Based on our analysis, we identified resonance (Rosa 2019) as a salient pattern underlying all further engagement with a certain health topic. The reconstruction was based on participants’ resonance with a specific health information in a certain situation, which was then photographed. First, during the diary phase, participants chose the situations they photographed themselves, according to their attention and connection with the encountered health information in the world. Later, for the interviews, participants again chose three pictures out of their individual collection according to what Barthes (1986) calls the punctum (that which captures the interest) of the image.

Typification of images/content frames

The analysis of the 25 photographs elaborated on in the interviews led to the reconstruction of different types of orientation frames employed by the providers of the picture content. Formulating and reflecting interpretations as well as comparative analysis between cases allowed the reconstruction of the following six orientation frame types (see Fig. 2).

Fig. 2

This figure depicts the reflective interpretations and key narratives of image content and the built typology of content frames of the images

Firstly, a do it yourself (DIY) frame was identified, encouraging viewers to take action and create self-made solutions. An exemplary photograph for this frame is an Instagram screenshot of an advertisement posting by hellofresh.de, a German meal delivery company (Appendix, Data-ID: 54_211127_TBS04f). The posting’s title roughly translates to “Four herbal do it yourself home remedies against a cold”.

Secondly, a manipulation frame was observed, triggering or playing in lurid ways with peoples’ conception of being manipulated by the government or the system. An exemplary photograph shows a screenshot of the start page of e-mail provider gmx.de during the coronavirus pandemic (Appendix Data-ID: 5_211112_TBS06a). The title can be translated as “Head of WHO calls refresher vaccinations for healthy people a scandal”.

Thirdly, an optimization frame was identified, referring to numerous aspects of lifestyle, body, and mental health issues, suggesting that people can optimize and do even better. Exemplary for this frame is a screenshot of a commercial on Instagram. The commercial picture promotes an over-the-counter menopause product Serelys by the German company AVIVA PHARM GmbH titled “Naturally through menopause” (Appendix Data-ID: 4_211113_TBS04d).

Fourthly, there was a naturalness frame, which promotes herbal and natural products for health and well-being as opposed to industrial products. An exemplary photograph depicts a screenshot of a chatgroup, telegram messenger. The picture (Appendix Data-ID: 2_211111_TBS02a) shows two glasses of water with several slices of lemon accompanied by a short text arguing to drink lemon water every morning to reduce toxins in the body and regulate the kidney and bowel systems.

Furthermore, a fifth frame was identified. The security/protection frame plays with possible anxieties, but also the individual responsibility to take action and protect one’s health. An exemplary picture is a screenshot of an Instagram commercial by Nervoregin, which indicates that persistent sleep disorders weaken the immune system (Appendix Data-ID: 9_211113_TBS04i). Hence, protecting the immune system using the product Nervoregin is suggested to prevent such  weakening.

Lastly, there was a conformity frame, relating to people following rules and complying with standardized evidence-based narrations of health. An exemplary picture is the photograph of a magazine article with the subtitle “With globuli against Corona, this is how homeopathy becomes a deadly danger” (Appendix Data-ID: 27_211121_TBS08b).

Typification of appraisal patterns

The following analysis focuses on the reconstruction of appraisal patterns and respective consequences for action. The reconstruction does not refer to individual opinions, attitudes, or psychological mechanisms for appraisals. Rather, the reconstructive process carves out concepts, paradigms, and societal logics, which the appraisals touch upon. It was possible to reconstruct four meaning-genetic evaluation types, namely control, confidence, optimization, and responsibility. Furthermore, different approaches of action on how to engage with these encounters were identified: defence/acceptance, empowerment, protection, and reflection (see Fig. 3).

Fig. 3

This figure depicts the typification of appraisals to health information: control, optimization, responsibility, and confidence

Control Being controlled

By comparing and contrasting reconstructed appraisal patterns between cases, superordinate categories of patterns were carved out.

Reflecting formulations carry concepts like coercion, information overload, and manipulation in the context of encountering health-related topics in everyday life. In particular, in relation to advertisement, it seemed inevitable to encounter health-related content which was expressed in relation to a feeling of overload. Others encountered health information in relation to a strong perception of manipulation. When elaborating on the diary entry, regarding the Serelys menopause product (Appendix Data-ID: 4_211113_TBS04d), a female participant expressed her discomfort when randomly being confronted with a health topic on Instagram she regards as personally sensitive:

"But I found it very interesting that, in their opinion (,) they know how old I am on Instagram, right? Uh, that they think they have to show me this advertisement now. I haven't looked into the product. […]" (TBS04, 44–49)

"I don't want to say that I have a huge problem with age, but I'm not really thrilled that I'm already over 40. I still live my life the way I have for the last 20 years, so it's just a number. But I don’t appreciate being confronted with it. It's like that for me (.) yes, by the way, remember, soon it will be your turn too. Of course, it's all in my head, I know that, right? Others laugh about it and don't care, but I found that somehow, (.) yes. This is not about a cold […]." (TBS04, 66–101)

When talking about this picture in the interview, the respondent reflected on the previous media behaviour on an abstract level and found social media algorithms to be manipulative. The participant claimed to not having actively engaged with this topic herself, and assumed direct algorithmic targeting due to her age. From the participant’s perspective, she was targeted due to algorithmic categorization, which imposed this topic onto her and therefore influenced how this female participant felt about her body and age in that situation. Hence, the Instagram algorithm controls the narrative of a healthy, vital female body, whilst the participant as an Instagram user cannot control the algorithm-based displayed content.

