Sage Journals: Discover world-class research

Abstract

Background

Aboriginal and Torres Strait Islander people avidly use technology for a variety of purposes. Digital health technologies offer a new way to build on Aboriginal and Torres Strait Islander peoples propensity for early adoption and innovation with technology. Only limited research has focused on mature aged adults in non-urban locations as partners in digital health research and there is no research related to wearables for health tracking for this cohort.

Objective

This paper provides insights into mature aged Aboriginal and Torres Strait Islander adults interest, use and trust of social media, apps and wearables to gain health information and manage health.

Methods

This cross-sectional survey study was co-designed and co-implemented with Aboriginal Community Controlled Health Services (ACCHS) in three locations in New South Wales, Australia. The 13-item survey was administered via a semi-structured interview.

Results

Aboriginal and Torres Strait Islander adults (n = 78), in regional, rural and remote locations indicated their interest in and use of apps and wearables for health purposes. Mature aged participants, particularly women, used Facebook, ACCHS websites and YouTube for acquiring health-related information which they then shared online and in real life with a diversity of family, friends and colleagues.

Conclusions

Aboriginal and Torres Strait Islander people are using digital health technologies to acquire and share health information and want to use apps and wearables for health management. Co-designed research enables a greater understanding of the diverse needs for different cohorts and informs culturally responsible design. Broader use of co-design will foster effective user-focused digital health communication and health-management.

Keywords

Digital health Aboriginal and Torres Strait Islander Indigenous social media health disparities co-design cultural safety cultural determinates of health health trackers wearables

Introduction

Rapid advancements in digital health technologies are shifting how we approach health care. According to the World Health Organisation, these digital innovations offer new avenues to care for underserved populations.¹ Correspondingly, the Australian government has encouraged research that uses technology to help Aboriginal and Torres Strait Islander people manage and promote better health outcomes.²

Since the early 1990's, people worldwide have used static websites to access information about their health and wellbeing. By 2003, Eysenbach and Kohler found that health-related searches accounted for 5% of internet searches.³ Each web iteration has sparked adaptations not previously imagined. Recent advancements have contributed to a proliferation of user-based digital health technologies that have potential to empower people to take charge of their health. And people are seizing the opportunity to use technology to participate in their health care more actively.

Social media

Social media has empowered people to not only access information from professional sources but also tap into the knowledge and experiences of friends, and trusted sources.^4,5 Social media's immediacy and interactive nature mean that individuals can access specific personalised recommendations from within their network, potentially contributing to greater trust.^6,7 Cultural safety and trust are particularly relevant for communities underserved by centrally-controlled, mainstream-focused health messaging, including Aboriginal and Torres Strait Islander people.^8–10

Tailored, trusted and effective health communication is particularly relevant for Aboriginal and Torres Strait Islander people. Research indicates that Aboriginal and Torres Strait Islander people have died from avoidable causes at three times the rate of other Australians and have also experience significant health gaps.¹¹ Nolan-Isles and colleagues found that ineffective health messaging creates a barrier to service utilisation for Aboriginal and Torres Strait Islander people.¹² Communication that is racist, not sensitive to health needs, marginalises cultural identity or fails to recognise the context of colonialism may reduce Aboriginal and Torres Strait Islander people's understanding of western health concepts and practices.¹³ Reduced understanding of these concepts and practices is associated with less engagement in preventive services such as screenings and protective health practices, reduced understanding of medical advice and poorer health self-management.¹⁴ Social media can provide an avenue for engaging Aboriginal and Torres Strait Islander community members in designing and disseminating health messaging, thereby ensuring relevance and cultural safety.

Aboriginal and Torres Strait Islander people embraced social media early and have been innovators in using social media for social and political empowerment, and activism.^15,16 Carlson & Dreher noted that social media, with its emphasis on peer-to-peer connectivity and movement away from hierarchal top-down centrally controlled messaging is more in keeping with Aboriginal and Torres Strait Islander ways of learning and being.⁸ Likewise, Rice et al. observed that the nature of social media is culturally compatible with orally and visually focused cultures.¹⁷ Moreover, the Aboriginal health sector was an early adopter of social media for advocacy, public health promotion and community development.¹⁸ Building on these strengths, social media-based health messaging has the potential to tap into the inherent assets of community and connection to facilitate greater empowerment.

