This review of the literature was undertaken by Flinders University (SA Community Health Research Unit and Southgate Institute for Health Society & Equity) to provide an overview of changing health promotion communications to inform the Falls Prevention Project of Country Health SA's Local Health Network. Older people can successfully use websites for fall prevention activities, but the percentage of the rural elderly population using the Internet limits the reach of country health services. This review of the literature was conducted for the Country Health SA Local Health Networks Falls Prevention Project by the SA Community Health Research Unit (SACHRU) and the Southgate Institute for Health Society & Equity at Flinders University.
Factors Influencing Consumer Participation in e-Health
In Europe, among non-users of the Internet in 2008, 38% said that they did not need the Internet, the cost of purchasing a computer was too high (for 25%) and the cost of connecting was too high (21%), that they did not have the necessary skills (24%) and security issues deterred them (5%), while in terms of e-health 14% said they simply did not want to use it ( European Commission 2009). An older US study provided 13 low literacy adults (year 3 to year 8 reading levels) with specific difficulties in finding online health information and found that participants did not use optimal search terms, had difficulty finding online. Another study of Internet users found that those with poorer health status and chronic conditions were more likely to be Internet newcomers than those in good health, and that clinicians and eHealth developers needed to develop resources to meet the needs of these group (Houston & Allison 2002).
Nevertheless, some research suggests that people in poorer health are more likely to participate in e-health services, suggesting that they may already be more “addicted to” healthcare systems (Beckjord et al. 2007). Although patients with chronic illness generally have less access to technology, those who do gain Internet access are more likely to seek out health information online than those without a chronic condition (Fox 2007). This may be because those in poorer health, once online, are more extensive users of online health care support, including being ten to thirteen times more likely to participate in online support groups, which also results in more positive health outcomes (Huntington et al. 2004). .
Non-English speakers are also less likely to find eHealth resources that are understandable and meet their needs, given that a significant portion of Internet content is usually in English (Global Reach 2005; Greenstock et al. 2012). An American study showed that Latino Americans often obtained health information from Spanish-speaking 'health care'.
Communication Preferences of Different Population Groups
It appears that individuals who feel that their communication with physicians is not satisfactory or patient-centered (e.g., the physician does not understand their questions or their emotional distress) are more motivated to turn to alternative communication channels, including the Internet (Hou & Shim 2010 ). However, the participants in the study in question were predominantly English, educated, middle-aged Americans who had the means to access the Internet as an alternative source of information. In this group, most (71%) reported that they do not use the Internet to find health information, and this reflected their generally low Internet connectivity at home.
Other barriers to using the Internet and mobile phones (other than receiving incoming calls or sending simple text messages) include lack of trust in telecommunications companies, fear of. People with low health literacy are also less likely to use the Internet (Shieh et al 2009). Other people can also act as proxy users or intermediaries to help consumers with low IT skills access the Internet and other technologies.
A study in central Scotland found that homeless people can successfully integrate the Internet and mobile phones into their daily lives, and that mobile use is much more common than Internet use among homeless people (Buré 2006). It is unclear to what extent people from lower income or disadvantaged groups currently have the finances, skills or motivation to use the Internet on their mobile phones, although it is possible that this will become more feasible as prepaid and subscription contracts for mobile phones continually change to become more favorable include prices for internet, calling and text message use.
Digital Communication in Falls Prevention
Evaluation of the usability and acceptability of a fall prevention website with 16 older adults (primarily white women) and 26 assisted living caregivers found that older adults chose balance training activities for interest and enjoyment (eg, Tai Chi ) and added them to their current routine, while wardens promoted the website to their residents (Nyman & Yardley 2009). However, participants found the website too formal and suggested that more colors and graphics would increase appeal, also noting that the reach of the website was limited as only a minority of older people are internet users (Nyman & Yardley 2009). Another article criticized fall prevention websites for lacking reliability and usability, and for having a presentation style that was not motivating for older people (Bond & Nyman 2010).
A recent US study suggests that tailored falls prevention education is relatively absent from current research, although this has been shown to encourage behavioral changes that reduce fall risk (Schepens, Panzer & Goldberg 2011). ICT is also being used in a variety of formats to support falls prevention physical activity. The use of Wii Fit has been trialled with older people at the repatriation hospital in South Australia (mostly over 85 years, inpatients and women) (Laver et al. 2011).
