A usability gap between older adults and younger adults on interface design of an Internet-based telemedicine system

Internet-based telemedicine is becoming an effective tool to deliver home-healthcare services and health information on demand, especially in rural areas, where there is often a large elderly population with greater rates of preventable chronic diseases. However, the designs of current interfaces for these internet-based telemedicine systems do not take elderly user characteristics into consideration. This study conducted usability testing on the interface of an internet-based telemedicine system using two different age groups, young adults and older adults. Differences in overall performance and satisfaction between the two groups were identified. Based on these results, a future direction is suggested for the interfaces of Internet-based telemedicine systems.     

Telemedicine,rural elderly,and policy issues

Historically, rural America has had a difficult time providing health care to its residents, particularly its frail elderly population. Rural health care is often faced with a shortage of health care specialists, facilities with inferior equipment, and insufficient resources compared to health care in more urban areas. It is anticipated that the use of telemedicine will help address many of the problems facing the delivery of health care services to rural elderly. This paper reviews some innovative projects delivering services to the elderly. Also, the paper discusses several issues that need to be addressed before telemedicine can reach its full potential in improving access to health care, including reimbursement policies, patient and provider liability and confidentiality, and the infrastructure supporting telemedicine. Although telecommunications has tremendous potential to address the care needs of frail isolated elderly, without comprehensive reimbursement policies, guidelines for ethical conduct of a teleconsultation, acceptable security measures of patient records, and adequate as well as compatible infrastructure, that potential cannot be completely realized.     

Prospective role for telemedicine as a communication tool for rural rehabilitation practice

The current trend of cost containment in health care has prompted a search for innovative methods of providing the best quality care at the lowest possible cost. One method that has received much attention is the use of telemedicine to conduct evaluations at rural locations. There has been much research conducted in the area of telemedicine for radiology, and some other medical specialties, however there has been very little research examining the utilization of telemedicine for allied health, vocational rehabilitation, and Assistive Technology evaluations. In addition to providing an overview of telemedicine service delivery history and mechanisms, results of a focus group are discussed, and specific applications for the field of vocational rehabilitation are considered.     

Healthier and Happier? The Urban-Rural Divide in Thailand

This study aims to explain the relationship between socioeconomic factors and physical health and happiness outcomes of the Thai people. The study specifically investigates the differences between health and happiness outcomes of people who live in urban and rural areas in Thailand. Unlike results found in other countries, income is found to not affect the level of happiness of those who live in either urban or rural areas. Urbanization is found to have no effects on physical health, but it does have an adverse impact on the level of pleasure among Thai people. However, overall happiness levels of those who live in urban areas and those who live in rural areas are not statistically different.     

Changing health culture in rural Appalachia: Implications for serving the elderly

This article explores the dual themes of place and time as influences on health care service delivery to the rural elderly, through a case study of rural Appalachia. Traditional patterns of indigenous health care practice and values are contrasted with more “professional” formal models of health care service delivery that have entered the region. The result has been a clash of health care cultures. The continuing validity of this perspective is appraised in relation to apparent generational differences between the old-old and the young-old in the degree to which contemporary health care practices and values are adopted. It is concluded that traditional and contemporary health care cultures can be reconciled through an expanded vision of health care service delivery premised on: understanding health care within a total community context; redefining the role of the health practitioner; improving education of both the rural elderly and service providers; and enhancing communication in the rural health care environment.     

The elderly in rural environments

This paper provides a critical examination of the research available on the rural elderly in America. A detailed review of the many studies and topical areas investigated by rural gerontologists is not attempted. Rather, several ‘salient aspects’ of rurality (occupational, ecological and sociocultural) are identified as a basis for describing and explaining the status and experiences of older people in rural areas. The meaning of these dimensions as they relate to rural environments and the elderly is explored through both a general discussion and an application to two substantive issues — health status and life satisfaction. This examination illustrates the sizeable gaps that exist in what we currently know about the rural elderly and the problems/drawbacks of approaches traditionally used to study this topic. The paper concludes with a call for a more unified and conceptually based approach to future rural elderly research, that focuses on how and why the ‘salient aspects’ of rurality produce different circumstances and experiences for the elderly, and that emphasizes rural variation, not just ‘rural vs urban’ comparisons.     

Design recommendations for the creation of icons for the elderly

During employment of icons in order to represent system functions, specific user requirements from elderly people have not been scientifically gathered and thus will merely be considered during the process of system design. The survey, with explicit consideration of technology acceptance and experience of 120 elderly probands, looked into the comprehension of four different classes of non-animated graphical representations. It was shown that among elderly, the use of photos compared to pictograms or clip art leads to a significantly higher recognition rate. The mapping of actions rather than objects leads to a further reduction of the error probability and is thus, especially in the context of telemedicine, preferable for the target group.     

