A Multisensory Literacy Approach to Biomedical Healthcare Technologies: Aural, Tactile, and Visual Layered Health Literacies

Western medicine tends to separate disease from the bodily and lived experience of having an illness. This perspective seeks out specific etiologies and pathologies for diseases by fragmenting, monitoring, and externalizing the body as a passive object: blood is drawn, tissue samples are collected, CT scans and X-rays are taken, blood sugar levels are monitored, vaccines and immunizations are administered. Through these healthcare practices (many of which are considered routine, preventative care in Western cultures), patients are continually studied, analyzed, and assessed, enacting the clinical gaze that Michel Foucault (1973/2012) described. Thus, patients' health and their understanding of their health becomes separated from their own sensorial experiences.

Healthcare technologies can enable and hasten such artificial separations by facilitating this fragmentation, by communicating data about the body's individual parts, by downplaying the ways that these parts function as a whole, and by disconnecting the body from its sensorium—the interconnectedness of its senses and sensibilities. In other words, fluids, cells, bones, and systems, too, typically become compartmentalized into their own artificial separations. This disconnect between health, disease/illness, and bodily experience, both implicit and explicit, is further reinforced by a narrow, static understanding of health literacy, which has tended to focus on the acquisition of alphabetic literacies as demonstrated in our literature review, The Evolving Landscape of Health Literacies.

As rhetoricians of health and medicine we "offer a unique viewpoint on how to communicate and educate" by lending insight into the ways that "discourse is created, used, disseminated, and also critiqued" (Meloncon & Frost, 2015, p. 9). Through our critique of the healthcare technologies we analyze in this webtext, our discussion suggests that public audiences demonstrate varying levels of healthcare-related expertise and that such competencies play a key role in the ways that patients engage in health literacy practices. We propose that a definition of health literacy that engages and requires aural (Kristin Marie Bivens), tactile (Lora Arduser), and visual (Candice A. Welhausen) literacies can mitigate such artificial separations. More specifically, we explore these "layers" to investigate the ways that non-expert and lay expert audiences enact non-discursive literacies through three healthcare technologies—physiological monitors, insulin pump systems, and flu maps, respectively.

We contend that the literacies that users engage in through these health-related technologies are shaped in both discreet and overt ways by Western medicine, which in turn influences how these audiences enact agency through aural, tactile, and visual health literacy practices. To this end, our case studies offer a multisensorial, embodied definition of health literacy, as well as a question-oriented heuristic, which we outline in more detail below.

We suggest our work aligns with other efforts to problematize the idea of literacy, such as Marilyn Cooper's (2000) understanding that "writing [and thus literacy as well] is an embodied interaction with other beings and our environments" (p. 18). Our work also connects to Cynthia Selfe's (1999) argument that technological literacies involve much more than functional skills as they necessarily involve a "complex set of socially and culturally situated values, practices, and skills" (p. 11). As our case studies demonstrate, health literacy practices reveal similar complexities.

Our heuristic offers a multisensorial health literacy framework that both technical communicators and medical rhetoricians can draw from to better understand and assess how users might engage aural, tactile, and visual literacies with health-related technologies.

• What previous experiences does the user have with the healthcare technology? Are there routine practices they engage in with the healthcare technology?
• What will the user hear, feel, and/or see when using the healthcare technology?
• What is the user expected to do when they hear, feel, and/or see the healthcare technology?
• Can the user manipulate the healthcare technology? If yes, how so?
• What possible effects could the user experience by manipulating the healthcare technology?
• Ideally, how would a user respond if the healthcare technology made a sound, produced an image, or required tactile manipulation?
• What are the creator's aural, tactile, and visual expectations for users and the healthcare technology?
• How flexible or hackable is the technology? And how can/might users modify or hack the healthcare technology aurally, tactilely, and/or visually to meet their goals?
• What user expectations do you think creators have in mind for the healthcare technology?

Our heuristic's questions are not meant to be comprehensive or exhaustive. Indeed, through this heuristic, we provide an orienting process for technical communicators and medical rhetoricians to consider the ways non-expert and lay expert users experience healthcare technologies through the sensorial literacies we explore. Further, future research in technical communication might examine the kinds of aural, tactile, and visual literacies patients draw from in different healthcare scenarios and their associated technologies in the provision of routine care (like undergoing dental x-rays, blood draws, and/or screening mammography), which can lend insight into the strategies that creators and healthcare professionals might use when designing or providing health-related information to patients. Using our heuristic's questions can also provide opportunities for technical communication and medical rhetoric scholars to interrogate complex healthcare contexts and consider aural, tactile, and visual embodied, sensorial health literacy practices.