Malaysia is already experiencing population ageing, with 7.4 per
cent of the population aged 65 years and over in 2023. As
Malaysia heads towards an aged society, policies are needed to
better prepare seniors for healthy ageing. Digitalisation
promises to improve seniors’ well-being and promote ageing in
place. Through digital healthcare services, seniors can easily
access health-related information, telemedicine services,
fitness applications, etc., that enable them to manage their
health actively. However, the digital divide among seniors may
result in slower adoption of digital services. This research
project aims to study the state of digital healthcare services
adoption rate among seniors in Malaysia, to understand the
challenge of digital healthcare adoption, to identify the
current and future needs of digital healthcare services, and to
provide general recommendations on addressing the digital
healthcare gaps. A mixed mode approach, which comprises both
survey and interview, was adopted in this research. A total of
404 responses were collected through the survey, and 22
interviews were conducted. Based on the data collected, it is
found that most seniors are open to adopting these technologies,
provided that training or technical support is available.
Furthermore, six (6) building blocks that support the adoption
of digital healthcare services among senior citizens in Malaysia
were proposed: digital infrastructure, digital literacy, health
literacy, awareness, needs, and the senior’s perception.
Finally, general recommendations were proposed to relevant
stakeholders to spur the adoption of digital healthcare,
including healthcare professionals, digital healthcare service
entrepreneurs/developers, payers’ organisations and authorities,
community organisations, telecommunication companies, and
policymakers.
Keywords: Digital healthcare, senior citizens, digitalisation,
ageing
02 introduction
In Malaysia, the percentage of the population aged 65 years and
over has increased from 7.2 per cent to 7.4 per cent from 2022
to 2023 (Department of Statistics Malaysia, 2023). This
indicates that Malaysia is already experiencing an ageing
society. The World Bank further estimated that the rate of
ageing would increase in the coming years, and the share of the
population aged 65 and above is projected to double to 14 per
cent by 2044 and reach 20 per cent by 2056 (Schmillen, 2020).
As
the population ages, the demand for primary and specialist
healthcare resources increases. Seniors, as the most significant
users of healthcare services, could greatly benefit from the
digitalisation of healthcare services. Digital healthcare refers
to a field of knowledge and practice using digital technologies
for health preferences (Borle et al., 2021). It has paved the
way for new types of innovative services and is expected to
deepen the development of the Internet setting with novel
electronic devices. For instance, the advancements in digital
technologies, including the Internet of Services (IoT), virtual
care, remote monitoring, Artificial intelligence (AI), big data
analytics, blockchain, and smart wearables, have shown immense
potential in enhancing healthcare delivery. Healthcare
professionals can interact with patients remotely through
computers, tablets, and smartphones, breaking geographical
barriers and enabling faster medical attention (Haleem et al.,
2021).
Nevertheless, digital healthcare is a double-edged sword: it has
the potential to reduce health inequalities by increasing access
to healthcare, but it also holds the capacity to exacerbate
inequality in access to healthcare (Barnett, Mishuris, et al.,
2022). Seniors equipped with the necessary infrastructure and
digital skills are likely to reap the benefits of digital
healthcare. However, those not tech-ready may be left out,
putting them at an even greater risk of unmet healthcare needs.
In other words, ensuring the digital inclusion of seniors is the
key to delivering equitable healthcare and promoting healthy
ageing among seniors.
Seniors’ adoption of digital technologies is lower than that of
younger adults due to multiple reasons (Abouzahra &
Ghasemaghaei, 2022). According to the Malaysian Communications
and Multimedia Commision (MCMC) Internet Users Survey 2020, over
half of adults aged 60 and above (51.8 per cent) do not use the
Internet (MCMC, 2020), highlighting the digital divide between
different age groups. To bridge the digital divide, assessing
senior citizens’ challenges and the need to adopt digital
healthcare is crucial (Zainal et al., 2023). Through a better
understanding, policymakers can formulate a proper intervention
promoting equal healthcare access among seniors.
The following are the four (4) research objectives (RO) in this
research:
RO1
To study the state of the adoption rate of digital healthcare
services among seniors in Malaysia.
RO2
To understand the challenges of digital healthcare adoption
among senior citizens in Malaysia.
RO3
To identify the current and future needs of digital healthcare
services that will benefit and improve the daily lifestyle of
senior citizens in Malaysia.
RO4
To provide general recommendations on addressing digital
healthcare gaps as inputs to MCMC and critical stakeholders to
spur the adoption of digital healthcare among Malaysia’s
senior citizens.