Thus, a dissonance between the experienced state of one’s own body and numerical age versus the experienced categorization of the Instagram algorithm is expressed. The algorithmic categorization and its implications led to strong rejection towards this categorization. For the purposes of the paper, this action shall be called defence. In this particular case, the direction of defence targets algorithmic control over the individual conceptualization of one’s own health and body.

Since the separate and initial documentary analysis process of the picture itself carved out a content frame called optimization, the participant’s rejection or defence against the algorithmic categorization can further be read as a defence against a perceived optimization pressure regarding natural physical occurrences and changes.

Being in control

As opposed to being manipulated and controlled by health information, the reconstructive process carved out yet a different dimension. Whilst some participants appraised random encounters with health information in terms of being controlled, others did so in relation to gaining or being in control.

The diary photograph of a leaflet named “Learning how to give care at home: individual trainings and courses for care-giving relatives” (Appendix Data-ID: 5_211115_TBS10a) resonated with an adult woman in a caregiving situation, who lives in a socio-economically marginalized neighborhood, speaks Kurdish as a first language, and learned German as an adult.

“Uh, how we learn to give care at home. Uh, that at the moment so many of us or of our family who need care like that. And I would like to/ want to (.) I don’t like a stranger to take over care-giving, like for example, in an old people's home. Also, especially with us, in our tradition […] And that's why I find, when you find information like that about care, uh (,) for example, my father now, he lives alone, uh was in the situation that he needs a uh care (.) Or so/ so slowly that we deal with, uh what kind of caretaking will he need later/ what could you do in what situation, what should I do now. […]" (TBS10, 216-264)

The reconstructive process carved out an orientation frame for the encounter with this information based on reflective interpretations regarding self-determination and participation. The above-mentioned respondent indicated during the interview that she saw the leaflet on a visit to a friend, who works in a senior citizens office and took it with her to read it in her own time at home. This way she was able to take the time she needed to familiarize herself with the content and information in the German language. Due to the short brochure character of the information, she could share the content knowledge with her community and family. On a second level, this information led to an action the authors called self-empowerment, as the information posed an opportunity to fulfil her wish to take care of her elderly father, who lives in Germany as well and has little German language skills.

Hence, the information is appraised in relation to being in control of health and health-related practices due to self-determination and participation. The appraisal of being in control was nourished by being able to understand the information and being able to generate knowledge through language access.

Therefore, the appraisal pattern regarding being in control or being without control was unified in the orientation frame of control, which includes polarizing dimensions.

Optimization

The concept of optimization was reconstructed as an ambiguous orientation frame regarding health information in everyday life. On the one hand, this frame communicates a narrative of improvement regarding the self, the body, and personal health status. On the other, the reconstructive process also carved out a multidimensional appraisal pattern regarding encounters with random health information in relation to optimization.

However, the reconstructive process of appraisals also carved out a multidimensional appraisal pattern regarding encounters with random health information on the receivers’ side in relation to optimization. The orientation frame was reconstructed via reflecting interpretations regarding the impulse for optimization and self-improvement in relation to physical fitness and body shape, or the compensation for physical weaknesses. Furthermore, technological devices and tools were appraised as optimizing for the arrangement of sports training. Additionally, the adaption to socially desired health standards was appraised in relation to optimization.

Responsibility

Furthermore, the reflecting interpretations led to the reconstruction of yet another appraisal pattern, namely responsibility. Reflecting interpretations regarding the prevention of illness and provision of health information and participation were the underlying basis for the reconstruction of this appraisal pattern. The appraisal pattern of preventing illness was associated with an individual responsibility, while the provision of health information and participation in health practices were associated with the system’s responsibility.

Exemplary for this appraisal pattern is a photograph that a male participant took in the gym (Appendix Data-ID: 4_2111_TBS09c). It shows a gym promotion poster which is titled “Health isn’t everything, but without health, everything is nothing”. Underneath the slogan, the poster depicts the new reduced price for signing a membership at the gym. In the background, young people are depicted in a group workout, kicking the right leg into the air in a fighting position. The male participant was in fact already a member in this gym and encountered this poster on his way out after a workout. The participant appraised the poster in relation to an individual responsibility for fitness, health, and prevention of serious illness. The respondent focused on benefits of physical activity for the body and mind, implying that activity and health in life need training. The idea of training and strengthening fitness, and therefore health, but also compensation of lifestyle, can be read in terms of the poster content pattern of optimization. The action that follows the appraisal of responsibility is an urgency to protect and secure health, whilst understanding this activity as his individual and personal responsibility.

