of such initiatives.
    Public care organizations are guided by values of efficiency, effective-
ness, appropriateness, and the logics of consequence. In contrast, Mol
(2008) and Mol et al. (2010) point out that what is “good” in care prac-
tices, such as attentiveness or specificity, is not necessarily efficient or ap-
propriate. Furthermore, when shaped to fit into a public framework and
made public, the specificities of care risk being lost, together with its ca-
pacity and strength. As Mol and Moser (Mol et al. 2011, 84) state about
defining or setting boundaries around care practices, “Where objects are
tinkered with, where ways of working are developed, boundaries get con-
tested, unstable, take a variety of shapes.” Prioritizing specific definitions
and aspects of care and aging, and making these targets for innovative
measures, may mask why people need care in the first place, as well as
cause additional work rather than efficiency in care provisions (Pols
2010).
    Care is as an ongoing sociomaterial accomplishment that can be
traced in various practices (Gherardi and Rodeschini 2016, Mol et al.
2010). Such styles or workings are not innate human capacities, and tech-
nologies are not passive in care practices, even if they do not act on their
own. Technologies may be, for example, normative actors, as they help
enact different sets of problems that influence care practices (Mol et al.
2010). As argued by Mol et al. (2010, 11), “A noisy machine in the corner
of the room may give care, and a computer can be good at it, too.” In this
view, care practices are the enacted possibilities offered by sociomaterial
arrangements in the shape of humans and objects as an open set, which
arise as part of a broader policy dimension.
    The analytical implications of this perspective involve observing how
care is enacted as part of the sociomaterial arrangement of a specific situ-
ation; that is, we look for potentials or opportunities for care fostered in
and by assemblages of technology and humans (cf. Orlikowski and Scott
2008). The “art is to compare and contrast different situations of care and
to wonder which lesson might transport between them” (Mol et al. 2011,
86), leaving care practices and words “unbounded enough to adapt them
to local needs and circumstances” (Mol et al. 2011, 84). Attending to the
specificities of one particular social innovation (in our case, the
Give&Take project) at the intersection of formal and informal care may
develop our understanding of how sociomaterial arrangements co-
produce opportunities for the enactment of care, what tensions emerge as
part of such co-production and how actors navigate these.
78                                                         Tecnoscienza – 11 (2)

