Year 3 Nursing students with SIT faculty A/Prof Elaine Siow (far right), Ms Jade Soh (2^nd from left) and staff from Methodist Welfare Services (in light blue polo tees). (Photo: Elaine Siow)

As one of the most wired countries in the world, Singapore is well on its way to reaching its Smart Nation goal, which also includes the Singapore Health IT Master Plan. Whether you want to find information, or manage and improve your health, a smart phone is your gateway. With more than 1.4 mobile phones per resident, Singaporeans are generally empowered to take their health into their own hands. But how are the elderly adapting to the digital push?

SIT on the Scene

Three researchers from SIT have embarked on a study to understand enablers and barriers to digital health literacy in older adults. The urgency is there, said the team, to equip seniors with better cyber skills. Not only could the seniors benefit from health apps, but a 2019 study – the sole local one done so far^[1] – has highlighted their susceptibility to health misinformation. Furthermore, the researchers pointed out that during the COVID-19 pandemic, digital communication proved critical in conveying updates on the rapidly-changing situation. A fresh look at engaging older Singaporeans in the digital realm was timely.

Engaging Older Adults in the Digital Realm

Over three months in the first half of 2022, students from the SIT-University of Glasgow Nursing programme got involved in an initial study, as part of the research team’s three-year project under the KM Quek Applied Research Grant worth $30,900.

Two groups, comprising six students each, developed a digital health teaching package for seniors, and employed it at various Senior Activity Centres (SACs) under Methodist Welfare Services (MWS). The SACs serve older people in the communities where they are sited, so interacting with their clients offered SITizens a chance to better understand the concerns of this group. At the same time, it was an invaluable opportunity to get involved in real-world applied research, as research is also part of the nursing curriculum.

Boosting Digital Health Literacy

Health literacy encompasses the motivation and competency to access and apply health information. It enables a person to make decisions towards achieving a better quality of life. When it comes to digital health literacy, the definition widens to include media and computer skills. Around the world, including Singapore, digital health literacy tends to be particularly low among the older generation.

With this in mind, our SITizens set out to design teaching materials to encourage seniors to find health information using mobile phones and the internet. Their nursing module lead, Senior Lecturer Ms Jade Soh, is one of the researchers in the project.

Nursing student, Teoh Min En, was among those who conducted focus group discussions with participants from MWS in March, in an effort to discern existing levels of digital health literacy. Initially shy because it was their first time reaching out, our SITizens were relieved to find the seniors friendly and approachable. Contrary to their suppositions, some of the seniors were already conversant with using smart phones. “We realised that our perspective was very narrow,” Min En admitted. “The responses we received were more diverse than what we had prepared for, so we learnt to think on our feet and be more versatile.”

(L to R clockwise) Year 3 Nursing students  Elfira Binte Ezra Sham, Huang Yan Fang, Nur Sabrina Chua Binte Muhammad Taufiq Chua, Tan Jia Xin, Teoh Min En and Saaiyah Binte Abdul Malik. (Photo: Teoh Min En)

Facilitating Learning in Older Adults

While the students were happily received by the elders, the health apps they introduced were not. In fact, getting the elderly to feel enthused about using the HealthHub app turned out to be a challenge. The silver generation felt that being in the last stage of life, they had no use for novel methods. Meanwhile, others were not fluent enough in English to use the app.

Saaiyah Binte Abdul Malik was one of the SITizens who engaged the seniors when the training package was officially launched in April. Her aim: to teach a senior how to book, reschedule and cancel appointments using the HealthHub app.

The video proved to be too fast for the seniors, so a Health Promotion Board pamphlet was used to explain each step, at the seniors’ pace. When it came to the hands-on attempt, the old folks could not log in because they could not remember their Singpass accounts. Our SITizens resolved this by using their own accounts to demonstrate the process.

For Saaiyah, an additional hurdle was the language barrier. Most of them spoke Mandarin, and the materials were also in Chinese. But through gestures and mutual congeniality, the overall experience turned out to be fun and meaningful. 

She said, “The curiosity and engagement of the seniors made the time fly by!”

The Learning Continues

“The nurses’ experiences will be part of an iterative process in developing the teaching package fully.  Students benefitted from getting first-hand experience of how data collection is done in practice – something that would be difficult to simulate in a classroom setting,” said A/Prof Elaine Siow, Assistant Provost (Student Experience) and Programme Leader of the Nursing programme, SIT.

“Our nursing students may have starred in a small role in the overall scheme of things, but through their efforts, the researchers hope to explore how technology can best be used in caregiving.”

Dr Stanley Quek, Chairman of The Ireland Funds Singapore and Executive Director of Region Group Pte Ltd provided the grant for the project. He affirmed, “I am glad that the KM Quek Applied Research Grant at SIT has made possible learning opportunities for SIT students; to not only participate in applied research, but also make a difference in the lives of seniors.”

^[1]Reference: Soh, J. G. S. & Wong, A. W. (2019). Digital health literacy among adults living in the community in Singapore. European Journal of Public Health, 29 (Suppl 4), ckz187.006. doi:https://doi.org/10.1093/eurpub/ckz187.006