2. Research for Healthcare

Project Research 1

Pirates of Design are working on a project dealing with a domain space for rural and urban healthcare. Our team wants to get insights that would help us derive a solution on how we could improve the healthcare in the rural areas by connecting the rural areas to the urban areas together. Our team needs to get insights for this in order to come up with a solution that actually helps solves the problem for the people. This research will be so helpful to us, as we have to understand our users and the problems being faced by them so we could actually address the problem and put in place a suitable solution. There are several methods that we will be using in order to achieve our goals, some include:

1. Contemporary Literature
2. Other published documents: statistics or reports
3. Interviews
4. Feedback from stand-up meetings

In the next paragraphs, we will summarize all the findings we have into insights. We also will explain how we got into a certain decision based on the research we found in our design process.

Contemporary Literature

There are several works of literature that we continue to study in order to get to know our audience's problem. We have difficulty in finding the right literature that represents Australia to satisfy the needs of Australian Healthcare. We decided to focus on exploring the domain problem that might exist in Australia. Some insights that we have gained are described below.

As we searched for literature papers before in the proposal, the word 'rural' has become vague to our group. Based on Justin Wood paper about rural health care, the rural meaning is very diverse and could not be explained in short words. 'Rural' could be in between of geographies factors, distance factor, social-economic factors, etc. Wood also encourages us to explain our own 'rural' definition in a project whereas it would narrow down the meaning of the mural itself.

We are also curious about the issues people in rural areas have. Hardships from low income, isolation, and difficulties reaching essential healthcare are some of the issues rural people face in their daily life. These factors are connected to one another and bring our group to choose this project domain problem which is the issue behind the healthcare in rural areas. It is complicated to measure the improvement or possible services in order to satisfy the whole system.

Rural people generally have poor access to good healthcare services. The patient often faces with no choice to whom they see for treatment. One solution to receive the quality they want is to travel in the far distance in order to get the fair treatment. To conclude, the principal barrier of the overall rural health care is the distance, thus, people created telemedicine which remotely provides health care by the internet in order to solve the issue. However, telemedicine has a limitation in rural areas that might discourage people or medical teams from using the technology.

Another factor is the availability of health workers in rural areas. This issue also considered as the main problem. Some ideas to solve the issue are proposed but they are considered as ineffective because of the difficulty in sustaining such system in a long run. The availability of the health worker is mostly affected by attractiveness, recruitment, retention, and health workforce/health system performance factors. (Dolea, 2010)

As our group learns about the factors that cause poor healthcare system in rural areas, we also explored the cause they have. Our group founds out that the issue could be caused by a serious impact. Some example is:

In Scotland, research has shown that patients with common cancers have less chance of diagnosis before death, and/or poorer survival after diagnosis, the further they live from a cancer center (Campbell et al, 2000).

The statistic conducted from rural health research shows remote Australian have 40% higher death rates in term of coronary heart diseases and 3 times higher chance in term of type 2 diabetes. (Ruralhealth.org.au)

From the Rural Health Research statistic, it also shows that the ratio of the availability between doctors in cities and remote are 2 to 1. Although the statistic from Wood paper shown that rural people have a better chance on health than urban people, poor access to a health care means that people tend to not get a range of options receiving the health services. This could cause rural people to not able to getting the fair/good treatment when they have a medical condition. This issue would generate bad repercussion involving medical support in rural areas. Statistics and facts mentioned above are real examples of how with less option in remote areas, people also tend to have little opportunities to be helped. Based on only these insights, we gain that distance and service availability is affecting remote areas to a certain degree where it might bring bad impact.

Other published documents

Other published documents are also helping us find insights that support our design decisions. These published documents are getting our group to understand how the healthcare system works in Australia, specifically in Queensland. Below are the summarized insights we gain from different news or papers.