3. A Study of the Co-production of Care Practices as a
Social Innovation: The Give&Take Project and the
Walking Groups

    The Give&Take project (Give&Take 2019) was a three-year (2014–
2017) interdisciplinary co-design project funded by the EU Ambient As-
sisted Living program (AAL). The project involved collaboration between
three research institutions in Denmark and Austria, a Danish municipali-
ty, and two private companies based in Denmark and Portugal and aimed
to develop a digital peer-to-peer platform (the Give&Take platform) for
older people. These actors designed the platform to support and organize
the sharing of favors, things, and services among older people. In Den-
mark, where elder care is mainly a welfare state responsibility, the state
has set out to provide a stronger user orientation in the provision of care,
calling upon the participation of older people in developing new health
concepts. Therefore, there has been an increased amount of innovations
aiming to strengthen older people’s capabilities through innovative wel-
fare technologies and collaborations with citizens (Lassen et al. 2015).
Hence, Denmark is an excellent case to explore this kind of co-
production innovation.
    The empirical site of this study was a walking group, one of the pro-
ject’s local contexts or “living-labs,” where the innovation was developed.
The walking group started as a public initiative that followed a municipal
policy to create new and complementary welfare solutions through co-
production involving older community members. We consider, in retro-
spect, how the Give&Take innovation developed since its inception in
2014 and its situation as of 2019.
    The municipality’s idea behind the walking group was that the group
would self-organize after a few months of public support. The
Give&Take platform intended to address the absent linkage between the
walking group’s participants and the municipal services. It also aimed to
sustain the walking group’s activity, which the municipal staff from the
beginning worried would dissolve without their support. Over six
months, the Give&Take project worked to adapt and integrate the plat-
form into the group and provided the walking group a community page,
as well as trained its members to use the platform.
    To get an insider’s depiction of how care practices among older peo-
ple were co-produced in this specific milieu, we adopted ethnographic
tools and techniques (Emerson et al. 2011). We conducted fieldwork for
eight months from May to December 2019, which included five instances
of participatory observations of the walking group’s events, informal con-
versations with the walking group’s participants, 60 hours of observing
activity on the Give&Take platform, and conducting three individual in-
terviews. The first author (ES) interviewed two older persons who were
using the Give&Take platform and one municipal staff member who ini-
Siira et al.                                                             79
tiated the group. In the interviews, which were audio-recorded, tran-
scribed, and lasted up to 60 minutes, we used interview guides with open-
ended question sets that followed our emerging conceptual ideas to direct
the conversation. ES also analyzed five individual interviews previously
conducted as part of the Give&Take project, as well as written and visual
materials (both pictures and videos) linked either to the Give&Take pro-
ject or the municipality’s care services. One author (SY) also participated
in the Give&Take innovation and conducted participatory observations
in the walking group when the innovation project took place (during
2014–2017).
    To guide our ethnographic exploration, we adopted the principles of
grounded theory (Charmaz 2014). We gathered empirical materials and
continuously carried out analyses by letting codes and ideas about them
pinpoint directions for further empirical and theoretical exploration. ES
gathered and analyzed the data, but all authors took part in a critical dis-
cussion to reflect on ES’s and SY’s ethnographic observations, as well as
the analysis of the empirical material. ES coded the materials using a con-
stant comparison method (as part of grounded theory) to search for
meanings and actions associated with the co-production of care in this
specific social innovation, as well as what tensions emerged and how the
actors navigated them. Throughout the analysis—especially when creat-
ing conceptual categories and theories—we theorized the shapes of pos-
sibilities, established connections, and asked questions about the data.
Moreover, ES assembled her experiences and observations by composing
field notes and memos. All authors participated in finalizing the manu-
script.
    Before the participatory observations with the walking group took
place, ES informed the participants about the study’s research intentions
and project, and that interaction with the researcher implied the potential
gathering of data for the current study. All participants agreed to have ES
conduct participatory observations. Before the interviews, ES collected
informed consent from the participants. The participants were also noti-
fied that their observations and activity on the digital Give&Take plat-
form might be observed by ES and SY during the participatory observa-
tions. Those persons with access to the Give&Take platform agreed to
have ES observe their activity. Regarding the analysis of material gathered
at previous occasions as part of the Give&Take research project, in-
formed consent from the participating researchers was gathered. This
study follows the principles outlined in the Declaration of Helsinki.
80                                                            Tecnoscienza – 11 (2)

4. The Sociomaterial Arrangement of the Co-production
of Peer-to-Peer Care within Give&Take

   In this section, we portray the sociomaterial arrangement of the
Give&Take project, how care was co-produced by different actors, and
what tensions this co-production gave rise to, as well as how the actors
handled these tensions. We focus on the opportunities fostered in
particular by the Give&Take platform and the interactions of the
participants.

4.1 The Give&Take platform and how it shapes care practices in
the walking group

    Routines and artefacts are part of the enactment of peer-to-peer care
in the walking group. For example, the care center where the group met
up, which allowed the participants to sit down after the walk to chat, and
the coffee machine that ensured there was coffee for these occasions,
were essential for the enactment of care. The local walking routes, the
abled bodies (those who can walk), the older peoples’ relationships with
each other, their integrity as a group, and their undertakings to self-care
were other vital conditions for these care practices. The participants not-
ed that the walking group was about “more than just walking.” One
member even described it as “therapy.” While walking two-by-two or in
smaller groups, conversations spanned different topics, including difficult
ones, such as loneliness:

         “Yeah, on Monday walks there is someone who supports me. At
     home, I am alone and do not have anyone to talk to other than myself.
     Therefore, it is always nice […] because there is someone to talk to
     while walking and when having coffee together. It is actually the best
     day.” (Noah, 86 years old)

    The Give&Take platform was yet another dimension of the socio-
material arrangement that shaped (and continues to shape) the care prac-
tices in the walking group. The platform allowed social relationships to
intensify, the activities of the participants to be traced (thereby allowing
the municipality to supervise the co-production and self-organization of
the care service), the walking group’s attendance to formalize, and for dis-
tributing responsibilities concerning the walking group’s organization and
the care for other participants. Below, we elaborate on these opportuni-
ties afforded by the platform.

