Thursday 30 October 2014

Digital and Healthcare Divide (Essay Final draft)

In his TED talk, Molinari (2011) asserts the digital divide is a “new illiteracy”, and it occurs due to people not being able to afford the technology, lacking the skills of using it, and being unaware of the benefits. Having access to Internet should be a right in the digitally revolutionised 21st century as we are unable to operate without it.

Singapore has worked her way up to being one of the most connected countries in this highly digitalised world. However, there are still minority groups in Singapore, such as the elderly who lack the skills to access the Internet. This has caused repercussions for the elderly such as the decrease in efficacy of healthcare treatments. To resolve this, medical institutions will have to provide healthcare information actively, and government agencies can come up with Information Communication Technology (ICT) bridging courses.

According to Infocomm Development Authority of Singapore (iDA) (n.d.c), with Residential Wired Broadband Household Penetration Rate of 106.7% in June 2013, Singapore has positioned herself as one of the most connected countries in the world. However, digital divide still exists. Even with a broadband penetration rate of more than 100%, according iDA (2013) only 84% of the households actually have access to the Internet. While some households are subscribing to multiple broadband lines, others simply cannot afford it. Even if the household are subscribed to broadband lines, there are people, such as the elderly, who lack the required skills to use it. According to iDA (n.d.a), in 2012, only 16% of the people above 60 years old were using the Internet. The elderly who lack access to the Internet is therefore deprived of vital information for aspects such as healthcare. Healthcare information is extremely important for the elderly to allow them to make informed decisions regarding their health.

Lustria, Smith and Hinnant (2011) discuss the importance of having access to health information. In their research, they demonstrate that many studies have shown the various benefits of having access to health information. In another study, Fox and Purcell (2010 as cited in Lockwood et al 2013), observe that 81% of the healthy adults access the Internet frequently while only 52% of those who are diagnosed with chronic illness go online, and they concluded that ceteris paribus, people living with chronic illness have a negative correlation with having access to the Internet. Medical institutions and government agencies such as iDA will have to intervene to increase health information seeking among the elderly.

One of the many ways to bridge this disparity will be for medical institutions to actively disseminate healthcare information down the patient network via means such as mobile phone messaging service. Miloh (2009, as cited in Lockwood et al 2013) observes that after a text message reminder system has been implemented, there is a vast improvement in medication adherence and a decrease in rejection among pediatric liver transplant patients. With a successful framework already set up, we can further improve it by incorporating the dissemination of healthcare information. The patient will have to subscribe to this service and choose their preferred language. The healthcare messages keep the patient informed about their current conditions and provide tips to boost their recovery. Even after the patients have recovered, they can continue with this service for advices on post recovery and even tips for healthy lifestyle.

With Singapore having a mobile penetration rate of 156% in 2013 (iDA, n.d.c), we may safely assume that almost everyone owns a mobile phone. It is very crucial for the patient to own a mobile phone as this serves as a medium for information. Since medical institutions are already employing the use of mobile phone messaging for confirmation of appointments, they will not need to set up the Information Technology (IT) infrastructure from scratch, resulting in a huge amount of cost savings. With healthcare information readily available online, some people may view the messaging service to be a spam, and would be reluctant to subscribe to the messaging service. Although this service will be made available to all, the target audience of this service will be the elderly who have limited access to the Internet, opinions of the people who have access to the Internet will not affect the feasibility of this initiative. At the same time, the information obtained online may be dubious and lead to an adverse effect on the patient. With proper publicity, this service may attract more users than just those who lack access to the Internet as these are precious advice directly from the medical experts.

What some of the elderly lack are the skills to access the Internet. In 2007, iDA launched The Silver Infocomm Initiative (SII). The SII is a programme that aims to bridge the digital divide for the senior citizens in Singapore (iDA). This programme includes two parts, the Silver Infocomm Hotspots and Junctions. The first part will focus mainly on providing the facilities for the elderly to access the Internet by setting up 100 free hotspots island-wide in accessible location for the elderly, such as community centres. The second part will focus on imparting the skills of accessing the internet to the elderly. The senior citizens will be grouped based on their education background, language and their ability to use ICTs. Lessons on how to use the computer and the Internet will then be conducted based on the groups they are in. This will allow the senior citizens to be competent in using the Internet.

The elderly are divided into different classes and with the lessons being planned according to their choice of language and the experience they have with IT. This may facilitate their learning process and also provide them with a good learning experience. This programme is extremely feasible as it targets the root cause of the problem, digital divide, by providing both facilities and skills. However, the participation rate of the programme may be low, unless the programme is being publicised properly.

Efficacy of healthcare treatment increases when patients have access to more healthcare information. At the same time, with healthcare information, people will be able to make informed decisions for a healthy lifestyle. With so many benefits closely related to having access to healthcare information, medical institutes and government agencies such as iDA should participate actively to provide access to healthcare information. Medical institutes being a ‘bank’ for healthcare information, can provide the patients with these information through mediums such as mobile phone messages to bridge the information disparity directly, while government agencies can provide both the hardware and ‘software’ for the elderly by providing them the hardware and equipping them with the necessary skills access to the Internet to bridge the digital divide directly.


References
Infocomm Development Authority of Singapore (2013). Annual Survey on Infocomm Usage in Households and by Individuals for 2012. Retrieved from
http://www.ida.gov.sg/~/media/Files/Infocomm%20Landscape/Facts%20and%20Figures/SurveyReport/2012/2012HHmgt.pdf

Infocomm Development Authority of Singapore (n.d.a). Infocomm Usage- Household and Individuals. Retrieved from

Infocomm Development Authority of Singapore (n.d.b). Silver Infocomm Initiative. Retrieved from

Infocomm Development Authority of Singapore (n.d.c). Statistics: Telecommunications. Retrieved from

Lockwood, M. B., Saunders, M. R., Lee, C. S., Becker, Y. T., Josephson, M. A. & Chon, W. J. (2013, December). Kidney Transplant and digital divide: is information and communication technology a barrier or a bridge to transplant for African Americans? [Electronic version]. Progress in transplantation vol 23, No.4, 302-309

Lustria, M. L. A., Smith, S. A., & Hinnant, C. C. (2011). Exploring digital divides: An examination of eHealth technology use in health information seeking, communication and personal health information management in the USA [Electronic version]. Health Informatics Journal, 225-244.

Molinari, A. (2011, August). Let’s bridge the digital divide! Retrieved from

Weaver, J. B. III., Mays, D., Weaver, S. S., Hopkins, G. L., Eroğlu, D. & Bernhardt, J. M. (2010, August). Health Information- Seeking Behaviours, Health Indicators, and Health Risks. [Electronic version]. American Journal of Public Health vol 100, No. 8, 1520-1525



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