Barriers to adopting digital contact tracing for COVID-19: Experiences in New Zealand.

BACKGROUND: Digital contact tracing (DCT) was a central component of the global response to containing COVID-19. Research has raised concerns that DCT could exacerbate inequities, yet the experiences of diverse communities at greater risk from COVID-19 are typically underrepresented. METHODS: The present study aimed to understand the perceived barriers to the adoption of the app amongst Maori, Pasifika, and disabled people. Focus groups and interviews were undertaken with Maori, Pasifika, and disability sector stakeholders and community participants. RESULTS: Participants (n = 34) generally expressed willingness to utilise DCT and support its adoption within the communities. Simultaneously, participants revealed how the app could marginalise community members who struggled with the usability and those distrusting of the government's COVID-19 interventions. CONCLUSIONS: The findings highlight how addressing communication inequality can assist in the development of contact-tracing responses that are both effective and equitable. The study provides insights about the role of information and communication technologies as health resources. PATIENT OR PUBLIC CONTRIBUTION: Consulting with members of the target communities was central throughout the present study, including recommendations for potential participants, participation in interviews and sharing early findings for feedback. This study reports on focus groups and interviews with individuals from Maori and disability sectors.

Situating Health Experiences: A Culture-Centered Interrogation.

Culture-centered studies of health communication de-center the theorization of health as an individual behavior and reveal the structural conditions that shape inequalities in health outcomes. The present study examines the ways in which space and housing shape experiences of health in a low-income site in Auckland undergoing radical redevelopment. We draw from a culture-centered project undertaken in 2018-2021 predominantly among Maori and Pasifika peoples involving 60 initial in-depth interviews, seven focus groups, a series of filmed interviews, and 32 additional in-depth interviews conducted during the COVID-19 pandemic. The residents' narratives foregrounded the detrimental health impact of inadequate housing, financial constraints, transience, and displacement that severs ties to place and community. These findings reveal the relationship between housing challenges, economic marginalization, and neoliberal capitalism, highlighting the need for policy interventions to address housing as a fundamental determinant of health disparities among marginalized communities.

Receiving Healthcare Amidst Poverty During the COVID-19 Lockdowns: A Culture-Centered Interrogation.

COVID-19 has exacerbated existing health inequalities globally. Guided by the culture-centered approach, this study examined perspectives and experiences of healthcare during two lockdowns in four marginalized contexts in Aotearoa New Zealand. The participants' narratives depicted dissatisfaction with the new modes of healthcare delivery, reporting longer waiting times, a preference for face-to-face delivery, language barriers, and issues with the limitations in support people attending appointments. This resulted in healthcare being delivered in a way that was not in keeping with the localized cultural norms of communication and collective support, further exacerbating existing health inequalities. Our findings suggest that public health interventions in response to COVID-19 within the context of healthcare delivery have the potential to further reify and reproduce exclusions and experiences of marginalization, with cultural marginalization reifying structural marginalization.

Explorations of Health in Aotearoa New Zealand's Low-income Suburbia.

Underpinned by the notion that community voices should be central to the development of localized communication infrastructures for health and well-being, this study applied Dutta's culture-centered approach to examine the meanings of health and the navigation of being healthy among 118 people residing in low-income suburban areas in Aotearoa New Zealand. The culture-centered approach is based on dialog between researchers and community members, and it centralizes local contexts by building theories from within the culture and co-creating dialogic spaces of listening, formed at the intersection of structure, culture, and agency. In this study, participants constructed health in relation to food, housing, and health care, underpinned by financial inaccessibility and a deep-rooted cultural conflict between the collectivist norms practiced by the community and the neoliberal individualized structure. The study illuminates how the pathologization of culture by structure constitutes poor health outcomes and how agentic expressions of culture negotiate local structures to regain health and well-being through acts of resistance.

Negotiating Health Amidst COVID-19 Lockdown in Low-income Communities in Aotearoa New Zealand.

Aotearoa New Zealand's public health crisis communication approach amidst the COVID-19 pandemic effectively mobilized the nation into swift lockdown, significantly reducing community transmission. This communication approach has been applauded around the world. How did communities situated amongst the "margins of the margins" in Aotearoa New Zealand navigate through the existing structural barriers to health during the pandemic? In this study, we use a culture-centered analysis to foreground the structural context of disenfranchisement amidst the COVID-19 lockdown. Drawing on in-depth interviews with participants in a larger ethnographic project on poverty and health across three communities in Aotearoa New Zealand, we attend to the ways in which health is negotiated amidst the COVID-19 outbreak and lockdown response at the "margins of the margins." The narratives point out that health communication interventions to prevent COVID-19 in the context of Aotearoa New Zealand furthered the marginalization of communities at the margins, and community voices were largely erased from the enactment of interventions. With the extant structures failing to recognize these aspects of everyday struggles of health at the margins, the health and access challenges were further magnified during COVID-19. Our attention to communication situated in relationship to structures builds a register for health communication scholarship in the context of COVID-19 that is committed to disrupting the behaviorally based hegemonic health communication literature and transforming the unequal terrains of health experiences.

Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals.

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.

Technology to Assist Aging in Place: The Perspective of Health Organizations.

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.

Improving healthcare through digital connection? Findings from a qualitative study about patient portals in New Zealand.

Research has shown that patient portals can improve patient-provider communication and patient satisfaction. Yet few studies have examined patient portals in New Zealand. In this study, GPs from nine primary care practices were interviewed using a semi-structured interview technique to ascertain how they thought patient portals influence the delivery of primary healthcare. The interviews were transcribed and thematically analysed. The three themes detected were: patient portal usage, health information seeking and the changing consultation. Although most of the participants indicated that patient portals are not being effectively utilised, they were optimistic about the role of information technology in primary healthcare for providing accurate information and to connect with patients in modern terms. Participants reported that some patients have become more informed and compliant with medical treatments and interventions after using patient portals. It seems that patient portals have the potential to enhance patient-provider relationships and help patients manage more aspects of their health care.

User Requirements for Technology to Assist Aging in Place: Qualitative Study of Older People and Their Informal Support Networks.

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.

Intelligent Digital Environment for Wellbeing and Health.

This three-phase project seeks to identify the user-requirements and develop a novel and unobtrusive technology platform interpreting and integrating diverse sources of information from a variety of digital devices monitoring the health and wellbeing of an older person with social media networking. This technology platform will communicate that information within an individualised support network thus supporting the older person to 'age in place'. This poster presents the process and preliminary results of phase one.