4.1.1 Intensifying social relationships and allowing for care
among participants
Siira et al.                                                                     81
    The Give&Take platform’s member page encouraged everyone to up-
load a profile photo and brief information about themselves, along with
their preferences for helping and being helped by other members. This
enabled all participants to connect faces and information to others within
the group. When the participants were introduced to the Give&Take
platform, this enhanced their familiarization with one other. At the point
of implementation, the older people had been attending the walking
group for only three months, so not all of them knew each other by name.
By sharing information about themselves—such as pictures of their
grandchildren or information about their wedding anniversaries—via the
platform, the participants got to know more things about each other.
These actions opened up additional subjects for conversation during their
weekly walks and allowed the members to become more familiar with one
another, thereby permitting greater involvement in, and concern for, each
other’s daily go-about.
    The Give&Take platform also expanded the opportunities to care by
encouraging communication about and participation in activities outside
the walking group. For example, three people in the group participated
in another weekly event together outside the walking group, which one of
the members declared made them closer to each other:

           “[…] because we talk more often, and sometimes we accompany
        each other back and forth [to the walking group or the other activity]
        and stuff like that.” (Lily, 83 years old)

    Moreover, the platform allowed care to occur outside the weekly ac-
tivity and from a distance; for example, one participant discussed sending
greetings to another member who had been through surgery and there-
fore did not attend the weekly walk:

         “I wrote to Emma, who had surgery due to cataracts, and wished for
     her to get well soon. I wrote that I had the surgery myself, and it went
     well. I also wrote to Anne when she had a plastered arm and wished for
     her to get better.” (Margaret, 84 years old)

    The platform constituted part of the sociomaterial arrangement that
allowed for and shaped the group’s endurance and stability (i.e., through
the intensification and expansion of their social relationships, especially in
the beginning); however, these relationships may have evolved under oth-
er conditions, too.

4.1.2 Traceability of the walking group’s activity

   During the implementation of the platform, one participant was
encouraged to upload a screenshot of the walking tour and attach a
comment to it. The screenshot showed the data tracked via GPS during
82                                                                Tecnoscienza – 11 (2)

their weekly walk, including the route, distance, and speed they walked.
The comment provided information on the group’s experience of the
walk and noted anything extraordinary:

        “We had a nice walk through the cemetery. Today, we were a large
     group of about 15 [people]. The conversations were lively […]. We had
     guests from a Christian daily newspaper with both a journalist and
     photographer.” (Excerpt from The Give&Take platform)

    The platform thereby allowed the municipal staff to track the activi-
ties of the walking group, as well as the older people’s attendance. These
forms of visualization allowed the staff to steer the walking group into a
format that aligned with the municipality’s perspective of the group’s
functioning in terms of, for instance, effectiveness and efficiency. For ex-
ample, the municipality could follow the development of the group’s
walking activity and compile the information to see if the older people
made any progress concerning their physical health. This visualization al-
so allowed the staff to follow whether someone was not attending the
walks, for example, whether there was a risk of a person dropping out
and needing extra support, and simply to keep track of how the innova-
tion worked.

4.1.3 Formalizing attendance and distributing responsibility

    While the platform intensified familiarization between the participants
and expanded their care relations beyond the boundaries of the weekly
walking activity, it simultaneously helped formalize their involvement in
the group. This formalization was supported as they were provided their
own Give&Take community where their roles as members were visual-
ized. Similarly, by enabling the municipal staff to communicate with the
group as members of a community, the staff could promote the formality
and appropriateness of the group’s activities. For example, they could en-
sure that the group included all older people, no matter if they had close
relationships with others in the group, and keep the group open to
necomers. As one participant explained, even if a person did not know
the others, this person could communicate via the platform:

         “It is really helpful in case you don’t have anyone’s phone number or
     there is no one you can call. Then you just enter [the platform] and write
     that you are not coming.”(Lily, 83 years old)

    The platform enabled the municipal staff to distribute responsibilities
for care and support a particular format of the walking group’s practices.
As previously mentioned, the group was encouraged to upload a screen-
shot tracking their route with GPS. This occurred after the municipal
staff posted a request on the platform asking if anyone could take on the
Siira et al.                                                                        83
responsibility of uploading their route’s GPS tracking:

            “Dear walking group, I want to ask you if you would care to be
        part of a little experiment. Could you document the length of your
        Monday walks to see if there is any development? […] I imagine that
        it could be nice for you to see how long you have walked and if you
        have possibly made progress. […] I hope you have the guts for
        it?”(Excerpt from The Give&Take platform)