03 literature review
Digital healthcare has enormous potential to facilitate
independent living and enhanced access to health and assisted
living services. Digital health services encompass a wide range
of services, such as telemedicine, e-pharmacies, health
management services, and digital health insurance (Sit, 2021).
Some of these platforms in ASEAN countries include Halodoc
(Indonesia), MyDoc (Singapore and Vietnam), Doctoroncall
(Malaysia), Medgate (the Philippines), and Raksa (Thailand).
One
of the critical barriers to the use of technology is the impact
of poverty and the financial implications of relying on
technology that may be expensive to purchase, maintain, or keep
connected (Moody, 2022). This is relevant because seniors
typically have limited or no fixed income as they are retired.
Studies have also indicated that seniors do not use
digital healthcare services simply because they are unaware of
the opportunities (Kaihlanen et al., 2022; Sourbati, 2009).
Also, the adoption of digital healthcare relies heavily on trust
to succeed (Adjekum, 2018). A lack of trust in the digital
healthcare system will significantly hinder the adoption of
digital healthcare.
Ageing also brings about
physiological and psychological changes, such as poor eyesight,
hearing loss, memory loss, difficulty acquiring new information,
feelings of inadequacy, and lack of interest in learning. These
have led to other barriers, such as low digital literacy and
poor representation of their need in the digital platform
(Liljeroos, 2023). In addition, many must rely on family members
for support and guidance. Some have encountered difficulties
getting the understanding and patience from family members while
learning to use healthcare technology (Ocloo, et al., 2021).
To
facilitate the adoption of digital healthcare among senior
citizens, digital healthcare services or platforms need to
consider the specific needs of the seniors. The digital
healthcare services should reflect their needs through a better
interface design, including content that aligns closely with
their needs or a better integration into the existing health
systems.
In addition, the availability of dedicated
counsellors to train and educate seniors and provide continuous
support could greatly impact the uptake of digital healthcare
(Wilson et al., 2021). Additionally, financial support was also
highlighted as an important facilitator in the update of digital
health technologies. Although digital healthcare tools have the
potential to be useful, senior citizens might need time to
overcome their fears and adopt digital healthcare tools
(Safarov, 2021).
External factors such as policy and
legislation, the available incentives, and the level of public
awareness were also found to significantly impact the digital
healthcare uptake (Coves, 2022). Customised strategies, greater
integration of technologies, and well-planned training are
essential enablers to facilitate the successful implementation
of digital healthcare among senior citizens (Hung, 2022; Watt,
2022).
Numerous countries have implemented
initiatives to encourage the adoption of digital healthcare
among the elderly. In Singapore, the “Seniors Go Digital”
programme was launched to accelerate the digital adoption of
seniors through large-scale direct interaction with them.
Through this programme, seniors can sign up for
government-subsidised smartphone and mobile plans and learn
basic digital skills under the close personal guidance of the
Digital Ambassadors (Perdana, 2022).
Similarly,
Australia’s “Be Connected” programme adopts a community-centred
approach to assist older Australians in learning the basics of
digital technology. The programme offers free online learning
resources and free computer classes run by community
organisations across Australia. (Department of Social Services,
2022).
Instead of using a bottom-up approach to
encourage public adoption of digital healthcare services,
Estonia and Sweden focus on top-down strategies. These
strategies aim to enhance national IT infrastructure in terms of
interoperability and system integration. Elsewhere in Germany,
given the population’s high digital health readiness, digital
health services, especially electronic health record solutions
(EHRs) and e-prescriptions are very popular (Thiel et al.,
2018).
In Germany, digital health applications can
apply to be in a listing of DiGA - highquality approved digital
health applications (DHAs). DiGA has been integrated into
standard care by law. Under this Act, healthcare professionals
can prescribe DHAs to patients with costs covered by the
national health system (Wangler, 2023).
In Malaysia,
there are many programmes available to teach seniors Digital
technologies. These programmes are organised by different
organisations/ committees such as MyAgeingTM, the Digital
Technologies Seniors Programme (DTSP), Pusat Aktiviti Warga Emas
(PAWE), members of Parliament, and state assembly members. Of
the above, except for PAWE centres which are by the Social
Welfare Department, most programmes are often self-driven
initiatives and are not part of a centralised government
campaign. Recently, Malaysia has also started introducing
cheaper WiFi packages for seniors, such as Pakej Perpaduan
(Rahmah) Fibre Broadband.