A collaborative approach to nutrition education for college students

It is well established in the literature that college students have poor eating habits and that many barriers exist to achieving optimal nutrition for this busy population. Little is known about students' perceptions of this problem or suggestions for improving their dietary habits. Similarly, college health professionals need innovative approaches to nutritional education. In an effort to develop an online nutrition resource specifically geared to college students, the authors assessed the availability of Internet-based nutritional information for this population and conducted focus groups with students and health professionals to identify relevant nutrition concerns. They used concept-mapping techniques to conduct a systematic analysis of the qualitative information generated from their focus group participants. Their findings emphasize the need for targeted resources for college students and the importance of using students' suggestions in developing nutrition programs.     

Implementing public policies and services in rural Japan: issues and problems

While the sharply increased services for the elderly in the revised Gold Plan--announced in 1994--are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.     

Implementing Public Policies and Services in Rural Japan

While the sharply increased services for the elderly in the revised Gold Plan-announced in 1994-are noteworthy, implementation of the revised Plan is expected to present numerous issues and problems, particularly in the rural areas of Japan, because of unique circumstances such as depopulation and the presence of a disproportionately large number of elderly; geographical and physical isolation; a conservative and tradition-bound political climate; and conservative attitudes of the elderly. This article examines the current state of policy implementation, identifying issues and problems that are being encountered in the rural areas of Japan. Such issues as economic and family life, health care, and service delivery for the elderly are examined.     

Migration: Pre-requisite for rural economic regeneration?

Migration from and to depopulating areas is related to the prospects for rural economic regeneration. The focus is on whether or not migration processes give rise to the necessary human capital required for successful endogenous development. Data from Scottish case studies pertaining to in-, out- and return migrants are analysed. Only by leaving rural areas can young adults acquire the necessary skills to participate in endogenous development, however, few out-migrants subsequently return. In-migrants, while often possessing the necessary human capital to bring about an economic regeneration, are associated with relatively little new job creation. Instead in-migration is characterised by self-employment. It is argued that migration is a pre-requisite for rural economic regeneration, but that a rural endogenous development policy on its own will have limited success in regenerating areas experiencing on-going depopulation. Exogenous development strategies are also required.     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

Religiousness/Spirituality and Subjective Well-Being Among Rural Elderly Whites,African Americans,and Native Americans

SUMMARY

Little attention has been paid to subjective well-being among non-White elderly in rural areas where medical resources and financial support are deficient. The present study assessed a rural community sample of 215 elderly comprising 85 Caucasians, 75 African Americans, and 55 Native Americans, to examine roles of spirituality/religiousness on their subjective well-being. This study found ethnic differences in the reliance on religiosity/spirituality and a significant association between dimensions of religiousness/spirituality and subjective well-being among all ethnic rural elderly groups. The results of the study suggest that health providers, social workers, and faith communities need to provide rural elderly with religious and spiritual support in order to enhance their life satisfaction and lessen their emotional distress.     

Residential Location and Proximity to Children Among Impaired Elderly Parents1

Abstract The availability of adult children as potential caregivers is particularly critical to the rural elderly because of the dearth of health and human services in rural areas. This paper analyzes proximity to adult children among a large sample of older persons with some degree of functional impairment, employing four residence categories and two indicators of proximity: coresidence with a child, and residence within a half-hour's travel time. Results show that older residents of large cities are most likely to live with children and that large-city and farm residents are more likely than small-city or rural nonfarm residents to live near children. Implications regarding the potential for family caregiving for the impaired elderly are discussed.     

Urban/rural elderly health status differences: the dichotomy reexamined

Health policy research analyzes urban/rural differences as a simple dichotomy. Research characterizes the rural elderly as having a higher incidence of sickness, dysfunction, disability, restricted mobility, and acute and chronic conditions than their urban counterparts. However, population density as a dichotomy may obscure urban, rural, or urban/rural differences. Interviews measuring health status were conducted with a representative sample of 2,300 elderly people in six Northeastern Ohio counties constituting an urban/rural continuum. On medical condition, use of medical aids, and symptoms, health status improved significantly when moving from rural to urban, but correlations were small. Using dichotomies, urban elderly reported fewer medical conditions and symptoms than rural elderly, but four other health-status variables revealed no significant association and results differed depending on how dichotomies were defined. When individual communities were compared few urban/rural patterns emerged. Controlling for demographics did not change interpretations. Findings question blanket assertions about urban/rural health-status differences. Medical resources may be misallocated. Rather than assuming poor health status among the rural elderly, researchers must verify differences through community-based research.     