Queensland Rural and Remote Health Service Framework from health.qld.gov.au and ruralhealth.org.au

There is one solution in order to solve the distance issue. The technology used is called Telehealth where health services or information are shared via telecommunication technology. This technology is currently already applied in Australia for years. Telehealth aims to increase the access to healthcare in greater range geographically. It also aims to reduce the need for the patient to travel. However, telehealth has several deficiencies, such as the following examples:

At the Connected Health Conference, two medical experts — Dr. Andrew Watson, president of the American Telemedicine Association, and Dr. Ateev Mehrotra, an associate professor of healthcare policy and medicine at Harvard Medical School — debated whether the cost of telemedicine outweighs the benefits. [medicitynews])https://medcitynews.com/2018/10/debate-telehealth-cost-effective/)

Will Healthcare Providers See Value in Telehealth Accreditation?(mhealthintelligence)[https://mhealthintelligence.com/news/will-healthcare-providers-see-value-in-telehealth-accreditation]

Although telehealth has been helping a lot of people, there is a lot of refinement that the institute must do in order to provide a better result. Issues surrounding telehealth usually comes from external resources where it supports the system. Like above, telehealth is considered ineffective in terms of money and qualification, if there is no accreditation that bears the system. If some of these issues are solved, telehealth will have more advantageous quality in the medical world where people could use effectively.

In our research, we also found that there are five types of health facilities which are district hospitals, rural hospitals, community hospitals, community clinics, and multi-purpose health services that represent the facility services. District hospital provides higher acuity medical treatment and multi-purpose health services have the lowest capability in providing medical services. Each healthcare type has a different purpose, limitation, and capability. These facts that might affect our future decision where we consider the type of health care in order to narrow down our target audience.

Interviews

After doing research, our group conducted interviews with rural people and medical teams. These interviews aim to give us qualitative information where we hope it would spark us with new ideas. Following are some of the questions we asked the healthcare community which was our patients and medical staff. The interviews were made for the rural and urban healthcare communities. As such, we came up with some questions that will help us learn more about our users and the actual difficulties faced when it comes to health care.

For rural people

1. What is your age range?
2. What device do you mostly use to connect to the Internet?
3. How do you get any information regarding the rural area improvement
4. Is there a healthcare in the suburb? If yes, how far is the healthcare from your place?
5. Is the healthcare quality up to your standard? Please describe more about your healthcare quality.
6. If the quality is not up to your standard, is there any alternative healthcare that you prefer wish you had? If yes, how far is it?
7. Are there any difficulties in terms of accessing the healthcare itself? Please describe the difficulties.

For the medical team

1. What do you know about health care in rural areas?
2. In your own how would you describe the difference between urban and rural healthcare?
3. Do you know any problems related to healthcare? If yes what?
4. How does the medical staff gather information regarding rural health care?
5. Are there any issues you face when it comes to communicating with the rural healthcare communities?
6. What are the aspects that you usually consider when participating in a volunteer work?
7. Have you ever volunteered to serve the rural communities to improve the healthcare in the remote areas? If yes, what would be your motivation?
8. What are the constraints that arise when volunteering?

The questions above were customized for the people in the rural areas and urban areas. We also customized the questions for the medical staff. The interviews have been successfully conducted with 2 participants from people that live in rural area and 4 medical staff. Several insights gained from the interviews are summarized as below (Interview transcript could be found in Appendix):

• A device used to connect with the internet for any purpose that the medical team mostly used is a phone. They also answer a computer if they are working or in a workplace.
• Satisfaction to help the system is considered as the most of the motivation factor for doctors to participate volunteering.
• Constraints from volunteering for doctors are lack of funding, travel distance, and time.
• Information regarding rural health care usually available on social media.
• Rural people get updated news about rural area improvement from social media platform like Facebook.
• Distance proved as the main problematic factor for rural people to gain the treatment they wanted.
• Improvement suggested is to have trained and qualified staff in healthcare.

In conclusion, we learned that rural health communities have poor health facilities and there is a need to help these communities so that they could have a better tomorrow. We also learned more about the users, on what they preferred and what would work.

As the completion of the interview and research done, our group decided to put forward an idea we called as Medical Network Platform. The platform will expose the urban community to any possibilities to contribute to improving the quality of health care in rural areas. The platform will also support social interaction where people could share their experience of the contribution to the community.