04 methodology
This research adopts a mixed-methods approach that combines both
qualitative and quantitative methodologies. In this study, two
(2) research instruments were developed to collect the relevant
data to answer the research objectives and questions, i.e., the
survey questionnaire and interview questions. The survey
questionnaire consists of four (4) sections: demographic
information, the state of digital technology usage, the
perception of digital healthcare services, and the challenges
and recommendations of adopting digital healthcare services. A
semi-structured interview using a qualitative approach was used
to identify the challenges, needs, and potential solutions of
adopting digital healthcare services. The questions are loosely
structured and give interviewees more opportunities to express
themselves fully.
Survey questionnaires were targeted
to Malaysian seniors aged 60 and above. Malaysian seniors
comprise 11.1 per cent of the total Malaysian population,
equivalent to 3.6 million people (Baharudin et al., 2022). To
ensure sufficient sample collection, a minimum of 384
participants are sought (Krejcie & Morgan, 1970). Both
online and hardcopy surveys are distributed across all states in
Malaysia.
Purposive sampling is adopted when
selecting the informants for qualitative interviews. The sample
locations are Selangor, Kuala Lumpur, Johor, Pulau Pinang,
Perak, Kelantan, Sabah, and Sarawak. The senior respondent
selection is based on three (3) primary criteria to ensure
significant variation: experience in using digital healthcare
services, age, and gender. The saturation point will determine
the final number of participants, where further data collection
would not contribute significantly to the overall understanding
of the topic. (Strauss and Corbin, 1998). Besides seniors,
interviews were also performed with healthcare providers,
not-forprofit organisations, and caretakers so that inputs from
various stakeholders were considered.
The data
collected through the survey questionnaire is analysed using
univariate techniques and descriptive statistics. The audio
recordings collected from interviews were transcribed and
translated verbatim. The researchers then looked for emerging
codes and grouped them into relevant themes. The interview
transcriptions were also analysed using the qualitative data
analysis software NViVO.
05 findings and analysis
Demographic information
A total of 404 responses were collected from the survey. Among
the survey respondents, 208 (51.6 per cent) were female and 195
(48.4 per cent) were male. 47.9 per cent of the respondents are
aged 60 to 64. More than half of the respondents (54.1 per cent)
only received secondary education or lower. Table 1 shows the
socio-demographic characteristics of the respondents. While the
researchers have made the best effort to avoid coverage error,
the responses gathered from the survey do not reflect the per
capita ratio of the elderly in each state and the place of
residence. These results, therefore, should be interpreted with
caution.
Table 1: Socio-demographic of the survey respondents (n=404)
For the qualitative study, 22 volunteers participated in the
interviews, comprising 17 elderly people, two (2) digital
healthcare providers (Angsana Health, doc2us), two (2)
not-for-profit organisations (MyAgeingTM, DTSP), and one (1)
caretaker. Table 2 summarises the demographic information of the
senior interviewees.
Table 2: Demographic of the senior interviewees (n=17)
Among the 17 senior interviewees, three (3) (18 per cent) have
no basic digital skills and do not own or operate a smartphone
alone. Among the 14 senior interviewees with digital skills,
four (4) (29 per cent) have experience using DHS other than
MySejahtera, while 10 (53 per cent) did not use any DHS.
The State of Digital Healthcare Services Adoption
Table 3 shows the survey respondents’ adoption of digital tools.
Among the 404 survey respondents, 357 (93.1 per cent) own a
technological device and 316 (78.4 per cent) use the Internet
daily.
Table 3: The Adoption of Digital Tools
Figure 1 shows the digital skills of the survey respondents.
About 85 per cent (345) of the respondents could communicate
through instant messaging applications such as WhatsApp and
Messenger. This is followed by online search information (62 per
cent) and uploading photos and videos (51 per cent). Less than
half of the respondents can join video calls on Zoom, Microsoft
Team, etc., and perform online purchases and cashless payments.
Less than one-third of the respondents can install software or
mobile applications in their digital tools and edit documents,
photos or videos. Approximately eight per cent of the
respondents do not acquire any digital skills mentioned
above.
Figure 1: Digital skills of the survey respondents
The digital skills in Figure 1 were further grouped and analysed
according to the respondents’ demographic characteristics.
