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Soundararajan A, Lim JX, Ngiam NHW, Tey AJY, Tang AKW, Lim HA, Yow KS, Cheng LJ, Ho J, Nigel Teo QX, Yee WQ, Yoon S, Low LL, Ng KYY. Smartphone ownership, digital literacy, and the mediating role of social connectedness and loneliness in improving the wellbeing of community-dwelling older adults of low socio-economic status in Singapore. PLoS One 2023; 18:e0290557. [PMID: 37647263 PMCID: PMC10468072 DOI: 10.1371/journal.pone.0290557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, safe-distancing measures resulted in many community-dwelling older adults being socially isolated and lonely, with its attending negative impact on wellbeing and quality of life. While digital technology may have mitigated this, older adults of low socioeconomic status (SES) are more likely to be digitally excluded and hence susceptible to the adverse effects of social isolation and loneliness. This study aims to understand the factors that affect digital literacy, smartphone ownership, and willingness to participate in a digital literacy program (DLP), and to test the hypothesized relations between digital literacy, social connectedness, loneliness, wellbeing, and quality of life amongst community dwelling older adults of low SES. MATERIALS AND METHODS A questionnaire assessing digital literacy, social connectedness, wellbeing and quality of life was administered. Socio-demographic variables, pre-existing internet-enabled, and willingness to participate in a home-based DLP was also collected. Logistic regression was used to identify demographic factors associated with digital literacy, smartphone ownership, and willingness to enroll in a DLP. Serial mediation analysis was also performed using a structural equation model framework. RESULTS A total of 302 participants were recruited. Female gender, older age, lower education levels were associated with lower digital literacy. Those who owned a smartphone tended to be younger and better educated. Older adults who were better educated, of Chinese descent (the ethnic majority in Singapore), and who had lower digital literacy, were most willing to enroll in the digital literacy education program. Social-use digital literacy had a positive indirect effect on well-being ([Formula: see text]) and Quality of life ([Formula: see text]), mediated by social connectedness and loneliness. In contrast, instrumental-use digital literacy had a negative indirect effect on well-being ([Formula: see text]) and Quality of life ([Formula: see text]), mediated by social connectedness and loneliness. DISCUSSION The results suggest there are demographic barriers to participation in DLPs and highlight the benefit of focusing on enhancing social-use digital literacy. Further study is needed to evaluate how well specific interventions to improve social-use digital literacy help to reduce social isolation and loneliness, and ultimately improve wellbeing and quality of life.
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Affiliation(s)
- Amrish Soundararajan
- TriGen, Singapore, Singapore
- Department of Family Medicine, National University Health System (NUHS), Singapore, Singapore
| | - Jie Xin Lim
- TriGen, Singapore, Singapore
- Wee Kim Kee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Nerice Heng Wen Ngiam
- TriGen, Singapore, Singapore
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Angeline Jie-Yin Tey
- TriGen, Singapore, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
- Department of Respiratory Care & Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aaron Kai Wen Tang
- TriGen, Singapore, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Haikel A. Lim
- TriGen, Singapore, Singapore
- Department of Psychiatry, National Health Group, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Ka Shing Yow
- TriGen, Singapore, Singapore
- Department of Internal Medicine, National University Health System, Singapore, Singapore
| | - Ling Jie Cheng
- TriGen, Singapore, Singapore
- Health Systems and Behavioral Sciences Domain, Saw See Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jess Ho
- NTUC Health Co-operative Ltd, Singapore, Singapore
| | - Qun Xuan Nigel Teo
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Wan Qi Yee
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, Singapore Health Services, Singapore, Singapore
| | - Lian Leng Low
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
- Centre for Population Health Research and Implementation, Singapore Health Services, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Kennedy Yao Yi Ng
- TriGen, Singapore, Singapore
