Transcendent Technology and Mobile eHealth

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Technology is becoming a common place in the lives of all of us, the potential for it to help deliver health and social care is exciting. However, the full potential of this won’t be recognised if there is a failure to understand how such technology is interwoven within our daily lives. It must be remembered not everyone can interact with technology in the same way. Yet technology is often developed around the lives of the imagined average citizen, meaning many people can be disadvantaged by not having technology fit their into lives. Systems are still designed to help others in a rather paternalistic fashion. Therefore more needs to be done to involve the end users of the technology in the design of technology such as mobile ehealth (mhealth) and move towards a bottom up transcendent rather than technocratic approach to technology. In addition, there should be more space for understanding how technology, such as mhealth, can change society, examining how it challenges moral dilemmas and ethics. Regulation is important when developing new technology, but it needs to cover changes in practice not just the technology itself. Mobile ehealth also effects many current debates in the lives of older people and those in marginalised groups of society, including challenging systems of health and social care but also housing, transport and economics. More research is needed in the area of mhealth but the research must continue to be multi-disciplinary and fully involve stakeholders and end-users for full potential to be realised.

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... From this foundation, interventions can be developed that solve community problems and adjusts to their knowledge and skills [32]. Some research begins by formulating a direct intervention based on their initiative without first determining the targeted community's mindset [33]. This practice could prove to be a potential bias when performing the intervention. ...
... This practice could prove to be a potential bias when performing the intervention. This can be in the form of a knowledge bias in terms of a gap between the intervention maker or expert-driven method and the end-user of the intervention [33,34]. Creating mHealth interventions should begin with a theory-driven process followed by taking feedback from the end-user or targeted community [35]. ...
... The intervention designer should then determine the details of the design and intervention based on the end users' feedback [36]. Previous studies have compared different apps that use the top-down and bottom-up approaches and revealed that a bottom-up app was more effective for the community [33]. The hybrid approach (Fig. 1) comprises a complex mixedmethod design that begins with qualitative research and is followed by sequential and embedded qualitative to quantitative designs. ...
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Background Limited information is available on how mobile health (mHealth) application (app) technology on mother and child health (MCH) is developed. This research aimed (a) to explore the process of developing mobile apps for MCH community-based services in the Indonesian setting of Pos Pelayanan Terpadu ( Posyandu/ Integrated Health Service Post), (b) to determine the feasibility of using the app by community health workers (CHWs), and (c) to evaluate the scalability of the mobile app at the national level in Indonesia. Methods A hybrid method was used to synergistically combine the action research principles and mixed methods comprising qualitative and quantitative methods. This study was conducted in the Pasawahan District, Purwakarta, Indonesia, from 2017 to 2019. Content analysis, coding, and categorizing were performed using NVivo 12 Pro for transcribed data. The Wilcoxon test (2018 and 2019) was conducted using STATA 15 Special Edition. Results (1) The use of a CHW notebook for data entry into the Posyandu Information System book delayed the data reporting process, resulting in the need to develop a mobile app. (2) There were significant differences in CHWs’ knowledge ( p = 0.000) and skills ( p = 0.0097) on training (2018) and Posyandu phases (2019). (3) A total of 964 Posyandu have been registered in the Posyandu mobile app from almost all provinces in Indonesia. Conclusions The three-year hybrid approach includes the crucial phases that are necessary to develop a mobile app that is more user-friendly and can act as a substitute for CHWs’ book. Hence, its implementation is promising for use at the national level.
... Starting a qualitative research as part of the action research is an important step to create a basis, thus it can help to develop the intervention that fit with the community problems as well as their knowledge and skills to adjust with the intervention (19). Some researches started formulating an intervention directly from their mind without involving the mindset of the targeted community (20). ...
... This manner will engender a potential bias when performing the intervention. The bias can be in the form of a knowledge bias in the sense of gap between the intervention maker or expert-driven method (which is a top-down maker) and the end-user of the intervention (20,21). Creativity in creating mobile health intervention should begin not only with a theory-driven process but also by exploring information from the end-user in terms of the targeted community (22). ...
... Then, the intervention designer should build the details of the intervention design based on the explored information. The previous researches compared different top-down and bottom-up applications, where it was revealed that a bottom-up application was more effective in the community (20). The hybrid approach comprising starting with a qualitative research, then followed by a quantitative research such as to quantify the significance of the implementation effect, which will render it more efficient and effective for the next improvement (action research). ...
