An investigation of the means of making eHealth more relevant to low socioeconomic communities

Dart, Jared Magnus (2006). An investigation of the means of making eHealth more relevant to low socioeconomic communities PhD Thesis, School of Medicine , University of Queensland.

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Author Dart, Jared Magnus
Thesis Title An investigation of the means of making eHealth more relevant to low socioeconomic communities
School, Centre or Institute School of Medicine
Institution University of Queensland
Publication date 2006
Thesis type PhD Thesis
Supervisor Prof Cindy Gallois
Abstract/Summary This thesis project investigated the means of making eHealth more relevant to low socioeconomic status (SES) communities. As with other information and communication technology (ICT) based initiatives, the uptake of eHealth is limited by access to technology. Online health information may be a means of providing increased access to health information. However, access to online health information and health information in general is disparate amongst sections of the populations. Middle and high SES communities, as well as the well-educated generally have high access to health information yet paradoxically they are less affected by modifiable/preventable diseases which can be influenced by effective health education. Therefore the challenge for health education and eHealth is how to reach those in low SES communities. This thesis employed three phases of research to answer this question. The first phase of the project investigated means of providing community based access to ICT in very low SES communities in India in order to provide data as to how such community based structures might deliver community oriented health information. The second phase investigated an online community portal to establish whether this would be a useful means of contextualising online health information and whether it could be the online counterpart to the community based ICT structures investigated in phase one. Phase three sought to determine what types of health information community members from various SES communities wanted and how their preferences as well as those of medical students might affect the design of a community eHealth approach. This thesis employed case study methodology to provide rich qualitative data in an area of research which is highly influenced by socioeconomic, socio-political and personal factors. The case studies which focused heavily on direct observation and key informant interviews as well as document analysis in turn informed the development of a series of community and medical student surveys which sought to provide a broader sample of opinions as well as quantitative data. The first phase investigated several community based ICT strategies – a hub and spokes telecentre model, a similar but less tightly structured model which employed a community portal, and a mobile community access point - to determine how they might be utilised to facilitate eHealth uptake in low SES communities. These field studies, based in India, found that a ‘hub and spokes’ model with peripheral field sites supported by a central knowledge hub would be a useful model to facilitate the delivery of appropriate health information. Information intermediaries at these peripheral sites could occupy a key role in delivering health information in an appropriate manner, as well as training individuals how to access appropriate health information independently. In addition, these studies identified a number of features necessary for a community based ICT access strategy employed for eHealth purposes. Making information relevant to the local context, as well as facilitating community access to health information, has been a challenge to the eHealth and wider health community. One means of achieving this employed by the UNITeS case study in phase one was an online community portal that delivers information relevant to a defined geographical area. The second phase of this project investigated the application of a non-health oriented community portal in a low SES community in South East Queensland, Australia, in order to determine how such a structure might be applied for eHealth purposes. This study demonstrated that there are significant problems associated with community members initiating and administering a community portal, especially regarding financial constraints and access to appropriate infrastructure. However, there are also a number of potential benefits of such a localising strategy being employed for eHealth. It is a useful means of contextualising information and providing access to practical information about local health resources; it may provide a recognisable contact point for health information seekers mediating their access to relevant and accurate online health information; and it provides greater proximity to community members and information seekers than a national health information portal. The third phase of research characterised the current health information environment in a low SES community and compared it to a mid-high socioeconomic SES community and to university students and staff. Through field work which included direct observation, key informant interviews, and surveys I explored the community demand for more health information, the current and preferred future use of health information sources, ascribed importance and trust of health information sources, the use of the local doctor as a source of health information, and the use of the internet for health information seeking. Results indicated a demand across all three communities for more health information, a remarkable concordance in the use of health information sources other than the internet, and that the local doctor is the most important and preferred source of health information. In addition, the research highlighted the importance of proxy health information seeking and the infrequent actual use of the doctor as a source of health information, despite community demand for more health information and stated preference for information from this source. The research also investigated the community’s requirements for a community eHealth strategy through key informant interviews in a low SES community, as well as through the survey research described above. Results revealed that community members’ requirements differed between the low and mid-high socioeconomic communities as well as from university students and staff. This was in part influenced by exposure to the internet as a source of health information, but also to the information needs of the various communities. This finding, not previously demonstrated in the eHealth literature, illustrates the need for a community specific approach. The survey results, thus, offer valuable guidance for the development of such an approach. Lastly, this project investigated the attitudes of medical students – the doctors of the future – to the current health education environment in which they are to practise, to the priority eHealth policies, and to potential components of a community oriented eHealth strategy. I found that most medical students believed that the current health system did not allow them to educate patients about their health issues, and that the principal constraint was inadequate time. Results indicated that the majority of students supported a patient information prescription system and community health portal to facilitate health information delivery, as well as delineating their attitudes to the various types of health information which should be provided by such a system. The final chapter presents a model for a community eHealth system which incorporates the findings of this research and addresses the needs identified through stakeholder consultation, as well as identifying areas for future research, including an action research project investigating a community oriented eHealth architecture. The model identified includes components for community based and hospital based delivery of health information; a means for keeping the clinician engaged with the health information process, fulfilling their role as coordinators of health care whilst allowing auxiliary health personnel to deliver basic health information; as well as an online means of coordinating the delivery of health information identified as important by community members. Specific, complex patient oriented health information should remain the domain of clinicians. This research has several limitations largely stemming from the fact that it is highly novel and covers a broad research area. As a result, a lot of the research is exploratory and raises many more questions than it answers. Nevertheless, it is a unique contribution to an internationally neglected area of research.

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