A major challenge in the design of useful technological tools is effectively conceptualizing the context in which users engage the technology. Contextually specific research on activities of patients and their caregivers - and how those activities are supported by social and material arrangements - can result in insights for design of consumer health informatics technologies and infrastructural advancements that can better support patients outside of institutional settings. This chapter describes an ecosystem focused on activity – how activity is shaped by cultural institutions, and the negotiations that arise between actors and institutions.