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Ngiam NHW, Yee WQ, Teo N, Yow KS, Soundararajan A, Lim JX, Lim HA, Tey A, Tang KWA, Tham CYX, Tan JPY, Lu SY, Yoon S, Ng KYY, Low LL. Building Digital Literacy in Older Adults of Low Socioeconomic Status in Singapore (Project Wire Up): Nonrandomized Controlled Trial. J Med Internet Res 2022; 24:e40341. [PMID: 36459398 DOI: 10.2196/40341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/05/2022] [Accepted: 11/13/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In a rapidly digitalizing world, the inability of older adults to leverage digital technology has been associated with weaker social connections and poorer health outcomes. Despite the widespread digital adoption in Singapore, older adults, especially those of lower socioeconomic status (SES), still face difficulties in adopting information and communications technology and are typically digitally excluded. OBJECTIVE We aimed to examine the impact of the volunteer-led, one-on-one, and home-based digital literacy program on digital literacy and health-related outcomes such as self-reported loneliness, social connectedness, quality of life, and well-being for older adults of low SES. METHODS A nonrandomized controlled study was carried out in Singapore between July 2020 and November 2021 involving 138 digitally excluded community-dwelling older adults aged ≥55 years and of lower SES. Older adults awaiting participation in the program served as controls. Older adults under the intervention were equipped with a smartphone and cellular data, underwent fortnightly to monthly digital literacy training with volunteers to learn digital skills, and digitally connected to their existing social networks. Primary outcome was the improvement in self-reported digital literacy. Secondary outcomes included improvements in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, EQ-5D-3L and EQ visual analogue scale scores, and Personal Wellbeing Score. RESULTS There were significant improvements in digital literacy scores in the intervention group as compared to controls (mean difference 2.28, 95% CI 1.37-3.20; P<.001). Through multiple linear regression analyses, this difference in digital literacy scores remained independently associated with group membership after adjusting for differences in baseline scores, age, gender, education, living arrangement, housing type, and baseline social connectivity and loneliness status. There was no statistically significant difference in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, Personal Wellbeing Score, or EQ-5D Utility and visual analogue scale score. CONCLUSIONS This study adds to the growing research on digital inclusion by showing that a volunteer-led, one-on-one, and home-based digital literacy program contributed to increase digital literacy in older adults of low SES. Future studies should look into developing more older adult-friendly digital spaces and technology design to encourage continued digital adoption in older adults and, eventually, impact health-related outcomes.
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Affiliation(s)
- Nerice Heng Wen Ngiam
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Wan Qi Yee
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Nigel Teo
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Ka Shing Yow
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Department of Internal Medicine, National University Health System, Singapore, Singapore
| | - Amrish Soundararajan
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Department of Family Medicine, National University Health System, Singapore, Singapore
| | - Jie Xin Lim
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Haikel A Lim
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Department of Psychiatry, National Healthcare Group, Singapore, Singapore.,Medical Education Office, Duke-NUS Medical School, Singapore, Singapore
| | - Angeline Tey
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kai Wen Aaron Tang
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Department of Psychiatry, National Healthcare Group, Singapore, Singapore
| | - Celine Yi Xin Tham
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Medical Social Services, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jamaica Pei Ying Tan
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore
| | - Si Yinn Lu
- Research and Translational Innovation Office, SingHealth Community Hospitals, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Kennedy Yao Yi Ng
- TriGen - Trigenerational Homecare, Singapore, Singapore.,Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Lian Leng Low
- Population Health and Integrated Care Office, Singapore General Hospital, Singapore, Singapore.,Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore.,SingHealth Duke-NUS Department of Family Medicine, Singapore, Singapore.,Outram Community Hospital, SingHealth Community Hospitals, Singapore, Singapore
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Yow KS, Tan CL, Nashi NB. Nailing the Diagnosis-Antisynthetase Syndrome as a Cause for Pyrexia of Unknown Origin. Am J Med 2020; 133:e737-e739. [PMID: 32502483 DOI: 10.1016/j.amjmed.2020.04.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | - Char Loo Tan
- Department of Pathology, National University Health System, Singapore; Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Yow KS, Liu X, Chai CN, Tung ML, Yan B, Christopher D, Ong KH, Ooi MG. Relationship of JAK2 (V617F) Allelic Burden with Clinico- Haematological Manifestations of Philadelphia-Negative Myeloproliferative Neoplasms. Asian Pac J Cancer Prev 2020; 21:2805-2810. [PMID: 32986384 PMCID: PMC7779444 DOI: 10.31557/apjcp.2020.21.9.2805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 01/10/2023] Open
