Review article
Digital health technology for Indigenous older adults: A scoping review

https://doi.org/10.1016/j.ijmedinf.2021.104408Get rights and content

Highlights

  • Telehealth is a major means of increasing access to healthcare and reducing geographical inequalities.

  • More telehealth technology is needed to meet the needs of Indigenous older adults.

  • Successful implementation of telehealth depends on the acceptance of end users and the indigenous culture.

Abstract

Background

Telehealth implementation is a great solution for Indigenous older adults (OAs) due to the rise of chronic disease and other age-related health disorders. Telehealth is a promising option to increase quality of life, decrease healthcare costs, and offer more independent living.

Objectives

This scoping review investigated existing telehealth solutions that have been implemented to serve Indigenous OAs.

Methods

A structured search strategy was performed on 6 electronic databases: Ovid Medline, Ovid PsycINFO, Ovid Embase, EBSCOhost, Scopus and Cochrane. Studies were included in the review if they contained information on telehealth technologies for Indigenous OAs (aged 65 years and older). Grey literature was also explored in ProQuest Theses and Dissertations, ERIC, Google Advanced and various government websites from Canada, Australia/New Zealand and the USA.

Results

Twenty six articles were included and reviewed by two assessors. Analysis of the results from five countries revealed eight different types of telehealth solutions for Indigenous OAs. No documented telerehabilitation technologies were available to OAs in Indigenous Communities. Analysis of a broad range of Indigenous OAs with different chronic diseases revealed that they are seeking telehealth technologies for ease of access to health care, increased health equity and cost-effectiveness. Results revealed various advantages of telehealth for Indigenous OAs and barriers for implementing such technologies in Indigenous communities.

Conclusion

The use of telehealth technologies among OAs is expected to rise, but effective implementation will be successful only if the patient’s acceptance and culture are kept at the forefront, and if healthcare services are provided by telehealth-trained healthcare professionals.

Introduction

Healthcare is problematic in rural and remote communities on Indigenous reserves, especially among vulnerable populations, including persons with disabilities [1], children [2] and older adults (OAs) [3]. Despite improvements in life expectancy and advances in medical therapies [[4], [5], [6], [7], [8]], these populations are faced with increasing inequalities in access to healthcare [[9], [10], [11], [12]], specifically in the OA population [9,13,14]. In fact, as compared to urban and suburban residents, health care in the OA population may be poorest in rural communities due to the increased need for access to prescriptions [3,15], transportation solutions for OAs in isolated communities [3,[15], [16], [17], [18], [19]], inadequate access to care [3,15], limited access to specialists and specialized resources [3,[16], [17], [18], [19]], poor infrastructure and coordination of services [15], lack of resources in the ambulatory setting [20], scarce assisted living [15] and in-home care for frail OAs [15], and barriers related to culture [15,21], language [15,21], and socioeconomics [3,[15], [16], [17], [18], [19]]. Telehealth has grown rapidly to meet the healthcare needs of remote and distant communities. Telehealth is a term used to describe the use of telecommunication devices that allow geographically separated individuals to exchange health information synchronously or asynchronously between them [22,23]. Literature concerning telehealth solutions for OAs has developed significantly over the past several years [24]. It is reported that greater use of technology is associated with higher levels of social connectedness, and improved health and general quality of life [25,26]. Education is also a key factor in improving health literacy, the use of technology and adaptation to new technologies in the future, and the ability to search health information on the internet [27]. The adoption of telehealth is increasing, but many OAs including Indigenous individuals remain isolated from digital life.

