Digital technology is increasingly being used to deliver interventions and initiatives to support the wellbeing of older adults. However, few studies have conducted needs assessments to identify the future wellbeing service requirements of an older adult population and their preferred modes of delivery, whether via digital technology or in-person, or a combination of both (ie, a hybrid model). This study aims to investigate the requirements of a rural region in New Zealand to inform planning to meet the future wellbeing needs of its older adult population over the next 30 years In total, two focus group discussions and 10 interviews were held with participants using a combination of phone and video. A total of 33 adults aged ≥57 years participated. The participants were asked how they saw the future wellbeing needs of the older adult population evolving, the role of digital technology and/or in-person interactions to deliver wellbeing services, and perceived barriers to, and enablers of, digital technology for providing services. Focus group and interview transcripts were thematically analysed. A total of 4 key wellbeing themes were identified across both focus group discussions and interviews with participants: “skills”, “services”, “spaces” and “social connection.” Each theme reflects the older adults’ interview responses in relation to questions about their demographic details and level of technology confidence. Results indicated that, within this rural regional population, older adults had limited understanding of, and low confidence in using digital technology. Although 57% of participants initially self-reported being very or somewhat confident using technology, most were unable to successfully engage in online focus groups. Meanwhile, digital technology is developing at a rapid pace, and as a result, we need to consider how to plan for the transition and bridge the gap identified between the current use of digital technology and its potential future use if technology is to support the older adults of the future. The findings indicate that older adults prefer to engage in-person, while trust is a barrier to digital technology use for some participants. The future offers many opportunities to support the wellbeing of individuals and communities through the application of the proposed 4 Ss Framework. N/A.

How can we effectively incorporate ethical considerations into technology design? Several frameworks and evaluation methods focused on ethical aspects of new and emerging technologies have been proposed over the past two decades. Despite this, we still lack a robust pathway for integrating ethical considerations into the design process. We examine three existing methods: ethical technology assessment, value-sensitive design, and embedded ethics. Drawing on their strengths and limitations, we propose a novel pathway for integrating ethics (PIE) that is flexible, multi-disciplinary, and person-centred. It consists of four stages: (1) bringing ethicists and designers together; (2) identifying ethical tensions; (3) exploring solutions to ethical tensions through stakeholder engagement; (4) integrating identified solutions into technology design. This pathway has been developed in the context of digital assistive technology for older adults' care, building on the principles of person-centred care and co-design, and embeds four fundamental values: inclusivity, collaboration, flexibility, and practicality. This novel approach could also be expanded into other areas of digital health technology design and development.

INTRODUCTION:Precision prevention has shown an upsurge in popularity among epidemiologists in both developed and developing countries in the past decade. OBJECTIVES:Initially practiced in oncology, this approach is increasingly adopted in public health to guard against other common non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases. It aims to tailor preventive measures according to each individual's unique characteristics, such as genomic data, socio-demographic features, environmental factors, and cultural background. METHODS:Healthcare information technologies, including telehealth and artificial intelligence (AI), have served as a vital catalyst in the expansion of this field in the past decade. Under this framework, real-time contemporaneous clinical data is collected via a wide range of digital health devices, such as telehealth monitors, wearables, etc., and then analyzed by AI or non-AI prediction models, which then generate preventive recommendations. RESULTS:The utilization of telehealth technologies in the precision prevention of cardiovascular diseases (CVDs) is a very illustrative application. This paper explores these topics as well as certain limitations and unintended consequences (UICs) and outlines telehealth as a core enabler of precision prevention as well as public health.

Aim: This project explored requirements for digital learning to support digital health literacy of older adults within a rural region. Method: A qualitative study with purposeful sampling and thematic analysis of data. Interviews were held with ten digital educators and seven older adults (four with low vision) living and/or working in rural New Zealand. Results: All participants recognised the importance of trust and having the right people to provide support and foster positive engagement with digital technologies. The digital educators recognised a missed opportunity to engage older adults using health as a topic for digital learning. Conclusion: A positive experience with learning to use digital technologies is necessary to facilitate digital health literacy for older adults. Digital educators want access to reputable resources to promote health websites; many don’t know these exist. A wide range of digital literacy learning services exist which need to be better promoted in hard copy and online. The authors recommend building on older adults’ existing relationships, engaging with community groups, providing pop-up sessions, and running events to increase digital technological knowledge and engage with health information online. The key is utilising the right people to support the older adult with opportunities for digital skills uptake.