While there has been some excellent research examining Aboriginal and Torres Strait Islander peoples’ perspectives on and use of social media for health enhancement,^19–21 most studies are qualitative with small samples and have included few mature aged adults and research has rarely segregated results by gender binary, non-binary or age cohort. Mature aged adults, particularly those residing outside of urban settings, have had significantly different technology experiences than Millennials, who grew up with the internet. Likewise, mature aged Aboriginal and Torres Strait Islander people of different genders differ from each other and from younger Aboriginal and Torres Strait Islander adults in terms of health needs. Understanding the perspectives and practices of each of these cohorts is an essential next step in understanding how to best use social media for health promotion and health management. We address this shortcoming in this study with Aboriginal and Torres Strait Islander people from three non-urban locations one regional, one rural and one remote location as classified by the Accessibility/Remoteness Index of Australia (ARIA).²²

mHealth

Social media and the internet remain important forces in how people interact with technology to enhance their health. However, we are on the cusp of a digital revolution which is likely to disrupt health care in multiple ways. Examples range from using big data to diagnose and treat cancers and rare diseases²³ to technologies such as blockchain that enable personal ownership, control and potential monetisation (or other rewards) for sharing of personal health data.²⁴ User-based apps and wearables are enabling people to track their bio-data.²⁵ Innovations in artificial intelligence create opportunities for individual citizens to use their bio-data in real-time to make informed choices about health-related behaviours. While the rate of technology development is important, personal confidence, comfort and government policies will contribute to the speed of uptake and efficacy these technologies will have in shaping health and health care.

The COVID pandemic has accelerated comfort and expertise in using mobile health technologies. Likewise, mobile apps and wearables are becoming ‘smarter’ and easier to use, and individual citizens are taking up the opportunity to access personal health data through self-tracking devices. Corbett & Schwager surveyed a representative sample of 2000 Australians aged between 18 and 75 and found that Australians using wearables increased from 28% in 2020 to 58% in 2021, which they attributed to a greater focus on fitness and health during COVID.²⁶ The most common aspects of fitness tracked by Australians in this study were steps (45%) followed by heart monitoring (29%) and sleep (25%).²⁶ In contrast to common beliefs, Corbett & Schwager found that older generations represented the most growth in the uptake of wearables, with the use of fitness bands growing from 17% in 2020 to 23% in 2021 for this segment of the population.²⁶

Early research suggests that wearables contribute to health self-efficacy. For example, Paré and colleagues (2018) surveyed 4109 Canadian adults stratified by region and used a quota method to ensure representation of age and gender. They found that adults who use digital trackers reported feeling more knowledgeable and informed about their health. Moreover, 70% of users in this same study believed they had maintained or improved their health status by using self-tracking devices.²⁷ Mobile apps and wearables look set to be an important component of health care in the future, encouraging greater health self-awareness, detection, monitoring and increasing health self-efficacy. However, access is not equitable in Australia. Affordability and connectivity limit choices and opportunities to use current heath technologies for many Australians, including those with lower incomes, people living remotely and Aboriginal and Torres Strait Islander people. Moreover, systemic racism, including unwanted surveillance (observation for health or other purposes) and deficit discourse (written or verbal communication represents Aboriginal and Torres Strait Islander people in terms of deficiency or failure)²⁸ that has historically informed Western health systems’ approach, impacts the choices offered to and the services/products requested by Aboriginal and Torres Strait Islander people. These same barriers may also influence Aboriginal and Torres Strait Islander peoples’ uptake of wearables. The systemic obstacles that have contributed to the current gap in health and life span remain and threaten to widen the gap as new technologies become ubiquitous in the broader Australian population. Therefore, it is critical that we understand Aboriginal and Torres Strait Islander peoples’ needs and requirements for new health technologies, including wearables, and design policies and practices to meet these needs.

Minimal research exists which relates to wearables among Aboriginal and Torres Strait Islander people. No research has specifically targeted mature aged Aboriginal and Torres Strait Islander people, despite the fact that the percentage of mature aged Aboriginal and Torres Strait Islander people is growing and is predicted to continue to grow to over 20% by 2031.²⁹ This lack of research attention is significant because Aboriginal and Torres Strait Islander people experience poorer health and chronic illness significantly higher than the broader population.¹¹ Moreover, the approach to health care innovation has typically been to adapt what works best for the wider population rather than understanding and incorporating the needs of Aboriginal and Torres Strait Islander people in the design of the system, policy or practice. We are aware of only one study related to wearables that purposefully included Aboriginal and Torres Strait Islander adults. Maxwell et al. conducted a study that included eight Aboriginal and Torres Strait Islander women students and concluded that wearables could improve the outcomes and experience of physical activity for Indigenous women. They identified three themes associated with Indigenous women's use of wearables: (1) quantified self, (2) governance by micro-nudge and (3) increased agency and empowerment.³⁰ Specifically, they found that measurement enhanced self-efficacy. Participants indicated that the quantitative data they got from trackers increased their self-health knowledge. This data included understanding their requirements for sleep, awareness of elevated heart rate and the amount of exercise they engaged in.³⁰ Participants uniformly interpreted micro nudges in the form of a buzzer as motivating and assisted participants in making healthier choices.³⁰ The flexibility afforded by the trackers enabled participants to choose activities that suited their circumstances and constraints and address common barriers such as being time-poor, which increased their feelings of agency and empowerment.³⁰ These findings are encouraging and warrant further investigation. An essential next step is to determine if Aboriginal and Torres Strait Islander people are currently using phone apps or wearables to track their health.