Although younger seniors have higher digital skills than older
seniors, the age factor alone is insufficient to explain the
digital divide. A cumulative number of factors such as education
level and the type of community, influence digital skills. For
example, as seen in Figure 2, respondents living in urban and
suburban areas have been found to have better digital skills
compared to those who live in rural and remote areas.
Nonetheless, the respondents from rural and remote areas only
comprised 15.8 per cent of the total. Further studies focusing
on rural and remote areas are needed to confirm the findings.
Among
the factors, the frequency of Internet usage (Figure 3) and
whether the seniors own any technological device were two (2)
factors that have been found to correlate strongly with digital
skills. This indicates that for seniors to be equipped with good
digital skills, owning a technological device and having
Internet access are the most important prerequisites.
Figure 2: Number of tasks the survey respondents can perform by
type of community
Figure 3: Number of tasks the survey respondents can
perform by Internet Usage
Figure 4 shows that more than half of the respondents did not
use any digital healthcare services during the survey. The most
used digital healthcare services are online appointment bookings
(25 per cent of the total respondents), followed by instant
messaging with healthcare providers 23 per cent) and wellness
monitoring applications (20 per cent). It was found that age
does not influence the type of digital healthcare services they
use.
Figure 4: The digital healthcare services used by the
respondents according to their age group
Figure 5 presents the survey results on why the respondents did
not use digital healthcare services. 59 per cent of respondents
prefer face-to-face healthcare consultation, 53 per cent are
unaware of any digital healthcare services, and 44 per cent are
concerned about their privacy and data security. Other than the
barriers listed above, interview respondents have also expressed
that physical and cognitive impairments such as poor eyesight,
shaky hands, and forgetfulness are some barriers to adopting
digital healthcare services.
Figure 5: The reasons for not using digital healthcare services
Based on the data from Figure 6, the survey respondents are more
likely to adopt digital healthcare services if they save time
(64 per cent), are convenient and easy to use (63 per cent), and
are recommended by healthcare professionals (51 per cent).
Figure 6: Reasons that will motivate the respondents to adopt
digital healthcare services
Nonetheless, seniors who can adopt digital healthcare could be
more if they are aware of the opportunity and perceive the
digital healthcare services as useful. This is because 62 per
cent of the survey respondents can perform three (3) or more
digital tasks, but only less than half of the respondents use
the DHS listed in Figure 4. This finding is also validated
through interviews whereby many volunteers are unaware of the
digital healthcare services they can use.
The
interview transcriptions were analysed using thematic analysis.
The text data were further categorised into subcategories. The
categories are digital infrastructure, digital literacy, health
literacy, user interface design and functionality, digital
trust, and lack of awareness. It is also important that digital
healthcare services be quality, accessible, affordable, and
trustworthy.
06 recommendations
Based on the findings, six (6) building blocks that support the
adoption of digital healthcare services among senior citizens in
Malaysia were proposed. They are digital infrastructure, digital
literacy, health literacy, awareness, needs, and perception.
These building blocks are illustrated in Figure 7.
Figure 7: The building blocks towards digital healthcare
services adoption among senior citizens
Digital Infrastructure
Digital infrastructure is often interpreted as the hardware,
software, and organisational and institutional settings for
transferring, storing, accessing, processing, and/or using
digital data (Scholz et al., 2018). Physical digital
infrastructure includes internet broadband, mobile
telecommunication, digital communication suites, data centres
and networks, etc. In addition, there is a growing perception
that data, too, is an infrastructure, as a deemed ‘raw’ material
for data-driven innovation (Ducuing, 2020).
Lack of
access to digital technologies has remained one (1) of the
critical contributors to the digital divide (Saeed, 2021). This
occurs due to the cost of technology, insufficient broadband
access, and the use of lower-performing devices (Saeed, 2021).
Moreover, many digital healthcare systems, such as remote
monitoring and telehealth, necessitate consistent, reliable
service and speed (Shahid, 2022). Thus, it is evident that
incorporating the construction of supportive digital
infrastructures is necessary, which was also a key strategic
focus in the MyDigital initiative.
In Malaysia, due
to the effort made by the Pelan Jalinan Digital Negara
(JENDELA), quality access to digital connectivity has been
improved nationwide. However, senior citizens may not benefit
from the recent changes due to low awareness of the
opportunities and support available to them. A proactive
approach is needed to inform the senior citizens of the cost
involved and acquisition methods to upgrade their digital tools.
These include setting a task force in health clinics to answer
their questions on “Can I afford it?”, “How do I buy it?”, and
“How do I select the right product?” (Akinola, 2021). This
should be accompanied by a subsidy programme to help seniors in
need.