Introduction: One Health (OH) refers to the integration of human, animal, and ecosystem health within one framework in the context of zoonoses, antimicrobial resistance and stewardship, and food security. Telehealth refers to distance delivery of healthcare. A systems approach is central to both One Health and telehealth, and telehealth can be a core component of One Health. Here we explain how telehealth might be integrated into One Health. Methods: We have considered antimicrobial resistance (AMR) as a use case where both One Health and telehealth can be used for coordination among the farming sector, the veterinary services, and human health providers to mitigate the risk of AMR. We conducted a narrative review of the literature to develop a position on the inter-relationships between telehealth and One Health. We have summarised how telehealth can be incorporated within One Health. Results: Clinicians have used telehealth to address antimicrobial resistance, zoonoses, food borne infection, improvement of food security and antimicrobial stewardship. We identified little existing evidence in support of the usage of telehealth within a One Health paradigm, although in isolation, both are useful for the same purpose, i.e., mitigation of the significant public health risks posed by zoonoses, food borne infections, and antimicrobial resistance. Conclusions: It is possible to integrate telehealth within a One Health framework to develop effective inter-sectoral communication essential for the mitigation and addressing of zoonoses, food security, food borne infection containment and antimicrobial stewardship. More research is needed to substantiate and investigate this model of healthcare.

Abstract Background: Professional socialisation is important for developing professional identity among newly graduated health professionals. Benefits extend tojob satisfaction, work engagement, internal motivation, adjustment to professional roles, social acceptance, and a sense of belonging. The clinical environment plays an important role in determining positive or negative professional socialisation experiences. In New Zealand, the education programme for anaesthetic technicians (ATs) is transitioning from an apprenticeship model to a three-year Bachelor of Health Science. As both models include a significant element of clinical exposure, it is important that we understand what influences the professional socialisation experience. There is a lack of studies focused on professional socialisation with AT education. Therefore, this study explored the experiences of recent graduate ATs in the clinical environment to inform the ongoing development of the training programme. Methods: This study used a qualitative, descriptive methodology. Five ATs were recruited in using purposive sampling in New Zealand during October 2020. All had graduated within the past 3 years. Semi-structured individual interviews explored participants’ interpretations of their professional socialisation experiences in the clinical environment. Data were analysed using standard qualitative analysis. Results: Three main themes and eight subthemes emerged from the interviews: learning to behave (professionally and by following role models); learning to survive (in a hierarchical environment, with a derogatory view of being invisible, with a lost voice striving for acceptance and by conforming); and learning to thrive (with support from the professional ‘family’ and by learning about each other). Conclusions: The findings suggest that ATs’ professional socialisation occurs in a challenging clinical context with competing professional identities and encompasses positive and negative learning experiences. In this environment, ATs’ student status may be perceived as weak and predispose them to conforming to survive. Academic and clinical education facilitators should be aware of the need to advocate for positive professional socialisation experiences. It is also important to enable an inter-professional identity to emerge to promote collaboration among future health professionals.

There is increasing interest in using emerging technologies, such as social media, digital devices, and smart home technologies, to distribute information throughout an older person's formal and informal support networks to assist them to live independently in their own home (to age in place). An open research workshop was conducted as part of a health informatics conference, 24 self-selected participants were organised into sub-groups to discuss four generic questions relating to the collection and distribution of an older person's health information. Thematic analysis of the discussions identified three major themes relating to roles and responsibilities of stakeholders, information collection and interpretation, system management and control. The findings emphasise the importance of taking a socio-technical perspective to understand the requirements of all stakeholder groups. A number of new and emerging research issues are identified, particularly in relating to the long-term management and adaptation of personal support networks and technologies.

OBJECTIVE:The goal of this paper is to provide a consensus review on telehealth delivery prior to and during the COVID-19 pandemic to develop a set of recommendations for designing telehealth services and tools that contribute to system resilience and equitable health.METHODS:The IMIA-Telehealth Working Group (WG) members conducted a two-step approach to understand the role of telehealth in enabling global health equity. We first conducted a consensus review on the topic followed by a modified Delphi process to respond to four questions related to the role telehealth can play in developing a resilient and equitable health system.RESULTS:Fifteen WG members from eight countries participated in the Delphi process to share their views. The experts agreed that while telehealth services before and during COVID-19 pandemic have enhanced the delivery of and access to healthcare services, they were also concerned that global telehealth delivery has not been equal for everyone. The group came to a consensus that health system concepts including technology, financing, access to medical supplies and equipment, and governance capacity can all impact the delivery of telehealth services.CONCLUSION:Telehealth played a significant role in delivering healthcare services during the pandemic. However, telehealth delivery has also led to unintended consequences (UICs) including inequity issues and an increase in the digital divide. Telehealth practitioners, professionals and system designers therefore need to purposely design for equity as part of achieving broader health system goals.

