‘That’s when we start being analogue’: Mitigating digital harms through street-level service provision

Background Across the world, public services including health services are increasingly digitalized, offering both new opportunities for harm reduction service provision, but also creating new barriers to services for structurally vulnerable people who use drugs. This article offers an examination of the effects of digitalization for street-level service providers in Denmark, which has one of the most digitalized public sectors in the world. Methods Using a multi-method qualitative approach, the study combines interviews, focus groups, field observations and a participatory workshop with service providers to explore how digitalized service systems shape street-level practices and efforts to mitigate barriers to digitalized services. Findings Street-level service providers describe unique harms experienced by structurally vulnerable people who use drugs as a result of rapid digitalization of public services. These include infrastructural harms that emerge at the intersection of risk environments and digital infrastructures, unequal access to the technologies required to access digital platforms, new demands on service providers’ everyday work organization and digital competences, a reduced space for the complexity and lived experience of structurally vulnerable people who use drugs in digital services, and the risk of rights-related harms and service exclusion. To mitigate these, service providers engage in a wide range of everyday digital harm reduction practices, including carving out alternative analogue pathways to services, selective rule-bending to secure access to digitalized services, mediating stigmatizing service encounters and rights-affirming practices. Conclusion The mitigation of digital harms has come to comprise a central part of street-level outreach work. While this adds new administrative burdens for service providers, this is often invisible work, carried out on an ad hoc level. This underscores the need for policy attention to vulnerable populations in public sector digitalization strategies, and for structural and inclusive interventions that counter digital harms experienced by structurally vulnerable people who use drugs.