Regarding Digital Healthcare, interoperability
has emerged as one (1) of the most important success criteria.
Interoperability is a prerequisite for digital innovations such
as artificial intelligence, big data, or mobile applications
(Lehne, 2019). Uncovering the full potential of digital medicine
requires an interconnected data infrastructure with fast,
reliable, and secure interfaces. Medical data hidden in isolated
databases, incompatible systems, and proprietary software are
difficult to exchange, analyse, and interpret.
In
addition, health data are classified as sensitive personal data
and require high safety and security standards. Digital
healthcare service providers and the users in the interoperable
digital health ecosystem should undergo a reliable digital
identification, authentication, and authorisation mechanism that
guarantees trust in the exchange of health data and aligns with
nationally appropriate means (WHO, 2021).
In
general, a standardised technology architecture for digital
healthcare in Malaysia needs to be proposed. More studies are
required to investigate the readiness of Malaysia’s healthcare
facilities in digital transformation, the opportunities for
integrating disruptive technology into healthcare services, and
the implementation strategy for successful digitalisation.
Digital Literacy
Digital literacy entails the ability and skills to create,
assess, acquire information, and learn from online sources and
digital platforms using technology. Many older individuals may
lack familiarity with technology, struggle to navigate digital
interfaces, understand medical applications, or engage
effectively with online health resources. This lack of digital
literacy can result in scepticism, fear, or reluctance toward
adopting digital healthcare solutions. By enhancing their
digital literacy, seniors gain the skills and confidence to
utilise these services effectively.
Bridging this gap
requires comprehensive education and support programmes tailored
to seniors, empowering them with the necessary skills and
confidence to effectively navigate and utilise digital health
tools. This can be achieved through training programmes and
outreach programmes targeting different groups of seniors.
Training involves educational programmes, workshops,
or activities designed specifically for senior citizens who need
to enhance their skills, knowledge, and abilities in navigating
digital healthcare services. For instance, the training
programmes can teach seniors how to use computers, smartphones,
the Internet, social media, or specific applications to help
them manage their healthcare needs. The setting of the training
sessions must be customised to suit the senior citizens.
For
effective adoption of digital tools, structured training should
also be complemented by outreach programmes. Outreach programmes
are organised initiatives or activities designed to engage
specific target groups or communities outside typical
institutional or organisational settings. These programmes aim
to connect with, educate, assist, or provide resources and
services to individuals who might not otherwise have access or
exposure to such opportunities. Outreach programmes are crucial
so that no one is left behind.
Improving digital
literacy was more effective with peer influence and community
support. Therefore, it is worthwhile to invest in community
organisations that aim to strengthen the social bond within the
community.
Health Literacy
Health literacy refers to the ability of individuals to gain
access to, understand and use information in ways that promote
and maintain good health for themselves, their families, and
their communities (WHO, 1998). Health-literate people are more
likely to make better health decisions by following healthy
lifestyles and using healthcare resources best. On the other
hand, people with low health literacy are more likely to make
riskier health decisions, have poorer chronic disease
management, be less likely to participate in health-promoting
and disease-detection activities, have poor medication
adherence, and have overall poorer health outcomes.
Health
literacy should be improved through better provision of
information, effective communication, and structured education.
Seniors should have regular access to high-quality health
information through effective channels. Conducting health
literacy surveillance regularly, providing funding to health
literacy programmes, and better coordination action across
ministries are a few strategies the government can use to help
improve the health literacy of seniors.
Media
publicity is a feasible strategy for communicating health
literacy to seniors. Media publicity refers to the strategic
efforts made by individuals, governments, and organisations to
engage with various forms of media, such as newspapers,
television, radio, online platforms, and social media channels.
It involves proactive communication to disseminate information,
share news, promote events, or convey messages to a broader
audience through media channels. Successful media outreach helps
increase brand visibility, shape public perception, and
disseminate information through credible media channels to
target audiences. Working on media outreach requires attention
to detail. For instance, if the target audience is senior
citizens living in rural areas, television and radio programmes
are still their primary source of information.
Awareness
The lack of awareness among senior citizens regarding the
existence and benefits of digital healthcare services poses a
significant barrier to their uptake. Many within this
demographic remain uninformed about the existence and
accessibility of these services, unaware of the advantages
accompanying their utilisation, even with high digital skills.