This study found that despite the widespread use of Wii Fit in rehabilitation units, the usefulness of Wii Fit as a therapy tool with hospitalized older people is limited both by the small proportion of older people who are able to use it and of older people's preferences. for traditional approaches to therapy (Laver et al 2011). The iStoppFalls program is intended to be integrated into the daily life of older people living at home to provide continuous training, fall risk assessment and appropriate feedback mechanisms (iStoppFalls Consortium 2011).
The Rural Health Workforce and e-Health
A review of several examples of health technology use among community health workers in India suggests that any eHealth initiative, if it is to be successful in the long term, must involve health workers in the design and ongoing development of the initiative and technology, rather than being solely led by IT professionals or health professionals. management. Without it, management can encourage initiatives, but workers are left without the motivation or commitment to participate because the initiative is unfeasible in everyday life and does not improve (or hinder) work. The authors also emphasize that the use of information technology in health services must become sustainable and maintain intrinsic motivation.
A recent study in regional Australia found that staff in non-governmental organizations (NGOs) perform an "ICT facilitator role" in addition to their normal work, spending time helping disadvantaged and vulnerable clients access, download and collect online information (Notara 2011). . The study found that few NGOs see ICT delivery as part of their work/service delivery and highlighted the need for specific funding to train staff in IT skills and use and to allocate time for community workers to use ICT in their work as well . as in customer assistance (Notara 2011). Another recent Australian study also notes the emerging role of the health professional as mediator and that this has significant implications for job roles and training (Greenstock et al 2012).
A study by Notare (2011) also highlighted problems with the persistent lack of IT infrastructure in regional areas, including basic connectivity and capacity. The telcos also noted that 'telehealth offers great potential in delivering health care in rural and remote areas, but there are barriers to systemic adoption, so the National Digital Productivity Expert Council's work program should include understanding and addressing potential barriers to delivering regional services for the adoption of telehealth – such as access and technological limitations, interoperability, the need for a national telehealth directory and the digital literacy of GPs (DBCDE 2012:9).
Recommendations for CHSA LHN’s Falls Prevention Project in the Digital Era
In summary, it is important to consider how any changes in communication formats impact the five key elements of access to healthcare. Bauer (2003) considers similar elements as essential when considering e-health in rural areas: accessibility, availability, efficiency, quality. and fairness, and argues that it may be necessary to make a trade-off between these elements, especially in light of the shortage of health workers in rural areas. Country Health SA LHN may wish to consider recommendations from a national US conference, organized by the American Medical Informatics Association, that agencies should consider opportunities to advocate at the policy level for standards supporting consumer equity in the accessibility of health information and communication, as communication is increasingly online (Chang et al. 2003).
A user-centered approach is proposed that places health consumers' needs, preferences, capacities, values and goals at the center rather than the periphery of eHealth, where consumers are involved in the design of eHealth tools; different consumers contribute to evaluating, selecting and using eHealth tools. Excitement about e-health opportunities masks more access issues for those without mainstream health sources and who are not Internet users. Do healthcare organizations and professionals have an obligation to promote access to eHealth systems for those who cannot afford to purchase access themselves.
As some eHealth services may be more likely to benefit highly educated and young people, they should not be favored at the expense of existing frontline services, unless equity issues can be addressed (EuroHealthNet n.d. ). Since those groups in society who are least likely to have easy access to the Internet (eg the elderly, rural, disabled or unemployed) are also those who are most likely to need more health services, it should be a top priority to promote access to and the benefits derived from e-health services for such groups and find ways to.
Espanha R & Lupiáñez-Villanueva F, Health and the internet: autonomy of the user', in Cardoso G, Cheong A & Cole J (Eds) (2009). The general public's use of (and attitudes towards) interactive, personalized digital health information and advice services. Neter E, Brainin E (2012), 'eHealth literacy: Extending the digital divide to the realm of health information', Journal of Medical Internet Research, 14(1):e19.
Active Aging & Employment – Summary of Research Evidence for Health in All Policies and Health Network of the Local SA Health Site. Perceptions of traditional information sources and use of the World Wide Web to seek health information: findings from the National Health Information Trend Survey. Presentation at the 3rd National Conference of the Australian Consumer Communications Action Network, Sydney, 5-6 September.
The quality of English-language websites offering falls prevention advice to older members of the public and their families. Using health access status as a way to more effectively target segments of the Latino audience, Health Education Research.
