Co-design of digital health technologies in Australian First Nations communities
Authors: Vishnu Khanal, Timothy Shaw, Elaine Wills, John Wakerman, Deborah J Russell
Journal: The Lancet Digital Health (2024)

In The Lancet Digital Health, Israel Júnior Borges do Nascimento and colleagues1Borges do Nascimento IJ Abdulazeem HM Vasanthan LT et al.The global effect of digital health technologies on health workers' competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis.Lancet Digit Health. 2023; 5: e534-e544Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar analysed current evidence of effects relating to several digital health technology (DHT) solutions, and health-care workers’ performance and professional competencies. One of the unintended consequences of telemedicine was that it might increase health-care workers’ burden and burnout (relative frequency of mentions in reviews 2·2%, 95% CI 0·3–7·9).1Borges do Nascimento IJ Abdulazeem HM Vasanthan LT et al.The global effect of digital health technologies on health workers' competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysis.Lancet Digit Health. 2023; 5: e534-e544Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar Recent findings from remote First Nations primary health-care providers showed that telehealth was associated with increased administrative and clinical workload because of the necessity to attend consultations with providers not on site, who were usually non-general practitioner (GP) medical specialists.2Mathew S Fitts MS Liddle Z et al.Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?.BMC Health Serv Res. 2023; 23: 341Crossref PubMed Scopus (7) Google Scholar This necessity took local primary health-care clinicians away from their regular clinical work, especially from the management of complex chronic diseases. In remote Australian First Nations communities—where the burden of disease is high, turnover of staff is extremely elevated, and health services are under-resourced—excessive workload and resultant burnout is widespread.3Zhao Y Wakerman J Zhang X et al.Remoteness, models of primary care and inequity: Medicare under-expenditure in the Northern Territory.Aust Health Rev. 2022; 46: 302-308Crossref PubMed Scopus (5) Google Scholar, 4Wieland L Ayton J Abernethy G Retention of general practitioners in remote areas of Canada and Australia: a meta-aggregation of qualitative research.Aust J Rural Health. 2021; 29: 656-669Crossref PubMed Scopus (3) Google Scholar Interventions that inadvertently increase burnout and turnover threaten the quality and safety of all health care for people living in the remote communities. We share early learnings from a digital health implementation project that is currently underway in a remote community in Australia.5Digital Health Cooperative Research CentreOptimising digital solutions to improve access to comprehensive primary health care services in remote Indigenous communities.https://digitalhealthcrc.com/projects/optimising-digital-solutions-to-improve-access-to-comprehensive-primary-health-care-services-in-remote-indigenous-communities/Date: 2023Date accessed: September 25, 2023Google Scholar This Digital Health Cooperative Research Centre project is unique because it co-designs DHT solutions with both consumers and health-care workers, which is anticipated will minimise unintended consequences while optimising uptake by meeting the prioritised needs of both groups. Initial engagement included workshops with remote health professionals; meetings and interviews with senior health executives, visiting clinicians, local health-care staff, and managers; and yarning (ie, informal and formal discussions) with First Nations people and community leaders. These discussions identified—from both community and service providers’ perspectives—the most important access issues to primary health care that DHTs could address. One example of a high priority for both consumers and health-care staff was effectively addressing the intermittent access to GPs who were known to the patients and health-care workers and who knew the community well, but only visited the community clinic 1 day each week. Remote primary health-care staff indicated that the added value of having telehealth access to a familiar GP in between face-to-face visits would greatly support provision of primary health-care services, including their ongoing management of chronic diseases, thereby assisting them with managing their workload, rather than being an added burden. For patients, being cared for by a GP who knew them well was important. The co-design of DHTs, by taking into account consumers and providers’ preferences, is a promising approach that is anticipated to improve access to primary health-care services. We declare no competing interests. The project described in this Correspondence is funded by the Digital Health Cooperative Research Centre, and is a collaborative project among multiple partners in Australia: Australian Government, Department of Health and Aged Care; Department of Health, Northern Territory Government; Northern Territory Primary Health Network; Aboriginal Medical Services Alliance Northern Territory; Healthdirect Australia; Menzies School of Health Research; and The University of Sydney. The global effect of digital health technologies on health workers’ competencies and health workplace: an umbrella review of systematic reviews and lexical-based and sentence-based meta-analysisSystematic reviews have quantified the effectiveness, feasibility, acceptability, and cost-effectiveness of digital health technologies (DHTs) used by health-care workers. We aimed to collate available evidence on technologies’ effect on health-care workers’ competencies and performance. We searched the Cochrane Database of Systematic Reviews, Embase, MEDLINE, Epistemonikos, and Scopus for reviews published from database inception to March 1, 2023. Studies assessing the effects of DHTs on the organisational, socioeconomic, clinical, and epidemiological levels within the workplace, and on health-care workers’ performance parameters, were included. Full-Text PDF Open Access