Abstract
JAK2 (V617F) allelic burden is the main genetic driver behind and a potential differentiator between individual myeloproliferative neoplasm (MPN) subtypes. This study aimed to explore the relationship between JAK2 (V617F) allelic burden, MPN subtypes and their clinico-haematological manifestations in a Singapore-based cohort. Analysis was performed on a retrospectively collected dataset of 128 patients diagnosed with JAK2 (V617F) positive Philadelphia-negative MPNs between 2016 to 2017 in Singapore. Genomic analysis was conducted on blood samples via DNA extraction and Droplet Digital Polymerase Chain Reaction (ddPCR). The mean age was 62.4 (SD=14.1). 85 out of the 128 (66.4%) patients were male. There was a statistically significant difference in allelic burdens between the different MPN disease subtypes χ2(3) = 9.064, p=0.028, with essential thrombocytosis (ET) patients having the lowest mean JAK2 percentage allelic burden (26.5%). Patients with an allelic burden >50% had higher leukocyte counts (MWU 1016.5, p=0.001), haemoglobin levels (MWU 1287.0, p=0.045), lactate dehydrogenase levels (MWU 611.5, p=0.001), and lower platelet levels (MWU 1164.0, p=0.008). Subgroup analysis revealed none of these correlations was significant in the ET subgroup. The results are largely in concordance with previous research in Asian cohorts demonstrating the association between allelic burden and clinico-haematological manifestations of MPN. However, in the ET subgroup, the JAK2 (V617F) allelic burden do not correlate positively for haematological parameters which is only seen in Asian patients.<br />.
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Affiliation(s)
| | - Xin Liu
- Department of Haematology-Oncology, National University Hospital, Singapore
| | - Chean Nee Chai
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Hospital, Singapore
| | - Moon Ley Tung
- National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Hospital, Singapore
| | - Benedict Yan
- Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Hospital, Singapore
| | | | - Kiat Hoe Ong
- Department of Haematology, Tan Tock Seng Hospital, Singapore
| | - Melissa G Ooi
- National University of Singapore, Singapore.,Department of Haematology-Oncology, National University Hospital, Singapore
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Ng KYY, Leung GYC, Tey AJY, Chaung JQ, Lee SM, Soundararajan A, Yow KS, Ngiam NHW, Lau TC, Wong SF, Wong CH, Koh GCH. Bridging the intergenerational gap: the outcomes of a student-initiated, longitudinal, inter-professional, inter-generational home visit program. BMC Med Educ 2020; 20:148. [PMID: 32393249 PMCID: PMC7216381 DOI: 10.1186/s12909-020-02064-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aims to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen. METHODS Teams consisting of healthcare undergraduates and secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes in knowledge and attitudes towards the older people and nine domains of soft skills pre- and post-intervention. Patients' reported satisfaction and clinical outcomes were also assessed. RESULTS Two hundred twenty-six healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1 and 62.4% respectively. One hundred six patients participated in TriGen. There was a significant increase in Kogan's Attitudes towards Old People Scale (KOP) scores for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5-16.2, p < 0.001) and 8.3 (95%CI: 6.2-10.3, p < 0.001) respectively. There was a significant increase in Palmore Facts on Aging Quiz (PFAQ) score for SS students but not for healthcare undergraduates. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was also a significant decrease in hospital admission rates (p = 0.006) and emergency department visits (p = 0.004) during the 6-month period before and after the program. Fifty-one patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier. CONCLUSION TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of SS students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst SS students and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.
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Affiliation(s)
- Kennedy Yao Yi Ng
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Angeline Jie-Yin Tey
- Department of Intensive Care Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Jia Quan Chaung
- Changi Naval Base, Singapore Armed Forces, Singapore, Singapore
| | - Si Min Lee
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ka Shing Yow
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | | | - Tang Ching Lau
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore, Singapore
| | - Sweet Fun Wong
- Populational Health and Community Transformation, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 117549, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.
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