    One person was already tracking the walking route via GPS, so she
took on the task. The other participants rarely wrote or uploaded any-
thing to the platform. By uploading the GPS tracking each Monday, the
participant took on the task of securing content to the platform. She was
aware that the others saw her posts and continued to do so out of concern
for the other participants:

         “We were asked if we could document the walk, and I said I could
     do it. […] I don’t really care if the route is uploaded to the platform, but
     then, I’ve asked if we shouldn’t stop uploading it, but the [other
     participants] are like, ‘No, it is so much fun to know where you have
     been walking when we are not attending the walk’ [laughs]. We walk
     almost the same route every time.” (Irene, 80 years old)

4.2 The older people’s resistance to formalization

   The platform’s distribution of responsibility and the formalization of
the participants’ membership in the group met some resistance from the
participants, who emphasized their integrity and control over the group
and their activities, as well as guarded their boundaries concerning more
formal responsibilities regarding organizing the group or caring for other
participants. While they were happy to help and did care for each other,
the participants argued that participation in the group was supposed to
be highly voluntary and without formal obligations. As one participant
declared:
         “I feel like this ‘walking group thing’ should be for me! […] and for
     me to take part whenever I feel like it. I really want to be part of the
     group, but not all sorts of other things. But, I mean, I really want to be
     of help […].” (Irene, 80 years old)

    As an example of this voluntary help, the municipality encouraged
new participants (i.e., vulnerable older people recruited through home
visits) to join the group. One day, when an older man attended the group
for the first time, one participant gave her number to the man in case he
needed to get in touch with someone about the walks. In other words, she
willingly took on responsibility through her own initiative, but resisted
being obliged to do so in a more formal way and per the instructions of
84                                                           Tecnoscienza – 11 (2)

the municipality. We now elaborate on how the participants took part in
co-producing care.

4.2.1 Emphasizing control over the walking group

    The older people’s attitudes toward the municipality and the
Give&Take project were rather halfhearted. Their care practices con-
nected to self-care and familiarity with other participants, routines, and
artefacts, such as the key to the care center where they met up or the cof-
fee machine there, rather than the cares or concerns of the municipality.
From the participants’ perspective, their routines maintained the walking
activity. These routines consisted of a particular time and day that the
group met, as well as a set place to meet. The group always walked, re-
gardless of the season or weather. As one of the members noted,

        “We have one rule, and that is that we always start walking at 1:30
     pm.” (Noah, 86 years old)

   When asked if they could manage without the platform, one partici-
pant of the walking group declared:

         “Yes, of course. We have! We had a walking group, and then
     Give&Take and the municipality came and were really keen on developing
     their thing […].” (Lily, 83 years old)

    However, the walking group did result from the municipality’s initia-
tive, as directed at policies involving citizens’ co-production of care ser-
vices, and when the participants were invited to start using the
Give&Take platform at the end of 2015, they did not have the same rou-
tines implemented in 2019.
    Furthermore, the key to the care center where they met up and the
coffee machine there (both crucial for the care activities to take place and
to link the older people to the walking group) were provided by the mu-
nicipality.

4.2.2 Safeguarding one’s own boundaries

    The older people were also keen to maintain the boundaries
pertaining to their involvement in the group and with the other members.
Although the Give&Take platform (and the older people’s use of it)
intensified their relationships, they withdrew from invitations that
entailed “fixed” interactions. One example was to meet outside the
walking group “just for a coffee,” as the Give&Take project intended. As
one participant explained, this could entail more than “just a coffee”:
Siira et al.                                                                        85
         “To have coffee or lunch together with someone from the walking
     group. That was really the idea of Give&Take, that you should organize
     that kind of stuff if people wanted to go to the movies or such, but we
     don’t do that. […] I try to stay out of that because I’m afraid to be caught
     up in the situation and that the other person might become too dependent
     on me.” (Irene, 80 years old)

    Here, the specific type of interaction aimed to intensify the
participants’ relationships was linked to a risk of being drawn into taking
on unwanted care responsibilities. While the participants allowed for
closeness in their relationships, the walking group setting created some
boundaries for this closeness, as well as for the responsibility of others
and the walking group as a whole. The meetings on Monday at 1:30 p.m.,
the walk, and the coffee after, which always ended at 3:00 p.m., framed a
start and end of the walking group activity. It was very rare that these
lines, which safeguarded the participants and that the platform attempted
to loosen, were crossed.