Feedback from stand up meetings 1

As we pitch our ideas to tutors and the course coordinators, we gained a lot of negative critiques in term of finding insights that support the idea. Like, do doctors really want to volunteer with the designated incentive? Does Australia(Queensland) support the eligibility of our idea? How the application could be working in a real-life scenario? We also learned that we come to the conclusion too soon. The idea is very raw and not taken into consideration in term of consulting from both parties (doctors and patient). The conclusion that we made based on assumptions and not supported by a lot of design problem insights. Other feedback that we took is that our idea is too general and not narrowed down. The idea is supposed to be narrowed down into a specific audience and certain flow. And as the idea is too narrow in a range of rural health care, it would be difficult for us to decide which task flow and design decision we have to choose in process. We are also were working with the workload (moodboard) too soon where it caused production and effort lost in our team. The course coordinator suggested that we gain more insights of where the idea is supported then continue with the prototype.

Design Decisions

Taken by surprise from the feedback of the stand-up meetings, we are continuing to explore more about the problem or issues in rural healthcare. We have come to the realization that the idea lacks insights information where it would not be proper for our group to decide and assume the solution at this stage. We decided to stop all the works of building prototype for now and we decided to focus on gaining insights that could uphold new ideas or solutions. The next step for us is to learn from the research we have done from this point and to do more research in the future to explore new ideas regarding the rural health care issue.

From the research that we found before, we learned that we must narrowed down the word rural itself. The word rural is very universal. Thus, after discussion within our group, we decide that rural means that it is the areas categorized geographically based on distance. The areas where the Queensland government labeled as rural, not outer regional. The map could be found in health.qld.gov.au

Appendix

Dolea, Carmen, et al. “Evaluated Strategies to Increase Attraction and Retention of Health Workers in Remote and Rural Areas.” Bulletin of The World Health Organization, vol. 88, no. 5, 2010, pp. 379–385. [Accessed 18 Sep. 2018].

Edwards, C. (n.d.). American Journal of Agricultural Economics. [online] 58(5),pp.914-921. Available at: https://academic.oup.com/ajae [Accessed 3 Sep. 2018].

Wood, J. "Rural Health and Healthcare" [online] Institute for Health Research Lancaster University. [Accessed 18 Sep. 2018].

Interviews Transcript

Interview for rural people

Questions	People 1	People 2
What is your age range?	37 Female with 4 children (3,6,9,11 years old)	35 Male
What device do you mostly use to connect to the Internet?	Mobile phones, desktop, tablets. However we are a younger household, you will find alot of older houses (60 year old +) only using desktop.	Mobile phone and laptop mostly when I'm working.
How do you get any information regarding the rural area improvement	Occasionally something will pop up in facebook, however this is a huge issue in our region, people are usually not aware of services available, especially new services.	From mouth to mouth words. Some are from newspaper too.
Is there a healthcare in the suburb? If yes, how far is the healthcare from your place?	There is a Multi-purpose Health Facility in both Quilpie and Augathella, they have a GP surgery attached to them and utilise a 2 week on/ 2 week off roster with 2 permanent doctors rotating.  It is difficult to get any continuity of care, if you are not happy with the service the GP is delivering it involves large distances to get a second opinion. We have visiting physio/ Occupational Therapists/ Podiatrists/ Mental Health workers/ Speech Therapists in both towns however these are only monthly visits, often staff turnover is high so continuity of care is low, often go months without someone filling these positions. Charleville does have permanent staff in these areas however this is a 200km round trip from Augathella and 400km round trip from Quilpie, more if you live out of town. The nearest dentist is Charleville.  THere are telehealth services available. There are no private services available, if you access private telehealth services for speech/physio it is costly as majority of private health companies do not recognise these services.	I think there are some small healthcares in the suburb, however, I never really come to the healthcare itself. I usually have to travel to Cairns since they have more complete medical system. Cairns is around 50 km from my place, thus, its not very far to get to the healthcare. Staffs there are more qualified too and doctors are more available. For the dentist, there is one 5 minutes from my place. For other specialty, I don't think they are available in the suburb.
Is the healthcare quality up to your standard? Please describe more about your healthcare quality.	No, alot of medical staff sent out here are graduates and don't have a high level of experience and are not able to be supervised by experienced staff due to lack of healthcare practitioners wishing to relocated to South-West Queensland, they tend to be transient and don't show a high level of care.	Quite, I could not said for sure. The dentist is up to my standard, but I don't think other treatment has the same quality as they are very few healthcare in the suburb.
If the quality is not up to your standard, is there any alternative healthcare that you prefer wish you had? If yes, how far is it?	I usually travel to Charleville 240km round trip. If it requires specialist treatment such as cardiologist, surgical treatment, most people travel to Toowoomba (1400km round trip) or Brisbane (1600km round trip) from Augathella.	around 50-80 km to Cairns.
Is there any difficulties in terms of accessing the healthcare itself? Please describe the difficulties.	Large distances, limited hours, high costs related to travel and accommodation.	Time constraint since I'm working full time. I must schedule very early so I could go round trip to Cairns just to get the treatment.