Aims

This study aimed to determine if mature aged Aboriginal and Torres Strait Islander adults living in rural, regional and remote locations:

use social media to acquire and share health information and, if so, what platforms they use and trust;

use mobile apps or wearable trackers and, if so, what aspects of health they track;

are interested in using mobile apps and wearables to track health.

Methods

Ethics

The study adhered to the guidelines for ethical research in Aboriginal and Torres Strait Islander populations and relevant ethics committee approvals. We obtained approvals from the Aboriginal Health and Medical Research Council Ethics Committee (AH&MRC) (reference 1862/21) approved 1/12/2021, and an amendment specific to this study was approved on 12/05/2022, and this manuscript was reviewed and approved by our APG and the ethics committee of the AHMRC.

Aboriginal and Torres Strait Islander governance

An Aboriginal Governance Group (APG) who are also overseeing a larger program of research provided governance for the research. A senior Aboriginal member of the research team, an Elder and an Associate Professor (BR) oversaw the project. The study was co-designed and co-implemented with the local Aboriginal Community Controlled Health Services (ACCHS) in each community. Our research team has a long-standing and trusted relationship with each of these ACCHS and this specific research extends previous co-designed studies examining health awareness and monitoring and management. The research team was comprised of Aboriginal (BR, BC, FC, GS) and non-Aboriginal people (CH, JC, JG, DM, KW, KG), and Aboriginal peoples’ perspectives were privileged throughout the design, data analysis and interpretation of the findings.

Design

We administered a cross-sectional survey via an in-person semi-structured interview in collaboration with the local ACCHS in three New South Wales locations (one each: rural, regional and remote).²² Aboriginal adults who attended a health promotion event which was facilitated by the local Aboriginal Medical Services Centres (AMS) in each location, were approached in-person and asked if they were willing to participate in a brief interview to share their perspectives about using social media and wearables to gain health information. The health promotion event was promoted by the AMS's via posters, social media and radio in the community and patients of the service were also directly invited to attend the event by their health care providers. Virtually all attendees we approached agreed to participate. Aboriginal and Torres Strait Islander adults were eligible for the study if they were 18 years or older and able to give informed consent to participate. Participants consented to participate and were free to withdraw at any time.

The 13-item survey was co-designed with the APG and included yes/no, multiple-choice (choose one option) and multiple-choice (choose all that apply) questions related to the use of and trust in social media in obtaining and sharing health information and the use of apps and wearables for tracking personal health information. The survey also included demographic questions (birth year and multiple-choice self-identified gender – options included: binary (female, male), nonbinary, trans, other and prefer not to say).³¹ ¹

Data from the in-person semi-structured interviews were entered directly into Lime Survey³² using a tablet during the interview and later exported to MS Excel version 16.61.

Results

This study included n = 78 participants from three locations: n = 19(24%) regional, n = 25(32%) rural and n = 34(44%) remote.²² We create two age cohorts: mature aged, comprising Seniors, Baby Boomers and Generation X, who were born prior to 1981 (>41years old) and a younger cohort, comprising Millennials and Generation Z who were born 1981 or later (≤41 years old), and who grew up with the internet.³³ See Table 1 for specifics including age, gender and location cohorts. Notably, n = 59(76%) were over 41 years old and n = 39(50%) were women aged over 41 years old.

Table 1.

Demographics.

Age cohorts	All n = 78	Women n = 51	Men n = 24	No gender given n = 2	Regional n = 19	Rural n = 25	Remote n = 34
Mature aged >41 years old	59(76%)	39(50%)	18(23%)	2(3%)	17(21%)	20(26%)	22(28%)
Younger ≤41 years old	18(23%)	12(15%)	6(8%)		2(3%)	4(5%)	12(15%)
No age given	1(1%)			1(1%)		1(1%)
Total full sample	78(100%)	51(65%)	24(31%)	3(4%)	19(24%)	25(32%)	34(44%)

Note: Denominator is full sample n = 78.

Social media use

Most participants, n = 56(72%), used social media, and n = 43(55%) described daily use. Only n = 20(25%) of all participants indicated that they did not use social media. More than double the proportion of mature aged women used social media daily (56%) compared to mature aged men (17%), and less than half the proportion of mature aged women indicated they never use social media (23%) compared to mature aged men (50%) (see Table 2).

Table 2.

Frequency social media use.

	All	Mature aged participants			Younger participants			Location
Frequency SM use	n = 78	Mature aged adults n = 59	Mature aged women n = 39	Mature aged men n = 18	Younger adults n = 18	Younger women n = 12	Younger men n = 6	Regional n = 19	Rural n = 25	Remote n = 34
Daily	43(55%)	26(44%)	22(56%)	3(17%)	16(89%)	11(92%)	5(83%)	10(53%)	14(56%)	19(56%)
Some	13(17%)	12(20%)	8(21%)	4(22%)	1(6%)	1(8%)	0	4(21%)	4(16%)	5(15%)
Never	20(26%)	19(32%)	9(23%)	9(50%)	1(6%)	0	1(17%)	3(16%)	7(28%)	10(29%)
Did not answer	2(3%)	2(11%)		2(11%)				2(11%)
Total users of social media	56(72%)	38(64%)	30(77%)	7(39%)	17(94%)	12(100%)	5(83%)	14(74%)	18(72%)	24(71%)

Note: Denominator = n for each cohort listed on top row.