Information about teleconsultations, health monitoring apps, or
telemedicine options often fails to reach seniors, leaving them
unaware of the potentially life-improving or life-saving
healthcare resources. The absence of awareness about these
digital solutions hampers their ability to make informed
decisions about their health and well-being, limiting their
access to convenient, efficient, and sometimes cost-effective
healthcare alternatives.
Recommendations from
healthcare professionals on digital healthcare services were
found to be an important facilitator in encouraging seniors to
adopt the service. Unfortunately, even healthcare professionals,
may not be aware of the services available and may not have the
time to promote them. Not all healthcare practitioners are
uniformly receptive to digital healthcare services. Generational
differences, lack of exposure, and complacency with traditional
practices make them hesitant to change their established
workflows, especially if they perceive technology as disrupting
their usual practices.
For national digital
healthcare services such as myUBAT and virtual clinics, it is
suggested that the government allocate additional manpower in
government healthcare facilities to proactively promote digital
healthcare services to seniors. For private digital healthcare
services, the government should provide clear guidance on legal
compliance to digital healthcare providers to market their
services without breaching the existing legislative and
regulatory laws, such as non-advertising laws. Setting up a
platform similar to DiGA in Germany can also recognise and
promote high-quality digital health applications.
Needs
Seniors are experiencing physiological changes such as eyesight,
hearing, memory, and cognitive skills. Retirement makes them
more likely to suffer from financial constraints and social
isolation. Products and services not considering seniors’ unique
needs will most likely fail to get them to adopt the system
(Briede, 2023).
However, product and service users often do not express their
needs well, unless seniors are involved during the design
process, designers may incorrectly anticipate the senior’s needs
and preferences. Hence, the creation and implementation of new
solutions should actively involve different stakeholders to
confirm that they meet the needs raised. Different
stakeholders should be encouraged to utilise the sandbox
environment and health technology assessment to ensure that
digital healthcare services are feasible and of high quality.
A sandbox environment would enable businesses to investigate and
trial new and groundbreaking products, services, or ventures
under the guidance and oversight of regulators. This mechanism
would allow the innovators to test their ideas within a
controlled setting, enabling regulators to gain deeper insights
into the technology.
In Malaysia, a Health Technology Hub under the National
Technology and Innovation Sandbox (NTIS) was established in 2022
to facilitate the implementation of health technology innovation
testing in a safe and controlled environment. In addition, the
Health Technology Assessment Section (MaHTAS) was established to
produce health technology assessments, clinical practice
guidelines, and other synthesised research evidence. It serves
as an input for decision-making and policy-making concerning
health technologies such as procurement, adoption,
implementation, disengagement, reimbursement, and pricing.
The government is also advised to incentivise companies to
create senior friendly and secure digital healthcare solutions.
Many countries recognise the importance of digital healthcare
solutions for seniors and have implemented initiatives that
promote innovation in digital health for seniors. These include
the United Kingdom’s National Health Service (NHS) Digital
Innovation Hub, Australia’s Medical Research Future Fund (MRFF),
and Singapore’s Healthcare Productivity Fund.
A well-designed payment system is also needed for the widespread
adoption of digital healthcare services as it addresses key
factors such as accessibility, convenience, trust, innovation,
data analysis, and financial sustainability for the service
providers. The payment system uncovers issues surrounding
digital healthcare services’ payment mechanisms and
reimbursement systems. In any healthcare system, there are four
(4) significant payors. They are the government, employer,
insurance companies, and individuals (out-ofpocket expenses).
Perception
A user’s perception plays a crucial role in adopting digital
healthcare services because it significantly influences their
attitudes, behaviours, and decisions regarding using these
services.
Perception shapes how users view a digital
service’s usability and overall experience. If users perceive a
service as intuitive, user-friendly, safe, and efficient, they
are more likely to adopt and continue using it. Users are also
more likely to adopt a digital service if they perceive it as
easy to use and offers significant utility or value compared to
alternatives.
Positive perception enhances trust in
the digital healthcare service provider. Users are more likely
to adopt services they perceive as trustworthy and credible
based on factors such as reputation, security measures, and user
reviews. Positive perceptions driven by social influence, such
as peer recommendations, encourage adoption. Concerns about data
privacy, security, or potential drawbacks may hinder adoption if
not adequately addressed by the service provider.