4.2.3 Caring without taking on personal responsibility

    The participants cared deeply about their walking activity and
through it about each other, such as through the procedures attached to
it. The group was firm on not deviating at all from their established
routine unless everyone was willing and able to take part in the change.
They always made sure that they included everyone—and that no one
took on personal responsibility for their decisions on, for example, where
to walk:

         “We tend not to go anywhere else besides the usual walking group
     or the walking route. […] If you don’t agree or not everybody thinks it is
     a good idea, we don’t go there. Then you have to go there on your own.”
     (Noah, 86 years old)

   If they wanted to walk at another location, they still met at the same
place and took the bus together from there. They did not want anyone to
miss the trip because they made changes. On one occasion, a participant
reported pain in her foot and had to stop during one of the walks;
however, she insisted,

          “No, I’ll keep walking, or I’ll just turn back. You should keep
     walking!” (Lily, 83 years old)

    She ensured the walking activity would be maintained and that no one
else assumed responsibility for her. By taking responsibility for
themselves but not for the group or others (unless voluntarily), and
86                                                              Tecnoscienza – 11 (2)

expecting this from others, the participants cared for the walking activity
without having to take on personal responsibility for each other.


5. Tensions Regarding the Co-production                              of    Care:
Effectiveness, Efficiency, and Appropriateness

    The sociomaterial arrangement of the co-production created
opportunities for peer-to-peer care between the participants to take
place. The arrangement included the older people’s ability to meet, be
together, and get to know each other; the care center where they met to
walk and have coffee afterward; their routines and independence; and the
flexibility and voluntary character of their attendance. However, tensions
occurred regarding the effectiveness, efficiency, and appropriateness of
the activities that made up the care service. While the older people
stressed control over the group, the municipality emphasized its need to
ensure the walking group’s alignment with the municipality’s principles.
As one municipal staff member explained regarding the “loose” format
and setup of the co-production:

        “[…] This peer-to-peer model is very loose; it is much more difficult
     to manage the result to develop in the direction you want it to, and it
     requires that you have a much looser working frame to work within.
     […] This group is more such a ‘we all do it together ad hoc’ group […]
     so who is it really that we can go to if there is something that doesn’t
     work?” (Alex, municipal staff)

    For the municipality, it became an issue of who was to take on the
responsibility to ensure, for example, the walking group’s appropriateness.
The goal of the co-production as part of the Give&Take project was to
create conditions for a new welfare service by supporting older citizens’
ideas concerning activities enabling them to meet and be together. One
necessary condition was the group’s ability to self-organize, which they
did, for example, by maintaining their walking group routines. However, in
the municipality’s view, their self-organization was problematic. The
municipal staff member explained that,

         “When they have walked together for some time and if they are not
     that big of a group […] they might become tighter and close themselves
     as a group. That is all right if there are four people who are personal
     friends, but then that is not a group that we should cooperate with
     because that you cannot support [as a municipality].” (Alex, municipal
     staff)

    To the municipality, the group had become inappropriately bound by
close relations between the participants. Attempts to make the group less
Siira et al.                                                                        87
informal by formalizing their attendance through the Give&Take platform
failed. The older people did not share this view and believed they were
open to newcomers. However, the older people’s unwillingness to take on
more formal responsibilities impeded the municipality’s attempts to
distribute responsibilities for the walking group (i.e., taking responsibility
for newcomers). Both present (as well as potential) participants expected
the municipal service to be responsible for allotting new participants to the
walking group. One municipal staff member described such an occasion:

            “Recently, we had an incident with a citizen who called and said, ‘I
        was out there [where the walking group meets] and there was no one
        there, so that group can’t exist anymore.’ He was very upset with us for
        having advised him to go there. So, then I needed to get in touch with
        someone to find out—does the group still exist so that we may allocate
        people there? Then there was one woman who was ill, and she was the
        one I was in contact with, and she didn’t really know. This can be
        difficult alright […].” (Alex, municipal staff)

    The municipality’s attempts to manage and link the group to the co-
production via the Give&Take platform required tying the participants to
the platform. Hence, for the municipality to manage them, the municipal
staff had to work to draw the older people to the platform, which required
more engagement from the municipality to handle the co-production
structure they set out to make. This work impeded the rationale for
effectiveness and efficiency, as associated with the previously mentioned
logic of consequence (Bekkers et al. 2011).
    The participants’ response to attempts to tie them to responsibilities was
to distance themselves from the municipality. However, the walking group
was dependent on the conditions the municipality supported; the care
center where the group met to sit down after walks and the coffee machine
there were both crucial for the care activities to take place and for linking
the older people to the walking group. For the municipality, questions
remained concerning the walking group’s access to the care home where
the group met:

           “I’m not sure how to put it, but they shouldn’t use our resources as a
        small private group.” (Alex, municipal staff)

    If the municipality withdrew from the co-production of the walking
group, the participants’ care practices, which included caring for the
activity itself, others, and themselves, would be difficult to maintain. At the
same time, there was no sign of their care practices becoming more
effective, efficient, or appropriate. The inability of the municipality to
manage the walking group created other problems, including how to co-
produce care at the intersection of formal and informal care.
88                                                          Tecnoscienza – 11 (2)

6. Discussion and Conclusion

    The digital platform and the participants constituted a sociomaterial
arrangement involving the interaction of humans and objects fostering
possibilities to enact peer-to-peer care as part of the Give&Take
innovation. The digital platform provided opportunities to intensify the
participants’ relationships and for care to take place outside the weekly
walking activity’s setting. Furthermore, it allowed the walking group’s
activities to be traced, thereby allowing the municipality to influence the
group by formalizing attendance and distributing the responsibility for
care within the walking group. The older people’s ability to enact care
linked to practices of being attentive to oneself and others, contesting
boundaries, and protecting one’s integrity (i.e., withdrawing from more
formal care responsibilities). However, as the participants stressed the
group’s and their own integrity, they impeded the opportunities provided
by the platform.
    Tensions arose as the Give&Take platform aimed to facilitate
opportunities for the municipality to supervise the co-production of care
among the participants, but the older people resisted such supervision
and showed little interest in using the platform. These conditions
eventually left the municipality with the same issue that the platform
aimed to solve: how to efficiently and appropriately manage the co-
production for the municipality to produce a legitimate care service that
builds on self-management and peer-to-peer interaction. What unfolded
were unresolved tensions regarding the appropriateness and efficiency of
the co-production, which implies that competing logics inform involved
actors when they set out to co-produce peer-to-peer care (cf. Boltanski
and Thévenot 2006, Mol et al. 2010). We now attend to these tensions.

6.1 The co-production of peer-to-peer care practices

    Similar to many other Scandinavian co-production innovations and
“welfare technologies” (Östlund et al. 2015), as well as the EU’s policies
and intentions to develop specific sets of active-aging activities (Lassen et
al. 2015), Give&Take asked older people for particular versions of care
(cf. Pols 2010). To co-produce peer-to-peer care, the innovation invited
participants to exercise independence, responsibility, and manageability
but discouraged them from becoming too self-governed, informal, or
“uncontrollable.” The Give&Take platform mobilized problems that
influenced such practices. This mobilization focused on the promises of
the Give&Take technology and the municipality’s expertise and interest.
Such focus has previously been portrayed by, for example, Lassen (2015)
and is said to lead to the failure of many innovations in aging (see Peine
and Neven 2019; Wanka and Gallistl 2018) and, consequently, to more
work for those who provide care (Pols 2010).
Siira et al.                                                                89
    Within public care, innovations try to overcome different logics by
creating new, innovative solutions for the co-production of care (Bekkers
et al. 2011). In the Give&Take project, institutionalized logics (i.e.,
effectiveness, efficiency, and appropriateness) molded the emerging co-
production between the municipality and older people. Consequently, the
co-production became more about administrating care resources (by
managing the older people) than actual care. As the ability to care by
principles that are unfixed, general, and manageable was lost, so were the
possibilities to utilize the strength of the older peoples’ care practices (cf.
Mol et al. 2010). In other words, the “resources” which were to be
utilized and that unfolded in older people’s care practices could not be
made “doable” (Lassen et al. 2015), in line with the norms and values
underpinning institutionalized logics.
    Characteristics such as attentiveness or specificity considered to be
good in care practices are not necessarily efficient or appropriate (Mol
2008). In their care practices, the older people demanded a certain degree
of freedom and rejected subordination to the municipality’s management.
We can view their withdrawal from the co-production as resistance
overlooked in the innovation (cf. Yndigegn 2015). This, we argue,
exemplifies how innovations in public care that try to tap into citizens’
resources need to handle the somewhat loosely bound nature of care
practices (see Mol et al. 2010). When developing the workings of care, its
boundaries are contested and take a variety of shapes (Mol et al. 2011),
causing tensions to arise between logics of care and institutionalized
logics.
    By offering co-production, the Give&Take project also fostered a sort
of partnership. The innovation’s loose character allowed for care
practices to occur and develop while simultaneously (loosely) linking the
older people to the municipality through, for instance, obligations to self-
care, be active, and organize the walking activity. The findings imply that
these activities were characterized by a certain equality or at least
inclusiveness that may also have served the older people. We may
therefore see the platform as a boundary object (Star 2010) that enabled
co-production of care where both the municipality and the older people
continued to meet social demands and obligations in relation to each
other, despite a somewhat loosely organized co-production arrangement
(cf. Allen 2020). However, obligations still guided the connections
between the older people and municipality.