While younger participants were more frequent (daily) users of social media compared with mature aged participants n = 16(89%) and n = 26(44%) respectively the majority of mature aged participants n = 38(64%) used social media. Moreover, of the n = 39 mature aged women, n = 30(77%) used social media and n = 22(56%) used it daily. Only younger women were more likely use social media with 100% reporting at least some use and n = 11(92%) daily use. Mature aged men were the least frequent users n = 7(39%). Just over 70% of participants in each of the three locations reported using social media, with around 50% using it daily.

Acquiring health information

Participants who described themselves as using social media, used one or more platforms for acquiring health-related information (see Table 3). Facebook was the most common platform, with n = 27(48%) of those who use social media acquiring health-related information through Facebook. Notably, Facebook was the platform most frequently cited by each cohort for acquiring health information. The ACCHS website was used by n = 14(25%) of all participants, and n = 13(23%) participants used YouTube to acquire health information.

Table 3.

Social media platforms/websites used to acquire health information.

	All	Mature aged participants			Younger participants			Location
Social media use to acquire info	n = 56 SM users	Mature aged participants n = 38 SM users	Mature aged women n = 30 SM Users	Mature aged men n = 7 SM users	Young participants n = 17 SM users	Younger women n = 12 SM users	Younger men n = 5 SM users	Regional n = 14 SM users	Rural n = 18 SM users	Remote n = 24 SM users
Facebook	27(48%)	17(45%)	15(50%)	1(14%)	9(53%)	7(58%)	2(40%)	5(36%)	11(61%)	12(50%)
ACCHS	14(25%)	10(26%)	9(30%)	1(14%)	4(24%)	4(33%)	0	2(14%)	6(33%)	6(25%)
YouTube	13(23%)	8(21%)	7(23%)	0	5(29%)	4(33%)	1(20%)	2(14%)	5(28%)	6(25%)
Snapchat	7(13%)	2(5%)	2(7%)	0	5(29%)	5(42%)	0	1(7%)	2(11%)	4(17%)
Instagram	6(11%)	1(3%)	1(3%)	0	5(29%)	5(42%)	0	0	4(22%)	2(8%)
TikTok	5(9%)	1(3%)	1(3%)	0	4(24%)	4(33%)	0	0	4(22%)	1(4%)
Twitter	0	0	0	0	0	0	0	0	0	0

Note: Denominator = n for each cohort listed on top row.

Sharing health information

Participants also used social media to share health-related information. Facebook was the most frequently used by all cohorts for sharing health information. The ACCHS site and YouTube were also used frequently (see Table 4).

Table 4.

Social media platforms/websites used to share health information.

	All	Mature aged participants			Younger participants			Location
Social media use to share info	n = 56 SM users	Mature aged participants n = 38	Mature aged women n = 30 SM Users	Mature aged men n = 7 SM users	Younger participants n = 17 SM users	Younger women n = 12 SM users	Younger men n = 5 SM users	Regional n = 14 SM users	Rural n = 18 SM users	Remote n = 24 SM users
Facebook	20(36%)	11(29%)	9(30%)	1(14%)	9(53%)	7(58%)	2(40%)	1(7%)	11(61%)	8(33%)
ACCHS	7(13%)	4(11%)	4(13%)	0	3(18%)	3(25%)	0	1(7%)	4(22%)	2(8%)
YouTube	10(18%)	5(13%)	4(13%)	0	5(29%)	4(33%)	1(20%)	3(21%)	3 (17%)	4(17%)
Snapchat	6(11%)	1(3%)	1(3%)	0	5(29%)	5(42%)	0	1(7%)	2(11%)	3(13%)
Instagram	5(9%)	0	0	0	5(29%)	5(42%)	0	0	3(17%)	2(8%)
TikTok	3(5%)	1(3%)	1(3%)	0	2(12%)	2(17%)	0	0	2(11%)	1(4%)
Twitter	0	0	0	0	0	0	0	0	0	0

Note: Denominator = n for each cohort listed on top row.

Participants shared health-related information online and more frequently in real life (IRL). Both mature aged and younger women more frequently than men shared health information with a wide variety of people, most frequently with family members but also with friends, colleagues and others (see Table 5).

Table 5.

Shared health information online and in real life (IRL) (age and gender cohorts).

