Empowering health, integrating privacy: a value-reflexive examination of smart health technologies

A long-standing assumption in health information technology research is that health empowerment comes at the expense of privacy, a trade-off that has shaped how Smart Health Monitoring Systems (SHMSs) are designed, adopted, and studied. Yet, this framing overlooks the growing need to design technologies that enable empowerment without eroding trust, obscuring how privacy and empowerment can be integrated rather than opposed. In this study, we challenge the trade-off model by conducting a value-reflexive examination of SHMS use, grounded in a Value Sensitive Design ontological perspective. We reconceptualise privacy not as a constraint but as an embedded dimension of autonomy, solidarity, and authenticity that constitute empowerment. Through a mixed-methods study of SHMS users, we show that privacy concerns vary by life stage and health context, and that privacy-preserving features can strengthen empowerment. Our findings advance a value-integrated model of SHMS adoption that embeds privacy as a constitutive element of empowerment.