Background Telehealth is often suggested to improve access to health care and has had significant publicity worldwide during the COVID-19 pandemic. However, limited studies have examined the telehealth needs of underserved populations such as rural communities. Objective This study aims to investigate enablers for telehealth use in underserved rural populations to improve access to health care for rural older adults. Methods In total, 7 focus group discussions and 13 individual interviews were held across 4 diverse underserved rural communities. A total of 98 adults aged ≥55 years participated. The participants were asked whether they had used telehealth, how they saw their community’s health service needs evolving, how telehealth might help provide these services, and how they perceived barriers to and enablers of telehealth for older adults in rural communities. Focus group transcripts were thematically analyzed. Results The term telehealth was not initially understood by many participants and required an explanation. Those who had used telehealth reported positive experiences (time and cost savings) and were likely to use telehealth again. A total of 2 main themes were identified through an equity lens. The first theme was trust, with 3 subthemes—trust in the telehealth technology, trust in the user (consumer and health provider), and trust in the health system. Having access to reliable and affordable internet connectivity and digital devices was a key enabler for telehealth use. Most rural areas had intermittent and unreliable internet connectivity. Another key enabler is easy access to user support. Trust in the health system focused on waiting times, lack of and/or delayed communication and coordination, and cost. The second theme was choice, with 3 subthemes—health service access, consultation type, and telehealth deployment. Access to health services through telehealth needs to be culturally appropriate and enable access to currently limited or absent services such as mental health and specialist services. Accessing specialist care through telehealth was extremely popular, although some participants preferred to be seen in person. A major enabler for telehealth was telehealth deployment by a fixed community hub or on a mobile bus, with support available, particularly when combined with non–health-related services such as internet banking. Conclusions Overall, participants were keen on the idea of telehealth. Several barriers and enablers were identified, particularly trust and choice. The term telehealth is not well understood. The unreliable and expensive connectivity options available to rural communities have limited telehealth experience to phone or patient portal use for those with connectivity. Having the opportunity to try telehealth, particularly by using video, would increase the understanding and acceptance of telehealth. This study highlights that local rural communities need to be involved in designing telehealth services within their communities.

Introduction Telehealth became the most practical option for general practice consultations in Aotearoa New Zealand (NZ) as a result of the national lockdowns in response to the COVID-19 pandemic. What is the consumer experience of access to telehealth and how do consumers and providers perceive this mode of care delivery going forward? Methods and analysis A national survey of general practice consumers and providers who used telehealth services since the national lockdowns in 2020 will be distributed. It is based on the Unified Theory of Acceptance and Use of Technology framework of technology acceptance and the access to care framework. The data will be statistically analysed to create a foundation for in-depth research on the use of telehealth services in NZ general practice services, with a specific focus on consumer experiences and health outcomes. Ethics and dissemination Ethics approval was granted by the Auckland Health Research Ethics Committee on 13/11/2020, reference AH2539. The survey will be disseminated online.

Increasing life expectancy and rates of chronic conditions place increasing demands on aged care health and support services. One response preferred by older adults and seen as cost effective is aging in place, whereby older people remain in their own homes and avoid aged residential care. For this to take place, it is crucial that older people maintain effective relationships with support networks and that older adults and these networks have adequate information to support patient centred health and wellness care at home. This study explored how smart home telehealth, a form of telehealth where health care is provided at a distance using smart home digital technology (sensors), could assist older people to age in place and enhance their health and wellbeing. It was a two-phase project, preceded by a workshop with experts:1) 41 interviews with older adults and their informal support networks, seven focus groups with 44 health providers working with older adults, which informed 2) a pilot implementation of a co-designed telehealth system, addressing key barriers identified in Phase 1. The system used low cost, easily accessible, and commercially available sensors, transferring information via email and/or text messaging. It was successfully piloted with five older adults and twelve of their respective support networks for six months, who reported an increased feeling of security and improved interpersonal communication. The findings indicate that smart home telehealth could assist aging in place, and the study provides insights into successful co-design of smart home telehealth services at scale that could be implemented and deployed in contexts wider than aged care.