Shared health information acquired online	Mature aged participants n = 38 SM users		Mature aged women n = 30 SM users		Mature aged men n = 7 SM users		Younger participants n = 17 SM users		Younger women n = 12 SM users		Younger men n = 5 SM users
Shared health information acquired online	IRL	Online	IRL	Online	IRL	Online	IRL	Online	IRL	Online	IRL	Online
Someone living in your household	20(53%)	12(32%)	17(57%)	11(37%)	2(29%)	0	7(41%)	6(35%)	6(50%)	5(42%)	1(20%)	1(20%)
Immediate family living outside of your household	19(50%)	11(29%)	16(53%)	10(33%)	2(29%)	0	7(41%)	7(41%)	6(50%)	6(50%)	1(20%)	1(20%)
Extended family member	18(47%)	11(29%)	16(53%)	10(33%)	1(14%)	0	6(35%)	6(35%)	5(42%)	5(42%)	1(20%)	1(20%)
Friend	18(47%)	10(26%)	15(50%)	9(30%)	2(29%)	0	8(47%)	8(47%)	7(58%)	7(58%)	1(20%)	1(20%)
Work colleague	11(29%)	5(13%)	9(30%)	5(17%)	2(29%)	0	5(29%)	4(24%)	4(33%)	3(25%)	1(20%)	1(20%)
Community acquaintance	14(37%	6(16%)	11(37%)	5(17%)	2(29%)	0	4(24%)	5(29%)	3(25%)	4(33%)	1(20%)	1(20%)
Other person	4(11%)	2(5%)	3(10%)	2(7%)	1(14%)	0	1(6%)	2(12%)	1(8%)	2(17%)	0	0

Note: Denominator = n for each cohort listed on top row.

Participants in all geographic locations shared health information with rural and remote locations sharing in real life more frequently and regional users sharing more frequently online (see Table 6).

Table 6.

Social media platforms/websites used to share health information online and IRL (location cohorts).

Shared health information acquired online	All n = 56 SM users		Regional n = 14 SM users		Rural n = 18 SM users		Remote n = 24 SM users
Shared health information acquired online	IRL	Online	IRL	Online	IRL	Online	IRL	Online
Someone living in your household	27(48%)	18(32%)	3(21%)	5(36%)	12(67%)	7(39%)	10(42%)	8(33%)
Immediate family living outside of your household	27(48%)	18(32%)	3(21%)	4(29%)	12(67%)	7(39%)	10(42%)	8(33%)
Extended family member	24(43%)	17(30%)	3(21%)	3(21%)	11(61%)	6(33%)	9(38%)	8(33%)
Friends	26(46%)	18(32%)	2(14%)	2(14%)	13(72%)	8(44%)	10(42%)	8(33%)
Work colleague	16(29%)	9(16%)	1(7%)	2(14%)	5(28%)	2(11%)	9(38%)	6(25%)
Community acquaintance	18(32%)	11(20%)	1(7%)	0	8(44%)	4(22%)	8(33%)	6(25%)
Other person	5(9%)	4(7%)	1(7%)	0	3(17%)	2(11%)	2(8%)	1(4%

Note: Denominator = n for each cohort listed on top row.

Trusted source of health information

The two platforms most frequently trusted to provide accurate health information by the social media users were the ACCHS website n = 20(36%) and Facebook n = 18(32%). Social media users also indicated they trusted n = 10(18%) other government websites and n = 9(16%) indicated they trusted YouTube to provide accurate health information. A little over a third of participants n = 20(36%) indicated that they did not trust any social media platform to provide accurate health information (see Table 7).

Table 7.

Social media platforms/websites trusted to provide accurate health information.

	All	Mature aged participants			Younger participants			Location
Social media you trusted for Health information	n = 56 SM users	Mature aged participants n = 38 SM users	Mature aged women n = 30 SM users	Mature aged men n = 7 SM users	Younger participants n = 17 SM users	Younger women n = 12 SM users	Younger men n = 5 SM users	Regional n = 14 SM users	Rural n = 18 SM users	Remote n = 24 SM users
Facebook	18(32%)	12(32%)	10(33%)	1(14%)	6(35%)	6(50%)	0	6(43%)	4(22%)	8(33%)
ACCHS	20(36%)	15 (39%)	14(47%)	1(14%)	5(29%)	5(42%)	0	3(21%)	9(50%)	8(33%)
YouTube	9(16%)	7(18%)	6(20%)	0	2(12%)	2(17%)	0	3(21%)	2(11%)	4(17%)
Snapchat	3(5%)	0	0	0	3(18%)	3(25%)	0	0	2(11%)	1(4%)
Instagram	1(2%)	0	0	0	1(6%)	1(8%)	0	0	1(6%)	0
TikTok	4(7%)	1(3%)	1(3%)	0	3(18%)	3(25%)	0	0	4(22%)	0
Twitter	1(2%)	0	0	0	1(6%)	1(8%)	0	1(7%)	0	0
Other Gov	10(18%)	9(24%)	9(30%)	0	1(6%)	1(8%)	0	2(14%)	4(22%)	4(17%)
None	20(36%)	14(37%)	7(23%)	7(100%)	5(29%)	2(17%)	3(60%)	4(29%)	5(28%)	11(46%)

Note: Denominator = n for each cohort listed on top row.

