Mediated care: exploring institutional courses of action in instant group messaging in pediatric rehabilitation

Abstract Instant messaging (IM) has become an integral part of professional communication in the Netherlands, yet its role in institutional interaction remains understudied. This study examines IM in pediatric rehabilitation, where professionals and parents of children with developmental disabilities use IM to communicate and collaborate. Our data comprises naturally occurring IM group chats in Siilo, an instant messaging (IM) app designed for healthcare professionals. The chats we studied were group chat exchanges between three pairs of parents and multiple paramedical health care professionals over a period of three months. Using a qualitative approach based on digital conversation analysis, we identify four key courses of action accomplished in IM interaction: (1) continuous progress reporting; (2) instructing parents on implementing care at home; (3) integrating children’s experiences into therapy; and (4) displaying and transferring responsibilities. Our findings demonstrate that IM extends communication beyond clinical settings, facilitating real-time interaction, asynchronous coordination, and multimedia-enhanced collaboration. This allows for a more dynamic and responsive caregiving process, bridging institutional and home environments. However, it also raises questions about communicative burdens and professional boundaries. By situating IM use within an affordance framework, this study contributes to a deeper understanding of mediated communication in healthcare contexts.