6.2 Theoretical implications for practice

   Our study shows how care practices unfolded in a specific social
innovation that aimed to co-produce peer-to-peer care for older people
by tapping into their resources. We showed how care practices, their
specificities, and logics clash with institutionalized logics enacted in the
co-production of care. We argue that considering the logic of care
 90                                                             Tecnoscienza – 11 (2)

 practices (Mol 2008; Mol et al. 2010), together with the logics of
 effectiveness, efficiency, and appropriateness in public innovations from
 Bekkers et al. (2011), expands our understanding of the co-production of
 care that involves citizens’ resources—something that prevails especially
 pertaining to EU policies on co-production and active aging. Such
 consideration may enhance the chances of creating co-productions that
 serves and benefits from older citizens’ care practices. Future research
 may look into what kinds of ties this type of co-production generates and
 what the effects of these ties are. Regarding tensions, more research is
 needed on the tensions between managing and self-managing in relation
 to co-production.
     Instead of treating social innovations of care for older people in terms
 of failure or success stories, social innovations may be understood as
 arenas where possibilities to care are enacted as part of the sociomaterial
 arrangements. By taking practices as a central unit of analysis, we may
 bring together traditions of STS, design (Shove 2014), and care in this
 endeavor. If recognizing how and under what conditions co-production
 of care following EU policies on active aging (see European Commission
 2011) is enacted in innovation projects, we may use these projects as
 arenas to improve our understanding of the sociomaterial constitution of
 care (see Peine and Neven 2019). Opening up these innovations for
 analysis might invite discussions about good and bad that are suited for
 developing the organization of care. As noted by Mol et al. (2010), care is
 not always fun and successful: it is work; to care is to persist and to keep
 on tinkering.


 Acknowledgements

     We would like to acknowledge Lone Malmborg, Head of The Department of
 Digital Design at the IT University in Copenhagen, who contributed to making
 this study possible. We would also like to acknowledge and thank the participants
 in the Give&Take project who made this study possible.