DHS Adoption
A recent advancement in building public trust in digital
healthcare was the revision of Section 21 of the Poisons Act
1952 (Act 366). Under the revised provisions, the Poisons
(Amendment) Act 2022 (Act A1666) requires the use of digital
signatures on electronic prescriptions in accordance with the
provisions enforced by MCMC for the issuance of digital
signatures under the Digital Signature Act 1997 (Act 562). The
digital signature’s advantages include helping reduce
prescription errors and raise users’ confidence.
Other efforts to build public trust include
improving usability, addressing cybersecurity concerns,
highlighting value propositions, managing brand reputation,
establishing effective feedback mechanisms to handle the
feedback appropriately, and leveraging positive social influence
to shape positive perceptions and encourage adoption. In short,
to encourage the adoption of digital healthcare services,
policymakers and digital healthcare providers must understand
and actively manage users’ perceptions.
In summary,
the relevant stakeholders involved in spurring the adoption of
digital healthcare services for seniors in Malaysia are
identified as the seniors/users themselves, healthcare
professionals, digital healthcare service entrepreneurs/
developers, payers’ organisations and authorities, community
organisations, telecommunication companies, and policymakers.
Their involvement according to the six (6) building blocks was
tabulated in Table 4.
Table 4: The involvement of stakeholders in digital healthcare
services adoption
07 conclusion
The analysis is integral to the research objectives, as it
crystallises the recommendations for addressing the challenges
and fulfilling the needs of senior citizens and the digital
healthcare industry. These recommendations are geared towards
enhancing digital infrastructure, digital literacy, health
literacy, creating awareness, tackling seniors’ needs, and
building their trust in digital healthcare services.
Additionally, they emphasise the importance of government,
industries, and community collaboration to drive digital
healthcare adoption among senior citizens in Malaysia. Hence,
the findings serve as a strategic framework for offering
comprehensive recommendations to promote digital healthcare
adoption among senior citizens and improve the digital
healthcare industry’s capacity to cater to the needs of
seniors.
08 references
Abouzahra, M., & Ghasemaghaei, M. (2022). Effective use of
information technologies by seniors: the case of wearable device
use. European Journal of Information Systems, 31(2), 241-255.
Adjekum, A., Blasimme, A., & Vayena, E. (2018). Elements of
trust in digital health systems: scoping review. Journal of
medical Internet research, 20(12), e11254.
Akinola, S. (2021) How can we ensure digital inclusion for older
adults? World Economic Forum.
Baharudin, N. S., Talib, S. S., Mohamad Nor, N. F., Azri, M. A.,
Ahmad Ainuddin, H., & Che Daud, A. Z. (2022). Assessing
socio demographic factors affecting fatigue level among
community dwelling older people. ESTEEM Journal Of Social
Sciences And Humanities, 6(2), 133-146.
Barnett, K., Mishuris, R. G., Williams, C. T., et al. (2022).
Telehealth’s Double-Edged Sword: Bridging or Perpetuating Health
Inequities? Journal of General Internal Medicine, 37(11),
2845-2848.
Borle, P., Boerner-Zobel, F., Voelter Mahlknecht, S.,
Hasselhorn, H. M., & Ebener, M. (2021). The social and
health implications of digital work intensification.
Associations between exposure to information and communication
technologies, health and work ability in different
socio-economic strata. International archives of occupational
and environmental health, 94, 377-390.
Briede-Westermeyer, J. C., Radici Fraga, P. G.,
Schilling-Norman, M. J., & Pérez-Villalobos, C. (2023).
Identifying the Needs of Older Adults Associated with Daily
Activities: A Qualitative Study. International Journal of
Environmental Research and Public Health, 20(5), 4257.
Coves, A. F., Yeung, K. H. T., van der Putten, I. M., &
Nelson, E. A. S. (2022). Teleconsultation adoption since
COVID-19: Comparison of barriers and facilitators in primary
care settings in Hong Kong and The Netherlands. Health
Policy.
Department of Statistics Malaysia. (2023) Current Population
Estimates, Malaysia, 2023. Ducuing, C. (2020). Data as
infrastructure? A study of data sharing legal regimes.
Competition and Regulation in Network Industries, 21(2),
124-142.
Shahid, N. (2022). Harnessing technology and data for urban
healthcare in Malaysia. GSMA.
Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021).
Telemedicine for healthcare: Capabilities, features, barriers,
and applications. Sensors international, 2, 100117.
Hung, L., Wong, J., Smith, C., Berndt, A., Gregorio, M., Horne,
N., et a., (2022). Facilitators and barriers to using
telepresence robots in aged care settings: a scoping review.
