What we NEED is to build a bridge over the digital divide

How do you bridge a digital divide to stop overlooked and underserved people from falling into the abyss?

Monash University is on a mission to find out.

An innovative new program aims to fast-track digital health solutions for people with low access to technology and digital literacy.

It’s all about delivering what people need to overcome inequities.

Perhaps it’s a chatbot that helps nurses cope with professional burnout?

Or, a device that can predict and prevent epileptic seizures?

Maybe it’s finding a digital solution to boosting immunisation rates in migrants and refugees?

The initiative mobilises collaborators from multiple disciplines and regions who want to overcome health and wellness inequalities in Australia, and the Asia-Pacific and Southeast Asian regions.

This includes rural and regional areas in Australia, Malaysia, Indonesia, the Philippines, Bangladesh and the Pacific Islands.

The Network for Equity through Digital Health (NEED) was founded by Professor Chris Bain, Monash’s first Professor of Practice in Digital Health, Faculty of Information Technology and Professor Andrew Walker, the Pro Vice-Chancellor at Monash University Malaysia.

“NEED supports Monash’s change agenda; a commitment to deliver global impact through its research, teaching, and learning,” Professor Bain said.

Partnering with Monash Malaysia makes geographical and strategic sense.

It is situated in the heart of Southeast Asia and has strong relationships with many healthcare organisations and government agencies.

“We are well-placed to drive positive change in surrounding communities through innovation and leadership,” Professor Walker said.

Another strength is that the researchers can utilise the South East Asia Community Observatory (SEACO), Monash Malaysia’s platform for assessing regional population health and wellbeing.

To help drive innovation on the ground, is the Southeast Asia NEED lead, Dr Jessica Watterson, who is based at the Jeffrey Cheah School of Medicine and Health Sciences at Monash’s vibrant Malaysia campus.

Dr Watterson’s interest in digital health was first sparked in a classroom in California.

“It was the first time that I heard about using mobile phones to try to improve people's health and back then it was a cutting-edge concept.”

The chance to work on a digital health project in Samoa, where pregnant women were sent text messages to encourage them to attend antenatal appointments, solidified her belief in the power of simple, low-cost digital health solutions.

Dr Watterson is skilled in human-centred design, which co-creates digital solutions with the users of the technology.

“The vision of NEED is to use digital technologies to improve equity in Malaysia and beyond,” Dr Watterson said.

Whilst high-tech solutions appear as silver bullets, too often they take for granted the user’s access to internet connectivity, large amounts of data, or costly devices.

The ubiquity of smartphones in Malaysia, estimated to be 91 percent of the population, provides an extraordinary opportunity.

“Most people in Southeast Asia are already highly engaged in the use of their smartphones,” Dr Watterson said.

“They use them to order groceries, arrange transport, communicate with friends and family, so we have an advantage because we are trying to meet people where they already are, not asking them to adopt new behaviour.”

However, the team is determined not to forget about the percentage of people who do not own a smartphone.

“They are probably the most marginalised and vulnerable people on low incomes living in rural areas,” Dr Watterson said.

“We are being really intentional not to leave anyone out when we are designing our research and interventions.

“The other challenge that I think we can get kind of caught up in is designing something just because we can.

“We need to continue to ensure that we are addressing a real need and that we are learning from people what they actually want.”

Professor Bain recalls an article he read in an IT journal about a man in a remote region, who, in the midst of an earthquake, uses ‘two hand technology.’

He was smart enough to somehow reconfigure his phone, attach it to a big pole and use it as a network point, allowing people to call out.

“It was a simple and innovative way to solve a real-world problem,” Professor Bain said.

In its inaugural grant round, NEED funded seven innovative research proposals.

One of the projects that Dr Watterson is excited about is called Deaf In Touch Everywhere (DITETM), led by Associate Professor Uma Devi Palanisamy from the Jeffrey Cheah School of Medicine and Health Sciences

It’s an app that helps people who are deaf access a Sign Language Interpreter (SLI), by appointment or on-demand, so they can have their health consultation translated via video conferencing.

“Often deaf people avoid going to the doctor because there is no guarantee that they will have an interpreter with them in the room,” Dr Watterson said.

Sometimes the only way to communicate with the doctor is by writing, or texting and sharing their screen.

The DITETM app enables a sign language interpreter to be booked online, almost like finding a rideshare.

The grant is being used to help gain insights and input from the users, such as the interpreters, doctors and members of the deaf community.

It will also help screen and manage deaf patients for COVID-19 and include a Medical Sign language bank and health promotional videos.

“An app like this is really exciting, because it has the potential to increase access to healthcare and, ultimately, improve health outcomes.”

Part of what makes the project unique, is the way it is being designed in conjunction with the SLI and the deaf community in Malaysia.

Another project to receive funding is an ambitious bid to design a wearable device that detects seizures before they strike, by monitoring variations in a person’s heart rate.

“You could potentially deliver medication before the seizure happens and prevent it,” Dr Watterson said.

The complexity of the project, led by Dr Mohd Farooq Shaikh, Senior Lecturer in the Jeffrey Cheah School of Medicine and Health Sciences, cannot be underestimated. It requires heart monitors, sensors that send signals to mobile phones, a device to deliver medication, and a way to formulate the medication.

“The project has a lot of potential and there is a long road to go, but we have a great team from a range of backgrounds, including engineering and pharmacology. That reflects the strength of digital health, it’s an interdisciplinary approach.”

Dr Watterson is leading the human-centred design of the app and will carry out qualitative research, speaking to doctors and people with epilepsy.

“For instance, does the user want to be able to see the details of their heart rate, or would this add an additional layer of stress?”

Whether it’s improving healthcare outcomes for people with epilepsy or the deaf community, the NEED team hopes to grow the initiative over time, by increasing the number of collaborators and research projects funded.

“We want to have a tangible and positive impact on people's health in the region and our intentional focus on equity will help us stop people from falling through the cracks,” Dr Watterson said.