JMIR Publications

ABSTRACT

Healthcare is undergoing rapid change due to digitalization, artificial intelligence, data-driven decision-making and shifting patient needs. These developments raise complex ethical, social and organizational questions that cannot always be addressed by conventional research methods alone. There is a growing need for tools that help stakeholders imagine alternative futures to surface underlying values. Futures studies and speculative fiction respond to this need by presenting “what if” scenarios that make uncertain futures concrete and discussable, enabling dialogue among diverse stakeholders such as healthcare professionals, researchers, policymakers, and decision-makers. This paper examines how speculative fiction can be used as a structured yet imaginative tool in healthcare research. It positions speculative fiction as a tool within futures studies and participatory research approaches, outlining its conceptual grounding and clarifying its role that stimulates interpretation and reflection within methods such as focus groups, workshops, and surveys. In this way, speculative fiction complements established approaches such as human-centered design, contextual inquiry and value specification by addressing what does not yet exist and making abstract future issues tangible. The paper presents a case study, The Digital Data Divide, in which speculative fiction was used to explore the use of personal data in healthcare. Two contrasting short films were developed to stimulate dialogue and invite participants to reflect on associated values. Insights from this case are structured into six practical steps: determining whether speculative fiction fits the research aim, choosing an appropriate form of speculative fiction, creating or selecting speculative scenarios, engaging participants, analyzing responses, and sharing results. Across these steps, the paper discusses methodological and ethical considerations, including alignment between scenarios and study aims, balancing utopian and dystopian elements, questions of plausibility and interpretability, and the need for researcher reflexivity. Overall, this paper contributes to the growing discussion on future-oriented tools in healthcare research by showing how speculative fiction can help address complex and uncertain challenges in ways that are accessible to a wide range of stakeholders and that support dialogue across perspectives, provided that its use is ethically transparent, methodologically explicit and carefully reported. The paper concludes with a call to other researchers to also experiment with speculative fiction and to share their experiences with the healthcare research community to learn and advance its use.