Fitness tracker use

Participants used a smart phone n = 15(19%) or a wearable fitness tracker n = 7(9%) to track some aspect of their health or fitness, including steps, other types of exercise, diet, sleep and period. Younger people were the more frequent users of tracking apps and wearables with n = 6(50%) younger women indicating they had used a smart phone and n = 4(25%) had used a wearable fitness tracker. No mature aged men had used either device for health tracking (see Table 8).

Table 8.

Fitness tracker use.

	All	Mature aged participants			Younger participants			Location
Fitness tracker use	n = 78	Mature aged participants n = 59	Mature aged women n = 39	Mature aged men n = 18	Younger participants n = 18	Younger women n = 12	Younger men n = 6	Regional n = 19	Rural n = 25	Remote n = 34
Use an app in your smartphone	15(19%)	7(12%)	6(15%)	0	8(44%)	6(50%)	2(33%)	2(11%)	7(28%)	6(18%)
Use a fitness tracker, like a Fitbit	7(9%)	4(7%)	4(10)%	0	3(17%)	3(25%)	0	0	4(16%)	3(9%)
Want to try using a fitness tracker or smartphone app	65(83%)	48(81%)	36(92%)	11(61%)	17(94%)	11(92%)	6(100%)	16(84%)	21(84%)	28(82%)

Note: Denominator = n for each cohort listed on top row.

Most participants indicated they would like to try a fitness tracker n = 65(83%), which was consistent across each of the location types. Likewise, 100% of younger men, and 92% of mature aged and younger women expressed interested in trying a fitness tracker.

Discussion

Our co-designed study, which recruited from three geographically diverse locations, is the largest study of Aboriginal and Torres Strait Islander adults’ use of wearable health trackers. The study, mainly comprising mature aged adults, found that individuals in these non-urban locations use digital technologies to acquire and share health information despite well-documented barriers, including connectivity and affordability.³⁴ Moreover, while only a few participants (7%) had actually used a fitness tracker an overwhelming number of participants (83%) expressed a desire to try a fitness tracker or smart phone app to track exercise, diet, or other habits.

The present study builds on work by Maxwell et al., which found that Indigenous women students perceived wearables as enhancing their experiences and assisted in achieving goals of being more active.³⁰ Findings from our community sample indicated that Aboriginal and Torres Strait Islander mature aged adults, particularly mature aged women, are interested in trying a fitness tracker. Our study also builds on the growing body of work that has shown the Aboriginal and Torres Strait Islander people use social media for a variety of purposes, including for health communication.^8,19,35,36

Disaggregating data for mature aged and younger Aboriginal and Torres Strait Islander women and men in this study illuminates differences in how different age and gender cohorts use social media for health. In keeping with Corbett & Schwager finding that older Australians represent the most growth in use of wearables,²⁶ 81% of the mature aged participants in this study expressed an interest in using a health tracker, and 92% of the 39 mature aged women indicated their interest in using a health tracker. An important next step is research to better understand discrepancy between desired and actual use of fitness trackers and phone apps, including specifically exploring the barriers for Aboriginal and Torres Strait Islander people living in non-urban locations to use of apps and trackers,

This study found that mature aged participants were active social media users, with 43% using one or more platforms daily. In keeping with previous studies, women and particularly younger women in this study used social media more compared to men.³⁷ However, the observation that mature aged Aboriginal women frequently use social media to acquire health information and that they shared health information they acquired with a diversity of family, friends and colleagues (both online and in real life) is a particularly valuable finding. This insight points to a community strength that could be used to help disseminate relevant and timely health information to not only social media users but also community members that do not use social media themselves. This is particularly relevant in Aboriginal and Torres Strait Islander communities where mature aged women are often seen as influencers and trusted advisors.^38–40 An important next step is to explore what types of health information each cohort finds most relevant and examine other characteristics of the messaging that impact trust and sharing.

Whilst the numbers are small, participants in rural and remote locations more frequently used social media (other than YouTube) to acquire and share health information compared to regional. This finding is intriguing considering previous findings that remoteness in Australia is associated with less internet use.⁴¹ Given that only three locations were included in this study, additional research that specifically examines how frequently people living in other rural, remote or very remote locations, seek and share health information obtained online is needed. It will also be important to understand if different cohorts from the locations differ in frequency and how they use social media to acquire or share health information.