Interview for medical team

Questions	People 1	People 2	People 3	People 4
What do you know about healthcare in rural areas?	Clinical Trial Pharmacist	Ophthalmologist	Assistant in nursing	University academic
In your own how would you describe the difference between urban and rural healthcare.	more organized, few drug shortages, they are more stuffed in terms of doctors and nurses and they usually have enough medical suppliers to treat patients accordingly.	urban health care has more skilled human resources providing care, usually has better availability of medications and equipment and covers a wider range of conditions.	Rural healthcare is often basic and does not have the same facilities. Resources are limited cause of transporting them so far and also lack of adequate government funding for rural health centres	Inequity, difference in care levels, staffing, resources
Do you know any problems related to healthcare? If yes what?	Drug shortages and a delay in responding to patients due to staff shortage e.g Doctors, Pharmacist and Nurses	it is of poor quality because skilled human resources prefer to stay in cities,  it is poorly financed and medical equipment which is allocated there tends to not be advanced	Lack of access, poor capacity (could be one doctor and nurse in the clinic all day), lack of resources	Lack of care facilities, doctors
How does the medical staff gather information regarding the rural healthcare?	News and Social Media	From the health management information system (at ministry of health level and within the district health offices)	Word-of-mouth, google, twitter/fb	Phone/telehealth
Are there any issues you face when it comes to communicating to the rural healthcare communities?	Information reaching the rural healthcare later than the intended time	I'm not aware. It is usually the District Health Management Team at the District Health office which communicates to rural facilities.	Not sure, haven’t been in this situation	Connectivity problems
What are the aspects that you usually consider when participating to a volunteer work?	I usually look at the objectives and outcomes, if the outcomes will be of great benefit and will have a great impact in improving healthcare.	Health promotion and conducting surgical camps. It is usually an opportunity to improve my skills and it gives me satisfaction that I'm helping a system (thereby benefiting large numbers of patients) as compared to helping individual patients.	What the need is, who is affected, how can I help, what are other people doing to help	Benefits to others/time availability
Have you ever volunteered to serve the rural communities to improve the healthcare in the remote areas? If yes, what would be your motivation?	Yes I have, through Research, currently am part of 6 studies, that will improve the healthcare of children and HIV patients.	Yes. Via medical research. My experience has been that research helps to bring evidence by which health care policies could be based on. HOWEVER, the evidence is usually not implemented in policy due to political factors which affect the decision makers	Research. Worked with a team in Malawi that was researching the problems with the health care system in Malawi. We found that access was a problem and people were visiting hospital for trivial issues and wasting time and also over-crowding health centres. For example, people would have to travel into town and pay MWK200 both ways just for a headache when they could have taken Panadol. We began developing an app	Teaching telehealth to medical and other students/health professionals; doing research in telehealth
What are the constraints that arise when volunteering?	When there is too much politics involved	Lack of funding to enable us do the work (it is only practical that we carry out voluntary work when the costs are taken care of by an external source).	Travel distance, time constraints, money	Time