IntroductionPolicy discussions reference ideas of informed and active users of eâhealth services who gain agency through selfâmanagement, choice and care delivered outside clinical settings. In this article, we aim to problematize this association by âthinking withâ material from multiple disciplines to generate higher order insights to inform service development, research and policy.MethodsDrawing on metaânarrative review methods, we gathered perspectives from multiple disciplines using an iterative process of expert consultation to identify seminal papers citation mapping, synthesis and peer review.ResultsWe identify six relevant paradigms from sociology, philosophy, health services research, public health, the study of social movements and computer studies. Bringing these paradigms together illuminates the contrasting epistemological and ontological framings that coâexist in this area, including competing conceptualizations of eâhealth technologies as: neutral tools for service delivery, mediators within complex and unpredictable clinical interactions and as agents in their own right.DiscussionThere is a need for eâhealth policy to recognize many human and nonâhuman actors, the blurred boundaries between them and the unpredictable and evolving interactions that constitute engagement with eâhealth care. Established models for eâhealth service development and policy making are not designed for this landscape. There is nothing to be gained by asking whether eâhealth, in general, either âincreasesâ or âdecreasesâ agency. Rather specific types and aspects of eâhealth have diverse effects and can be simultaneously enabling and disempowering, and be differentially experienced by differently positioned and resourced actors.