 References

Allen, D. (2020) From Boundary Concept to Boundary Object: The Practice and
      Politics of Care Pathway Development, in “Social Science & Medicine”, 69
      (3), pp. 354-361.
Bekkers, V., Edelenbos, J. and Steijn, B. (2011) Innovation in the Public Sector.
     Linking Capacity and Leadership, Basingstoke, Palgrave Macmillan.
Boltanski, L. and Thévenot, L. (2006) On Justification: Economies of Worth,
     Princeton, Princeton University Press.
Brandsen, T. and Honingh, M. (2018) Definitions of Co-production and Co-
 Siira et al.                                                                     91
      creation, in T. Brandsen, B. Verschuere and T. Steen (eds.), Co-production
      and Co-creation. Engaging Citizens in Public Services, New York, Routledge,
      pp. 9-17.
Brandsen, T., Trommer, W. and Verschuere, B. (2017) The State and the Recon-
     struction of Civil Society, in "International Review of Administrative Scienc-
     es", 83(4), pp. 676-693.
Charmaz, K. (2014) Constructing Grounded Theory, Thousand Oaks, Sage Publi-
    cations.
Cozza, M., Cusinato, A. and Philippopoulos-Mihalopoulos, A. (2020) Atmosphere
     in Participatory Design, in "Science as Culture", 29(2), pp. 269-292.
European Commission (2011) How to promote active ageing in Europe. EU sup-
     port to local and regional actors. Brussels: European Union. Commitee of the
     Regions.
Emerson, R.M., Fretz, R.I. and Shaw, L.L. (2011) Writing Ethnographic Fieldnotes,
    Chicago, University of Chicago Press.
Gherardi, S. and Rodeschini, G. (2016) Caring as a Collective Knowledgeable Do-
    ing: About Concern and Being Concerned, in "Management Learning", 47 (3),
    pp. 266-284.
Gibson, J.J. (1977) The Theory of Affordances, in R.E. Shaw and J. Bransford
     (eds.), Perceiving, Acting, and Knowing. Hillsdale, N.J. Erlbaum, pp. 67-82.
Give&Take (sd) The Give&Take project, in http://givetake.eu/ (retrieved May 1,
    2019)
Hultin, L. and Mähring, M. (2014) Visualizing Institutional Logics in Sociomaterial
     Practices, in "Information and Organization", 24(3), pp. 129-155.
Lassen, A.J., Bønnelycke, J. and Otto, L. (2015) Innovating for ‘Active Ageing’ in a
      Public–Private Innovation Partnership: Creating Doable Problems and
      Alignment, in "Technological Forecasting and Social Change", 93, pp. 10-18.
Manzini, E. (2014) Making Things Happen: Social Innovation and Design, in "De-
    sign Issues", 30(1), pp. 57-66.
Mol, A. (2008) The Logic of Care: Health and the Problem of Patient Choice, Ab-
     ingdon, Routledge.
Mol, A., Moser, I. and Pols, J. (2010) Care: Putting Practice into Theory, in A. Mol,
     I. Moser, and J. Pols (eds.), Care in Practice: On Tinkering in Clinics, Homes
     And Farms, Bielefeld, Transcript, pp. 7-26.
Mol, A., Moser, I., Piras, E.M., Turrini, M., Pols, J. and Zanutto, A. (2011) Care in
     Practice. On Normativity, Concepts, and Boundaries, in "Tecnoscienza. Ital-
     ian Journal of Science & Technology Studies", 2(1), pp. 73-86.
Orlikowski, W. and Scott, S. (2008) 10 Sociomateriality: Challenging the Separation
     of Technology, Work and Organization, in "The Academy of Management
     Annals", 2(1), pp. 433-474.
Osborne, S. and Strokosch, K. (2013) It Takes Two to Tango? Understanding the
 92                                                              Tecnoscienza – 11 (2)

      Co-production of Public Services by Integrating the Services Management
      and Public Administration Perspectives, in "British Journal Of Management",
      24(1), pp. 31-47.
Östlund, B., Olander, E., Jonsson, O. and Frennert, S. (2015) STS-inspired Design
      to Meet the Challenges of Modern Aging. Welfare Technology as a Tool to
      Promote User Driven Innovations or Another Way to Keep Older Users Hos-
      tage?, in "Technological Forecasting and Social Change" 93, pp. 82-90.
Peine, A. and Neven, L. (2019) From Intervention to Co-constitution: New Direc-
     tions in Theorizing about Aging and Technology, in "The Gerontologist"
     59(1), pp. 15-21.
Pols. J. (2010) Telecare. What Patients Care About, in A. Mol, I. Moser, and J. Pols
      (eds.), Care in Practice: On Tinkering in Clinics, Homes And Farms, Biele-
      feld, Transcript, pp. 171-194.
Pols, J. (2012) Care at a Distance: On the Closeness of Technology, Amsterdam,
      Amsterdam University Press.
Rolandsson, B. (2020) The Emergence of Connected Discretion – Social Media and
     Discretionary Awareness in the Swedish Police, in "Qualitative Research in
     Organisation and Management", 15 (3), pp. 370-387.
Shove, E. (2014) On “The Design of Everyday Life”, in "Tecnoscienza. Italian
     Journal of Science & Technology Studies", 5(2), pp. 33-42.
Star, S.L. (2010) This Is Not a Boundary Object: Reflections on the Origin of a
      Concept, in "Science, Technology, & Human Values", 35(5), pp. 601-617.
Sørensen, E. and Torfing, J. (2011) Enhancing Collaborative Innovation in the Pub-
     lic Sector, in "Administration & Society", 43(8), pp. 842-868.
Yndigegn, S.L. (2016) Managing resistance and negotiating co-design:Reflections
     on troublesome and elusive moments (Doctoral dissertation), IT-University of
     Copenhagen, Denmark.
Wanka, A. and Gallistl, V. (2018) Doing Age in a Digitized World – A Material
    Praxeology of Aging with Technology, in "Frontiers in Sociology" 3(6), pp. 1-
    16.