Urban/Rural Elderly Health Status Differences

Health policy research analyzes urban/rural differences as a simple dichotomy. Research characterizes the rural elderly as having a higher incidence of sickness, dysfunction, disability, restricted mobility, and acute and chronic conditions than their urban counterparts. However, population density as a dichotomy may obscure urban, rural, or urban/rural differences. Interviews measuring health status were conducted with a representative sample of 2,300 elderly people in six Northeastern Ohio counties constituting an urban/rural continuum. On medical condition, use of medical aids, and symptoms, health status improved significantly when moving from rural to urban, but correlations were small. Using dichotomies, urban elderly reported fewer medical conditions and symptoms than rural elderly, but four other health-status variables revealed no significant association and results differed depending on how dichotomies were defined. When individual communities were compared few urban/ rural patterns emerged. Controlling for demographics did not change interpretations. Findings question blanket assertions about urban/rural health-status differences. Medical resources may be misallocated. Rather than assuming poor health status among the rural elderly, researchers must verify differences through community-based research.     

农村女儿养老支持力研究

养老是一项关系国计民生的重要工程,关系到整个社会的和谐与稳定。基于豫东A村的调查发现,随着农村大量男性青壮年向城市大规模的流动和女性自主意识的提高,农村儿子养老力量有所弱化,女儿养老的能力和养老意愿不断增强。女儿对父母的经济支持、生活照料、精神支持等方面的支持力作用愈发显著,女儿在家庭养老方面的重要性愈发显现,在农村老人晚年生活保障方面起着非常重要的作用。     

Contestability and social justice: The limits of competitive tendering of welfare services

Abstract

This paper critically analyses competitive tendering as a model for the provision of welfare services. Competitive tendering, driven by National Competition Policy and other imperatives for greater efficiency and a smaller public sector, is now used extensively by governments to fund welfare services. However, the suitability of this funding model to welfare services generally, and specifically welfare services in non-metropolitan areas, can be criticised on both theoretical and empirical grounds. Competitive tendering is grounded in economic rationalist, urbo-centric assumptions that are largely inappropriate for welfare provision, and have limited validity in rural areas. There is little rigorous empirical evidence of improved efficiency and effectiveness of service delivery under this model. Conversely, there is mounting evidence about the negative impacts. In rural areas this includes the erosion of community service obligations, less collaboration and greater secrecy between agencies, the reduction of choice, limited opportunities for local planning, cost shifting, and threats to continuity of care. This paper concludes with a call for greater application of the ‘public benefit’ test under the provisions of the National Competition Policy, and the development of more sophisticated frameworks for assessing the contestability of welfare services. Social workers have a leading role to play in challenging the dominant ideology of competition-orientated welfare reforms.     

Community Based Rural Health Care in India

SUMMARY

India is a large country, geographically as well as popula-tionwise. The majority of its population lives in rural areas, i.e., villages. Again, most of the villages are in remote areas. The State has been making sincere efforts to make the basic social services accessible to all in the rural area. Health being one of the vital services, it has been a challenging task before the State to extend it to the remote rural areas, many of which are not yet connected by motorable roads. As a result of various experiments carried out over the last five decades, the State has developed a fairly well-designed primary health care service, and it is in operation in rural areas. However, there appears to be a striking gap between the delivery of health services in rural areas and utilization of the services by the people. Attempts have been made in this article to apprise the readers of the health service system in India, and it discusses the issue of health service delivery at the village level. The discussion is based on a small study carried out in a rural area in the State of West Bengal (India) where students of social work of the University to which the author belongs are placed for field work. Following the inputs received through supervision of the students' work, the study was initiated and conducted.

This article based on the study seeks to focus on peoples' perception of the health services as provided by the State in rural areas, which in turn gets reflected in the extent to which they utilize the services. Social workers being an integral part of the health set up, their role bears special significance. Discussion, therefore, centres on scope for social work intervention at the community level as well as in institutional level of the health service delivery system to make the services meaningful and effective in rural areas. In fact, it has to take the leadership role in reforming the service delivery system when required.     

Understanding intimate partner violence against women in the rural South

Most U.S. intimate partner violence (IPV) research to date has been limited to women residing in urban areas, with the small body of research focusing on rural populations being primarily qualitative. In this case-control study of Southern rural women, while many factors are consistent with those found in urban settings, unlike findings elsewhere, IPV risk appears to increase with age, and race showed no increased risk. Furthermore, in rural areas where guns are more acceptable than in other parts of the United States, partners of IPV victims are considerably more likely to carry weapons than partners of nonabused women. Given the geographic limitations to police and medical response to severe IPV in a rural setting, an improved understanding of IPV risk among this population can aid health care providers in ascertaining risk before it escalates further.