Background For mobile app–based COVID-19 contact tracing to be fully effective, a large majority of the population needs to be using the app on an ongoing basis. However, there is a paucity of studies of users, as opposed to potential adopters, of mobile contact tracing apps and of their experiences. New Zealand, a high-income country with western political culture, was successful in managing the COVID-19 pandemic, and its experience is valuable for informing policy responses in similar contexts. Objective This study asks the following research questions: (1) How do users experience the app in their everyday contexts? and (2) What drives the use of the app? Methods Residents of New Zealand’s Auckland region, which encompasses the country’s largest city, were approached via Facebook, and 34 NZ COVID Tracer app users were interviewed. Interview transcripts were analyzed using thematic analysis. Results Interviews ranged in duration from 15 to 50 minutes. Participants ranged in age from those in their late teens to those in their early sixties. Even though about half of the participants identified as White New Zealanders of European origin, different ethnicities were represented, including New Zealanders of South Pacific, Indian, Middle Eastern, South American, and Southeast Asian descent. Out of 34 participants, 2 (6%) identified as Māori (Indigenous New Zealanders). A broad range of careers were represented, from top-middle management to health support work and charity work. Likewise, educational backgrounds ranged broadly, from high school completion to master’s degrees. Out of 34 participants, 2 (6%) were unemployed, having recently lost their jobs because of the pandemic. The thematic analysis resulted in five major themes: perceived benefits, patterns of use, privacy, social influence, and need for collective action. Benefits of using the app to society in general were more salient to the participants than immediate health benefits to the individual. Use, however, depended on the alert level and tended to decline for many participants at low alert levels. Privacy considerations played a small role in shaping adoption and use, even though the participants were highly aware of privacy discourse around the app. Participants were aware of the need for high levels of adoption and use of the app to control the pandemic. Attempts to encourage others to use the app were common, although not always successful. Conclusions Appeals to civic responsibility are likely to drive the use of a mobile contact tracing app under the conditions of high threat. Under the likely scenario of COVID-19 remaining endemic and requiring ongoing vigilance over the long term, other mechanisms promoting the use of mobile contact tracing apps may be needed, such as offering incentives. As privacy is not an important concern for many users, flexible privacy settings in mobile contact tracing apps allowing users to set their optimal levels of privacy may be appropriate.

OBJECTIVES:Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.METHODS:We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.RESULTS:Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.CONCLUSION:COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.

Background: Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective: The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people's health and well-being. Methods: Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results: The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was "access to technology and systems," which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was "collecting and sharing of information," which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients' social environment. The third theme was that all respondents identified similar "barriers to uptake": cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions: The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people's unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

Summary Objectives: To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives. Methods: We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth. Results: Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts. Conclusions: Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.

This paper presents findings from a series of focus groups which is exploring the implications of and stakeholder requirements for, integrating social media technologies and 'smart home' technologies to connect older adults with their formal support networks (i.e. to healthcare and social service providers) thus enabling them to live independently at home.

This paper investigates how spatial and temporal context information can be used in smart homes to detect abnormal behaviours. We discuss how various formalisms, such as probability theory, the Dempster-Shafer calculus, and fuzzy logic, can be used to capture context information and argue that fuzzy logic is the most suitable. We evaluate our approach by analysing one of the CASAS smart home datasets.

Background Informal support is essential for enabling many older people to age in place. However, there is limited research examining the information needs of older adults’ informal support networks and how these could be met through home monitoring and information and communication technologies. Objective The purpose of this study was to investigate how technologies that connect older adults to their informal and formal support networks could assist aging in place and enhance older adults’ health and well-being. Methods Semistructured interviews were conducted with 10 older adults and a total of 31 members of their self-identified informal support networks. They were asked questions about their information needs and how technology could support the older adults to age in place. The interviews were transcribed and thematically analyzed. Results The analysis identified three overarching themes: (1) the social enablers theme, which outlined how timing, informal support networks, and safety concerns assist the older adults’ uptake of technology, (2) the technology concerns theme, which outlined concerns about cost, usability, information security and privacy, and technology superseding face-to-face contact, and (3) the information desired theme, which outlined what information should be collected and transferred and who should make decisions about this. Conclusions Older adults and their informal support networks may be receptive to technology that monitors older adults within the home if it enables aging in place for longer. However, cost, privacy, security, and usability barriers would need to be considered and the system should be individualizable to older adults’ changing needs. The user requirements identified from this study and described in this paper have informed the development of a technology that is currently being prototyped.