The two most used and trusted platforms across all cohorts were the ACCHS website and Facebook. These platforms may provide an avenue to reach Aboriginal and Torres Strait Islander people, including mature aged adults, with accurate and timely health information. Likewise, YouTube, while not as popular, is used and trusted by a reasonable proportion of social media users and may provide an opportunity to provide health information in visual or oral narrative formats identified as appealing to Aboriginal and Torres Strait Islander people.¹⁷

Strengths and limitations

This study is a preliminary exploration of mature aged Aboriginal and Torres Strait Islander peoples’ use of and interest in user-focused technologies, including social media, phone apps and wearable trackers to acquire health information/data. Social media and phone app use require at least intermittent internet connectivity. Rural and remote locations in Australia are known to have less reliable internet connectivity compared to urban locations. Moreover, costs can reduce or prohibit internet use particularly for individuals using pre-paid services. We did not ask participants about the consistency of or any barriers to connectivity such as availability or costs, which may impact use and even interest in these technologies. Gathering this information in subsequent studies may help to explain differences between desired use of apps and wearables and previous use. Likewise, a brief survey with a convenience sample across three non-urban locations provides useful information for the ACCHS serving these locations but limits the generalisability of the findings Aboriginal and Torres Strait Islander people living in other localities. While the short survey provided valuable data, it did not give a rich picture of how these technologies are currently used or detail what Aboriginal and Torres Strait Islander people want and need from these technologies. Also, the sample size, while the largest community sample to explore the use of wearables, is too small to enable more sophisticated statistical comparisons between different age, gender and location cohorts. Another limitation is the potential impact of social desirability on participant responses, causing participants to describe more frequent use of social media and wish to try health trackers.

Despite these limitations, this study demonstrated that Aboriginal and Torres Strait Islander people, including mature aged adults from non-urban geographically diverse communities, are interested in and use social media, phone apps and wearables for health purposes.

This research benefited from Aboriginal and Torres Strait Islander governance, leadership and community engagement. Historically, new health care practices and technologies have been developed with little or no input from cultural experts. The move to digital health provides an opportunity to shift to an approach that privileges Aboriginal and Torres Strait Islander perspectives, thus building on the inherent strengths of adaptability and innovation. The collaborative co-design approach which privileged Aboriginal researcher perspectives helped to ensure the design was culturally safe and that we collected relevant data. Moreover, the results of this research will be disseminated in lay language (video and written) to each ACCHS. Likewise, data disaggregated by location enables each ACCHS to better understand the people it serves and use the data to inform health messaging and determine the relevance of future translational research related to digital health in their community. This disaggregation is an important first step in recognising the significant diversity of Aboriginal and Torres Strait Islander people and designing digital health products and services to meet the specific needs of different cohorts.

Knowledge to action

Co-designed digital health research which privileges Aboriginal and Torres Strait Islander perspectives to better understand the needs and requirements of different cohorts within communities is the next step. In-depth qualitative and quantitative research is necessary to understand the enablers and barriers that impact the use and efficacy for Aboriginal and Torres Strait Islander people of different ages, genders and community types. Privileging the perspectives of Aboriginal and Torres Strait Islander people is critical to inform practices, programs and policies related to implementing user-focused technologies for health communication and self-tracking. Building in user expertise through co-designed research will help to ensure that the subsequent programs and services are culturally safe and efficacious for Aboriginal and Torres Strait Islander people.

Conclusion

Aboriginal and Torres Strait Islander peoples’ propensity for early adoption and innovation suggests a path for addressing health disparities as digital health solutions become available. The promising findings of this research highlight the need for in-depth co-designed research to understand the unique needs and requirements of Aboriginal and Torres Strait Islander people to inform the design of user-focused health communication and health-tracking programs and services.

Footnotes

Acknowledgements

We thank Armajun Aboriginal Health Services and Brewarrina Aboriginal Medical Services as key partners and thank the staff members in these services for their assistance in this research. We would like to thank Walanga Muru for their support of this research. We thank Djurali Aboriginal and Torres Strait Islander Health Research Group for their support. We would also like to thank our APG for their leadership and guidance in this research.

Contributorship

CH, KG, GS and FC researched literature and conceived the study. CH, KG, GS, FC were involved in protocol development, gaining ethical approval, GS, KW, DM were involved participant recruitment, JC, FC, GS, CH, KG were involved in survey design and CH, KG, JG, GS, FC data analysis and interpretation. BR, FC and GS provided cultural oversight. CH wrote the first draft of the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

The study adhered to the guideline for ethical research in Aboriginal and Torres Strait Islander populations and relevant ethics committee approvals. We obtained approvals from the Aboriginal Health and Medical Research Council Ethics Committee (AH&MRC) (reference 1862/21) approved 1/12/2021, and an amendment specific to this study was approved on 12/05/2022.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Macquarie University (grant number 20213896 Allocation for PhD students).

Guarantor

CH.

ORCID iD

Connie Henson

Statement related to gender and age language in this manuscript

This research is focused on how mature aged Aboriginal and Torres Strait Islander women use digital health. Our definition of ‘mature aged’ is in keeping with a person's age when internet usage became common. We are therefore defining ‘mature aged’ as generations known as Seniors, Baby Boomers and Generation X, who did not grow up with the internet.⁴² Millennials who were born after 1980 (<41 years old) are generally thought to be more comfortable with technology and especially social/interactive media compared with mature aged generations.⁴³

With regard to gender, we are aware and respect that Aboriginal and Torres Strait Islander people of all ages describe themselves as gender-binary, non-binary, trans and/or other.⁴⁴ Participants in our studies self-identify their gender. Therefore, an Aboriginal and Torres Strait Islander person who identifies themselves as a women some or all of the time, are included in the studies focused on women. For our studies that include people other than women, we provide a variety of gender options and people are encouraged to self-identify with any description or to choose to not to provide a description of their gender.⁴⁴

Notes

References

WHO. Atlas of eHealth country profiles 2015: The use of eHealth in support of universal health coverage.

