Who Gets Care, When, and How: Responsibility Articulation in Platform-Mediated Health Communication

Across the United States, communities are shifting from fragmented care to local care networks (LCNs), which are interorganizational networks of health and human services (e.g., Community Care Hubs, Systems of Care) that use community referral platforms (CRPs), digital systems that connect organizations for service delivery. Fragmentation occurs when a client or patient's care is delivered across multiple uncoordinated providers and facilities. As CRPs evolve and services digitize, understanding their impact on responsibility sharing becomes crucial. This study employs articulation work theory to analyze how workers coordinate and negotiate roles within LCNs. It draws on 13 interviews with frontline workers in Chicago who utilize CRPs to investigate the impact of CRP use on health communication tasks within networked care. Using an abductive approach, the findings reveal that typical types of articulation work, namely task, relational, emotional, infrastructural, and temporal, are present in LCNs. Most notably, this study introduces responsibility articulation, a sociotechnical and communicative process through which frontline workers and digital referral platforms shape how care is communicated, coordinated, and made accessible to communities. Through this process, information about clients' needs is translated into system-recognizable cases that can be accepted, delayed, redirected, or rejected. In turn, responsibility for care is assigned, negotiated, limited, or refused across workers, organizations, and technologies. These findings demonstrate that CRPs do more than support coordination between institutions. They also influence health communication about access, eligibility, and response, with important implications for serving vulnerable populations in healthcare and community settings.