Exploring the feasibility of telehealth in singapore's ageing care: a multi-methods study

• Main Author: Zhang, Yichi
• Other Authors: -
• Format: Thesis-Doctor of Philosophy
• Language: English
• Published: Nanyang Technological University 2024
• Subjects: Medicine, Health and Life Sciences; Telehealth; Ageing care; Implementation science; Health-seeking behaviour; Health equity
• Online Access: https://hdl.handle.net/10356/180197
• Institution: Nanyang Technological University

Ageing has emerged as a critical global concern, with older adults often experiencing greater health needs than younger generations. Telehealth, delivering and facilitating healthcare and health-related services using telecommunication and digital communication technologies, offers a promising solution in ageing care spanning medical services, provider and patient education, health information services, and self-management. Despite the growing body of evidence investigating the use of telehealth in various domains of ageing care, earlier studies were predominantly conducted in Western countries; have focused mainly on disease diagnosis, treatment, and rehabilitation; gave insufficient attention to the perspectives of non-users; and presented a risk in generating health inequalities. Guided by the Implementation Research Logic Model (IRLM), this thesis consists of a series of interwoven studies with multiple methods conducted across different overlapping phases to address these gaps. The overarching research question is “What is the feasibility of utilising telehealth to address older individuals’ health needs?” Study One investigated community-dwelling older adults’ health-seeking behaviour and associated technology utilisation, to inform possible areas in which telehealth could provide a solution. Study Two explored perceptions of telehealth in ageing care among older adults, healthcare professionals, social health service providers, and telehealth providers, from both users’ and non-users’ perspectives. This study uncovered various determinants affecting telehealth implementation in Singapore’s ageing care context and summarised the corresponding implementation strategies from the perspectives of different stakeholders. In Study Three, a community-based multi-user phygital telemonitoring programme was designed with the guidance of IRLM and deployed in the Singapore community to lower the barriers to accessing health technologies and promote regular self-measurement practice among the older population. Study Four piloted a pre-created synchronous tele-education prototype on dementia and co-created a user-centred tele-education programme with older adults to address their health information needs. Taking these studies together, this thesis affirmed the potential feasibility of telehealth solutions in addressing the health needs of the older population in the Singapore community. The findings collectively underscore the importance of enhancing the inclusivity, equity, scalability, and sustainability of telehealth implementation in ageing care and propose strategies for achieving this goal. The insights gained from these studies could be useful for healthcare professionals, health educators, social health service providers, researchers, policymakers, and other stakeholders in designing and implementing telehealth with and for the older population, ultimately leading to better health outcomes and improved quality of life for this demographic.