Digital futures: Ehealth, health literacy and chronic disease self-management skills for older people

Increasing numbers of Australian older people are living with chronic disease. Their ability to effectively self-manage their conditions is an important issue, not only for their own health but also for the government, who are concerned with spiralling healthcare costs. CDSM is informed, in part, by an individual’s health literacy which are non-disease-specific skills relating to finding, appraising and using health information, and encompass factors such as communicating with health care providers, navigating complex health systems and having social support to engage in managing health. New technologies provide the opportunity to deliver healthcare in innovative ways. However, there is a paucity of evidence on their use, particularly in community care. The purpose of this study was to: (1) understand what home-based group videoconference (VC) interventions have been developed for the e-health setting; (2) identify the mechanisms of delivering group education and social support by VC for older people; and (3) examine the impact of such a program in delivering patient education on health literacy, chronic disease self-management (CDSM) and social support. E-health, an umbrella term which includes telehealth, provides healthcare from a distance using telecommunications techniques. The Australian Government considers e-health as a key component in the future delivery of healthcare. E-health and telehealth are emerging vehicles to provide health information on CDSM as well as the opportunity to develop innovative patient education methods. Telehealth disrupts usual care, for example, using videoconferencing (VCing) for a consultation can negate the need for health professionals and patients to be physically in the same space. A particularly underexplored area is the use of group videoconferencing (VCing) for CDSM and health literacy patient education that is delivered into the patients’ homes. Group work is an effective method for providing CDSM knowledge and skills. However, there are known barriers for patients in accessing groups; these include timing, mobility, transport, and fear of meeting new people. Group VCing may provide the opportunity to overcome some of these barriers to enable wider access to group settings. iii This study, the Telehealth Literacy Project (THLP) was situated in the real world setting, working in collaboration with an aged care industry partner provider with community-dwelling older people aged between 49 and 90. It was nested within a wider telehealth remote monitoring study and explored the methodology of using group VCing to engage with older people. In order to answer the research questions, an intervention was developed specifically to test the methodology of group VCing. This thesis is focused on answering the research questions on the methodology of using group VCing and not on critiquing the intervention. In addition it reports only data from the THLP. A mixed method research design was employed during the study, including a systematic review, co-creation of the intervention with health professionals and participants and for the program evaluation, pre- and post-intervention quantitative measures (with control and intervention groups) and qualitative interviews. An evaluation framework was developed from the literature comprising overarching concepts of feasibility, acceptability and effectiveness In the THLP there were two groups, an intervention group comprising 52 participants who opted-into the weekly VC group intervention and a control group of 60 participants who chose not to take part in the intervention but who completed a baseline questionnaire. Following baseline data analysis those who opted-in to take part in the intervention were grouped by similar levels of health literacy. Each week intervention participants would meet in a virtual room and take part in discussions with the researcher on different health literacy and generic CDSM issues. Slides and videos were used to facilitate discussion with an emphasis on participants being engaged in conversation with each other to promote social support.