Journal of Rehabilitation and Assistive Technologies
Engineering, 9, 20556683211072385.
Kaihlanen, A. M., Virtanen, L., Buchert, U., et al. (2022).
Towards digital health equity-a qualitative study of the
challenges experienced by vulnerable groups in using digital
health services in the COVID-19 era. BMC health services
research, 22(1), 188.
Krejcie, R.V., and Morgan, D.W. (1970) Determining Sample Size
for Research Activities. Educational and Psychological
Measurement. 30, 607 – 610.
Lehne, M., Sass, J., Essenwanger, A., Schepers, J., & Thun,
S. (2019). Why digital medicine depends on interoperability. NPJ
digital medicine, 2(1), 79.
Liljeroos, M., & Arkkukangas, M. (2023). Implementation of
Telemonitoring in Health Care: Facilitators and Barriers for
Using eHealth for Older Adults with Chronic Conditions. Risk
Management and Healthcare Policy, 43-53.
MCMC. (2020). Internet Users Survey 2020. In The Internet Users
Survey. https://doi.org/ ISSN 1823-2523
Moody, L., Wood, E., Needham, A., Booth, A., Jimenez-Aranda, A.,
& Tindale, W. (2022). Identifying individual enablers and
barriers to the use of digital technology for the
self-management of long-term conditions by older adults. Journal
of Medical Engineering & Technology, 46(6), 448-461.
Ocloo, J., Garfield, S., Franklin, B. D., & Dawson, S.
(2021). Exploring the theory, barriers and enablers for patient
and public involvement across health, social care and patient
safety: a systematic review of reviews. Health research policy
and systems, 19, 1-21.
Perdana, A., & Mokhtar, I. A. (2022). Seniors’ adoption of
digital devices and virtual event platforms in Singapore during
Covid-19. Technology in Society, 68, 101817.
Safarov, N. (2021). Personal experiences of digital public
services access and use: Older migrants’ digital choices.
Technology in Society, 66, 101627.
Saeed, S. A., & Masters, R. M. (2021). Disparities in health
care and the digital divide. Current psychiatry reports, 23,
1-6.
Schmillen, A.D., Wang, D., Yap, W.A., Bandaogo, MASS; Simler,
K., Ahmad, Z., Abdur Rahman, A. (2020) A Silver Lining -
Productive and Inclusive Aging for Malaysia (English). The
Malaysia Development Experience Series Washington, DC: World
Bank Group.
Scholz, R. W., Bartelsman, E. J., Diefenbach, et al. (2018).
Unintended side effects of the digital transition: European
scientists’ messages from a proposition-based expert round
table. Sustainability, 10(6), 2001.
Sit, David. (2021). The ASEAN Digital health landscape: an
overview. HKTDC Research. Sourbati, M. (2009). ‘It could be
useful, but not for me at the moment’: older people, internet
access and e-public service provision. New Media & Society,
11(7), 1083-1100. Strauss, A., & Corbin, J. (1990). Basics
of qualitative research: Grounded theory procedures and
techniques. Newbury Park, CA: Sage.
Thiel R et al. (2018). SmartHealthSystems: International
comparison of digital strategies. Bertelsmann Stiftung
Wangler, J., & Jansky, M. (2023). Two years of approved
digital health applications in Germany-Perspectives and
experiences of general practitioners with an affinity for their
use. European Journal of General Practice, 29(1), 2186396.
Watt, J. A., Fahim, C., Straus, S. E., & Goodarzi, Z.
(2022). Barriers and facilitators to virtual care in a geriatric
medicine clinic: a semi structured interview study of patient,
caregiver and healthcare provider perspectives. Age and Ageing,
51(1), afab218.
WHO (1998). Health Promotion Glossary. World Health
Organization, Geneva, Switzerland. WHO (2021). Global strategy
on digital health2020-2025. World Health Organization, Geneva,
Switzerland.
Wilson, J., Heinsch, M., Betts, D., Booth, D., &
Kay-Lambkin, F. (2021). Barriers and facilitators to the use of
e-health by older adults: a scoping review. BMC Public Health,
21, 1-12.
Zainal, A., Aziz, N. F. A., Ahmad, N. A., Razak, F. H. A.,
Razali, F., Azmi, N. H., & Koyou, H. L. (2023). Usability
measures used to a user experience in using digital health
technology among elderly: a systematic review. Bulletin of
Electrical Engineering and Informatics, 12(3), 1825-1832.
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