Many barriers to the use of technology in OAs have been identified, including computer and tablet usage, as well as internet and e-mail [[28], [29], [30], [31]]. Although there is a variety of telehealth technologies available to the chronically ill population, not all of these technologies may be used by OAs. In addition to chronic disease symptoms, OAs may experience alterations in vision, hearing, and dexterity, which may hinder their use of various telehealth devices [32,33]. They are more likely to require healthcare, specialized rehabilitation and palliative services as they continue to age, and telehealth can help increase access to these specialized services for this population [34]. Research has demonstrated telehealth services may be able to replace in-person visits and have been useful among OAs resulting in improved quality of life, health outcomes, and patient satisfaction [[34], [35], [36]]. This technology may therefore benefit OAs living in remote or rural communities. In fact, OAs living in rural or remote or Indigenous communities can often be located at a great distance from healthcare centers providing specialized services, making access to these centers more difficult for OAs within these communities. As a means of minimising this geographical barrier for OAs living within these communities, the implementation of telehealth services for OAs living in rural and remote communities has been suggested [34], and this may be especially relevant for Indigenous OAs. Telehealth services may be an effective way to increase access to healthcare within Indigenous communities by improving well-being and clinical outcomes and decreasing the need for Indigenous OAs to travel for specialized services [37]. However, to date, the development of telehealth technologies has seldom considered the important and unique cultural factors of Indigenous populations, as cultural appropriateness is one element influencing acceptance of use [37, 38].

Previous studies have established that telehealth enabled specialist consultations to be conducted in the safe environment, while improving affordability and convenience [39,40] and reducing the stress of healthcare, emphasizing the presence of an Indigenous health worker as a facilitator of culturally appropriate healthcare [37,[41], [42], [43]]. Literature clearly mentions a need for more in-depth research as the challenges associated with implementing telehealth in Indigenous communities are not unique to Indigenous settings, but are more pronounced as a result of cultural, political and jurisdictional issues [44,45]. Therefore, the aim of this study is to provide a clear state of the art regarding telehealth technologies that target Indigenous OAs living in Indigenous communities, and to identify emerging trends and future solutions to support this populace. In particular, this study aims to explore i. the existing telehealth solutions that have been implemented to serve Indigenous OAs and how have they evolved over time and for what healthcare need, ii. the approaches to implementing and evaluating telehealth solutions for OAs in Indigenous communities and iii. the barriers, facilitators and opportunities for implementing telehealth solutions for OAs in Indigenous communities.

Section snippets

Design

Literature corresponding to the topic of telehealth for Indigenous OAs is emerging and disparate; therefore, a scoping review was performed with the aim of gathering published literature with a broad range of study designs and grey literature without exclusions on the basis of country or year of publication [46,47].

Search strategy

A medical librarian searched the following databases: Ovid Medline, Ovid PsycINFO, Ovid Embase, EBSCOhost (including Ageline and CINAHL Full Text), Scopus and Cochrane Library. The

Study selection

Literature search identified a total of 674 manuscripts. Twenty six manuscripts fully met the inclusion criteria and were included in the review (Fig. 1).

Publication date, place of publication and publication channel

All manuscripts were published in the last two decades, between 2002 and 2019, with a zero to three manuscripts per year. Manuscripts were published in five countries, with most published in the United States (38.5 %, n = 10) and Australia (34.6 %, n = 9) followed by Canada and New Zealand (n = 3) and Taiwan (n = 1).

Regarding the publication

Opportunities for development

Thematic analysis of the included articles allowed to identify barriers, facilitators and gaps in terms of telehealth development for Indigenous OAs. Four studies reported three barriers to implementing telehealth solutions for Indigenous OAs in Indigenous communities, namely acceptance by Indigenous OAs [68], culture [51] and healthcare providers’ professional skills [42,43]. Five studies clearly mentioned that telehealth facilitates communication and medical information sharing, and

Discussion

The aim of this study is to provide a clear portrait of telehealth technologies that target Indigenous OAs living in Indigenous communities, and to identify future directions for developing telehealth to support Indigenous OAs in their communities. The literature of telehealth for Indigenous OAs emerged only in the last two decades (2002–2019), totaling only twenty six manuscripts published at a frequency of ∼1.5 manuscripts per year. Most of the literature is published in the USA (38.5 %) and

Authors contribution

Dr. Mohamed-Amine Choukou has initiated the study and built the concepts around the search strategy in collaboration with Caroline Monnin, Health Sciences Librarian at the Neil John Maclean Health Sciences Library. Dr. Choukou, Dr. Ali Maddahi and Anna Polyvyana have run the screening, data extraction and materials preparation. Dr. Choukou has initiated a first draft of the manuscript. All the authors contributed to the final version of the manuscript.

Declaration of Competing Interest

The authors report no declarations of interest.

Acknowledgements

This work was supported by the University of Manitoba College of Rehabilitation Sciences.

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