Confidence

Confidence as an appraisal pattern was reconstructed based on reflecting interpretations in relation to trust and mistrust in health content. Whereas some reflections regarded trust in the health care system and trust in resonance with a theme, others regarded mistrust in media coverage and public debate (especially in the context of the coronavirus pandemic) as well as  mistrust in health technology. Hence, the reconstruction of this appraisal pattern showed high ambivalence and multi-dimensionality.

On a forest walk, the female participant encountered health information concerning African swine fever (Appendix Data-ID: 9_211112_TSB08b). The information board gave written information in several languages and was posted by the German Federal Ministry of Food and Agriculture. In the interview, the participant claimed strong trust in the ministry as a source for health information. The participant trusted the governmental warning and information as well as recommendations for action. This appraisal further strengthened the construction of an action pattern, called acceptance. The picture of the information board was associated with the protection and security frame. Hence, it indicates that information in the protection and security frame seems to be accepted in relation confidence in the content (see Fig. 3).

On the other hand, a female participant encountered an advertisement for a pelvic floor fitness device in a shopping magazine, deposited  in her home letter box. When flipping through the pages, she saw the advertisement titled “Pelvic Floor Fitness 2.0” (Appendix Data-ID: 3_211119_TBS03a) advertising a training toy that might help with incontinence and improve sexual pleasure. The photograph shows the informative text and below three smartphone screens with different features of the accompanying app.

"It's basically information that's worth double-checking for me. Well, not this one in particular, they already call it a “toy”. Um (...), if you call something a toy, for me that's a sign, um, that it's, um, more of a toy. Because that's the translation for it. I find that a bit inappropriate to be honest. If it's about health issues and if this thing costs €129 and it is supposed to support me, then it can't be a toy." (TBS03, 141-144)

The appraisal at hand was mistrust. The participant wondered about the use and placement of the word toy; the Anglicism was also used in the German text. The connection of health information in the magazine under a medically connotated title led to dissonance with the displayed playfulness of the device. Hence, the information itself seemed less credible and was met with mistrust. Whilst the content of the picture was categorized with the optimization frame, the appraisal pattern of mistrust towards the perceived optimization narration of the female body, especially the pelvic floor, for medical and sexual reasons was rejected.

Reconstructing conjunctive spaces of experience

In line with the overall goal of the documentary method, shared conjunctive knowledge was reconstructed through the appraisal patterns of random encounters with health information. The data showed that encounters with health representation in everyday life are not restricted to self-imposed search attempts or discussions with health professionals, but can just as well be random, unexpected, or even unwanted in everyday life situations.

Through the processes of comparing and contrasting cases, a typification of appraisal patterns was built: control, optimization, responsibility, and confidence. Contrasting and comparing the appraisal patterns with picture content frames indicated different ambiguities regarding the relationship between receivers and content.

Firstly, appraisals regarding the orientation frame of control (control frame appraisals) were retrieved in relation to picture content frames like protection and safety, optimization, manipulation, do it yourself (DIY), and conformity. Those relations indicate that health content frames like protecting and optimizing one’s health transport a narrative of a possible controllability of health. This controllability might protect one’s health just as well as it might be misused or manipulative.

Secondly, optimization frame appraisals were retrieved from photograph content frames like optimization and conformity. This appraisal pattern might be read in relation to the controllability frame, since the possibility to optimize health implies the general controllability and effectivity of an individual’s action on health. However, the reconstruction of this pattern based on content frames like conformity might indicate a perceived optimization pressure.

Thirdly, the responsibility frame appraisals were connected with picture content frames like optimization, protection, and security, as well as  DIY. This uncovers a perceived or experienced responsibility to optimize health, to protect, and secure one’s health. Additionally, it exposes the narrative of responsible action, or rather, responsibility to take action oneself and to do it yourself. Lastly, the confidence frame appraisals (trust and mistrust) were reconstructed in relation to picture content frames like optimization, protection and security, naturalness, conformity, and DIY. In this case, the immanent ambiguity of this appraisal pattern, which stretches from trust to mistrust, is directed at picture contents that confront the receivers with narratives like optimization but also naturalness.

Through this reconstructive process, a shared experience-based knowledge was uncovered, which shall be called the narrative of individual responsibility for vitality. The reconstructed content patterns demonstrate the scopes for action, but also in relation to optimization, protection and security, and conformity. Furthermore, the typology itself indicates a common experience relating to controllability of one’s own health and scope for action. Therefore, the reconstructed common conjunctive knowledge shall be described as a shared perceived ambiguity between a feeling of individual responsibility for one’s health and a feeling of limited control over the scope for action to actually take this responsibility. Nevertheless, the shared feeling regarding individual responsibility for health refers to the narrative of striving for an optimum when it comes to a healthy and vital life. It seems that within the shared experience-based knowledge, the narrative of responsibility regarding health is somehow related to a conviction that health as a physical entity has an optimum (see Fig. 4).

Fig. 4

This figure depicts the overall reconstruction of conjunctive spaces as described in the text