Older People, Loneliness, Social Isolation and Technological Mitigations: Utilising Experiences of the Covid-19 Pandemic as we Move Forward

In this article, the effects of social isolation which can lead to increasing feelings of loneliness and abandonment for some are examined. The article analyses findings which emerged from a qualitative study carried out with older people in three distinct areas in Scotland (city, rural and urban) who were shielding during Covid-19. It focuses on the ways in which social isolation affected them and the extent to which information and communication technology (ICT) and telecare technologies served to mitigate key aspects. The key themes which emerged from the research included loneliness as 'multi-layered', with these layers including 'disconnections between loneliness and social isolation';'well-being reversals';'neighbours as strangers';'disjointed communities and co-production' and 'service abandonment'. Additional themes which emerged focused on 'ICT rebounds and evolvement' and 'hope, buoyancy and reciprocity'. These layers and themes can be seen to have longer term significance with regard to the implications for social work and social care planning as we move forward. They also emphasise the need for greater cohesiveness between health, telecare and social care services. In this article, social isolation and loneliness are explored in the context of, but also in the aftermath of, Covid-19. By means of a research project which incorporated a focus on technology enabled care, key themes were identified. These included loneliness as 'multi-layered', with these layers including 'disconnections between loneliness and social isolation';'well-being reversals';'neighbours as strangers';'disjointed communities and co-production' and 'service abandonment'. Additional themes which emerged focused on 'ICT rebounds and evolvement';and 'hope, buoyancy and reciprocity'. These layers and themes can be seen to have longer term significance with regard to the implications for social work and social care planning as we move forward. They also emphasise the need for greater cohesiveness between health, telecare and social care services.

Domestic abuse and intimate partner violence: The role of digital by design

Purpose: Domestic abuse or intimate partner violence is a term that describes a pattern of abusive behaviours, often experienced concurrently and linked to gender-based violence. This study aims to explore through the literature the potential to design effective digital services that work for victims, survivors and those who provide domestic abuse support services. Design/methodology/approach: This study is based on a systems or service design thinking methodology which was adopted during a Scottish Government-funded Technology Enabled Care (TEC) pathfinder project on domestic abuse. This methodology is the basis for the Scottish Approach to Service Design which is based on the Design Council Double Diamond. During the first phase, known as the discovery phase, desk-based research is conducted by the service design team to inform their approach to the later phases (the second half of the first diamond is define whilst design and deliver form the second diamond). Time is spent during discovery to unpack the complexity whilst the approach takes a pragmatic worldview. Findings: Technology has yet to be shown to provide an effective solution to any aspect of the victim or survivors' experience or support services albeit these are often over-stretched and under-funded even without the Covid-19 pandemic. Digital abuse is increasing with perpetrators adapting new technologies. Digital developments should be grounded on ethical design principles. Research limitations/implications: This study is the result of the desk-based research during a TEC project considering the potential role of technology in tackling domestic abuse. Limitations include only including evidence from the literature;interviews were conducted but are not reported here. Another limitation is the pragmatic rather than academic nature of the approach;it was to be a foundation for service re-design. So hopefully useful for new practitioners to immerse themselves in the topic area but with no claims to be reproducible as would be the case in a formal review. Practical implications: All the evidence shows the authors need to keep trying different approaches, different forms of engagement and ways to empower survivors. Could technology support health-care practitioners to consistently use sensitive routine enquiry? Perhaps enable independent domestic violence advisors to attend more multidisciplinary team meetings in local community settings? Meanwhile, digital abuse is increasing with perpetrators adapting new technologies. Technology has not yet provided a digital solution which is practical and meets the needs of the broad intersectional population affected by domestic abuse nor those who provide support. If the future is to be based on digital developments it must be grounded on ethical design principles. Originality/value: This desk-based review collates the current national and international policy and research literature whilst focusing on digital developments which support those affected by domestic abuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Organizational e-Health Readiness: How to Prepare the Primary Healthcare Providers' Services for Digital Transformation.

The COVID-19 pandemic has had two main consequences for the organization of treatment in primary healthcare: restricted patients' access to medical facilities and limited social mobility. In turn, these consequences pose a great challenge for patients and healthcare providers, i.e., the limited personal contact with medical professionals. This can be eased by new digital technology. While providing solutions to many problems, this technology poses several organizational challenges for healthcare system participants. As the current global situation and the outbreak of the humanitarian crisis in Europe show, these and other likely emergencies amplify the need to learn the lessons and prepare organizations for exceptional rapid changes. Therefore, a question arises of whether organizations are ready to use modern e-health solutions in the context of a rapidly and radically changing situation, and how this readiness can be verified. The aim of this article is to clarify the organizational e-heath readiness concept of Polish primary healthcare units. This study employs the triangulation of analytical methods, as it uses: (i) a literature review of e-health readiness assessment, (ii) primary data obtained with a survey (random sampling of 371 managers of PHC facilities across Poland) and (iii) the Partial Least Squares Structural Equation Modeling (PLS-SEM) method, employed to estimate the structural model. The evaluation of the model revealed that its concept was adequate for more mature entities that focus on the patient- and employee-oriented purpose of digitization, and on assuring excellent experience derived from a consistent care process. In the context of patients' restricted access to medical facilities and limited social mobility, a simpler version of the research model assesses the readiness more adequately. Finally, the study increases the knowledge base of assets (resources and capabilities), which will help healthcare systems better understand the challenges surrounding the adoption and scaling of e-health technologies.

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study.

BACKGROUND: Scotland-a country of 5.5 million people-has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. OBJECTIVE: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland's video consultation services both before and during the pandemic. METHODS: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. RESULTS: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations' general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. CONCLUSIONS: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.