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Background. There is little evidence available to better understand how mobile health application technology on mother and child health is designed. This study aimed: (a) to explore community health worker (CHW)/cadre and mothers’ activities information related with Posyandu, as well as inputs and feedbacks in developing the Posyandu mobile application, (b) to compare between training and implementation phases of the application, (c) and to see the potential use of the Posyandu mobile application in the country. Method. Using a hybrid method in which the action research principles and qualitative-quantitative methods were synergistically combined for the end users. The study was conducted in Pasawahan sub-district, Purwakarta, Indonesia from 2017 to 2019. Content analysis, coding and categorizing were done using NVivo 12 Pro for the transcribed data. Wilcoxon Test (2018 and 2019) was conducted using STATA 15 Special Edition. Results. (1) the use of CHW notebook for data entry in Posyandu information system book made a long delay in the data reporting process, thus, the development of mobile application would be necessary, (2) there were significant differences of CHW’s knowledge (p=0.000) and skills (p=0.0097) on training (2018) and Posyandu phases (2019), (3) As many as 964 posyandu are registered to Posyandu mobile application from almost all provinces in Indonesia. Conclusions. The 3-years hybrid approach suggests the crucial phases to build a mobile application in a more user-friendly manner that can replace the CHW’s old-fashion book use, and that it is promising for national use.
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Falls in older people represent a major age-related health challenge facing our society. Novel methods for delivery of falls prevention programs are required to increase effectiveness and adherence to these programs while containing costs. The primary aim of the Information and Communications Technology-based System to Predict and Prevent Falls (iStoppFalls) project was to develop innovative home-based technologies for continuous monitoring and exercise-based prevention of falls in community-dwelling older people. The aim of this paper is to describe the components of the iStoppFalls system. The system comprised of 1) a TV, 2) a PC, 3) the Microsoft Kinect, 4) a wearable sensor and 5) an assessment and training software as the main components. The iStoppFalls system implements existing technologies to deliver a tailored home-based exercise and education program aimed at reducing fall risk in older people. A risk assessment tool was designed to identify fall risk factors. The content and progression rules of the iStoppFalls exergames were developed from evidence-based fall prevention interventions targeting muscle strength and balance in older people. The iStoppFalls fall prevention program, used in conjunction with the multifactorial fall risk assessment tool, aims to provide a comprehensive and individualised, yet novel fall risk assessment and prevention program that is feasible for widespread use to prevent falls and fall-related injuries. This work provides a new approach to engage older people in home-based exercise programs to complement or provide a potentially motivational alternative to traditional exercise to reduce the risk of falling.
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The booming increase of the senior population has become a social phenomenon and a challenge to our societies, and technological advances have undoubtedly contributed to improve the lives of elderly citizens in numerous aspects. In current debates on technology, however, the »human factor« is often largely ignored. The ageing individual is rather seen as a malfunctioning machine whose deficiencies must be diagnosed or as a set of limitations to be overcome by means of technological devices. This volume aims at focusing on the perspective of human beings deriving from the development and use of technology: this change of perspective - taking the human being and not technology first - may help us to become more sensitive to the ambivalences involved in the interaction between humans and technology, as well as to adapt technologies to the people that created the need for its existence, thus contributing to improve the quality of life of senior citizens.
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Background Older adults are at increased risk of experiencing loneliness and depression, particularly as they move into different types of care communities. Information and communication technology (ICT) usage may help older adults to maintain contact with social ties. However, prior research is not consistent about whether ICT use increases or decreases isolation and loneliness among older adults. Objective The purpose of this study was to examine how Internet use affects perceived social isolation and loneliness of older adults in assisted and independent living communities. We also examined the perceptions of how Internet use affects communication and social interaction. Methods One wave of data from an ongoing study of ICT usage among older adults in assisted and independent living communities in Alabama was used. Regression analysis was used to determine the relationship between frequency of going online and isolation and loneliness (n=205) and perceptions of the effects of Internet use on communication and social interaction (n=60). ResultsAfter controlling for the number of friends and family, physical/emotional social limitations, age, and study arm, a 1-point increase in the frequency of going online was associated with a 0.147-point decrease in loneliness scores (P=.005). Going online was not associated with perceived social isolation (P=.14). Among the measures of perception of the social effects of the Internet, each 1-point increase in the frequency of going online was associated with an increase in agreement that using the Internet had: (1) made it easier to reach people (b=0.508, P
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In this review, we summarize and critically evaluate the major empirical, conceptual, and theoretical directions that studies of aging families have taken during the first decade of the 21st century. The field has benefited from an expanded perspective based on four overarching themes: (a) complexity in emotional relations, (b) diversity in family structures and households, (c) interdependence of family roles and functions, and (d) patterns and outcomes of caregiving. Although research on aging families has advanced theory and applied innovative statistical techniques, the literature has fallen short in fully representing diverse populations and in applying the broadest set of methodological tools available. We discuss these and other frontier areas of scholarship in light of the aging of baby boomers and their families.
The impact of ICT on family: views from an older generation. In: Family and communication technology workshop
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