Australian Digital Health A. Australia’s national digital health strategy. Canberra: Australian Digital Health Agency, 2017.

Eysenbach

Kohler

. What is the prevalence of health-related searches on the world wide web? Qualitative and quantitative analysis of search engine queries on the internet. AMIA Annual Symp Proc AMIA Symp 2003; 2003: 225–229.

Lauckner

Boehmer

, et al. Facebooking for health: an examination into the solicitation and effects of health-related social support on social networking sites. Comput Human Behav 2013; 29: 2072–2080.

Mano

. Social media and online health services: a health empowerment perspective to online health information. Comput Human Behav 2014; 39: 404–412.

Hocevar

Metzger

Flanagin

. Source credibility, expertise, and trust in health and risk messaging. Oxford Res Encycl Commun 2017. https://oxfordre.com/communication/display/10.1093/acrefore/9780190228613.001.0001/acrefore-9780190228613-e-287;jsessionid=84E624A66C5C1C991A8CC6C307597045 (accessed 18 July 2022).

Håkansson

Witmer

. Social media and trust: a systematic literature review. J Bus Econ 2015; 6: 517–524.

Carlson

Frazer

Farrelly

. That makes all the difference": Aboriginal and Torres Strait Islander health-seeking on social media. Health Promot J Aust : Off J Aust Assoc Health Promot Prof 2021; 32: 523–531.

Carlson

Frazer

. The Politics of (Dis) Trust in Indigenous Help-Seeking. In: Maddison

Nakata

(eds) Questioning Indigenous-Settler Relations : Interdisciplinary Perspectives. Singapore: Springer Singapore Pte. Limited, 2020, pp.87–106.

10.

Carlson

Frazer

. Looking out for mob on social media: help-seeking and giving online. Sydney, Australia: Macquarie University, 2022.

11.

AIHW. Aboriginal and Torres Strait Islander Health Performance Framework 2020 summary report. Camberra: Australian Institute of Health and Welfare, 2020.

12.

Nolan-Isles

Macniven

Hunter

, et al. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. Int J Environ Res Public Health 2021; 18(6): 3014. DOI: 10.3390/ijerph18063014.

13.

Australian Institute of Health Welfare. Cultural safety in health care for Indigenous Australians: monitoring framework. Canberra: AIHW, 2021.

14.

AIHW. Australia’s health 2020 data insights. Sydney: Australian Institute of Health and Welfare, 2020.

15.

Carlson

Dreher

. Introduction: indigenous innovation in social media. Media Int Aust 2018; 169: 16–20.

16.

Carlson

Frazer

. Yarning circles and social media activism. Media Int Aust 2018; 169: 43–53.

17.

Rice

Haynes

Royce

, et al. Social media and digital technology use among Indigenous young people in Australia: a literature review. Int J Equity Health 2016; 15: 81.

18.

Sweet

. Social media: new links for Indigenous health. Med J Aust 2013; 199: 18–18.

19.

Hefler

Kerrigan

Freeman

, et al. Using Facebook to reduce smoking among Australian Aboriginal and Torres Strait Islander people: a participatory grounded action study. BMC Public Health 2019; 19: 15.

20.

Hefler

Kerrigan

Grunseit

, et al. Facebook-based social marketing to reduce smoking in Australia’s first nations communities: an analysis of reach, shares, and likes. J Med Internet Res 2020; 22: e16927.

21.

Povey

Mills

PPJR

Dingwall

, et al. Acceptability of mental health apps for Aboriginal and Torres Strait Islander Australians: a qualitative study. J Med Internet Res 2016; 18: 65.

22.

ABA. Australian statistical geography standard (ASGS): volume 5—remoteness structure. Canberra: ACT, 2016.

23.

Koenig

Fuchs

Hansen

, et al.

What is precision medicine?

Eur Respir J 2017; 50(4): 1700391. DOI: 10.1183/13993003.00391-2017.

24.

Mayer

da Costa

RdR

. Electronic health records in a blockchain: a systematic review. Health Inf J 2020; 26: 1273–1288.

25.

Lupton

. Self-tracking, health and medicine. C: Taylor & Francis, 2017, p. 1–5.

26.

Corbett

Schwager

. Digital Consumer Trends – Touch-less, virtual, health-conscious and eco-wise. In: Technology, Media & Telecommunication (TMT). Deloitte, 2021. https://www2.deloitte.com/au/en/blog/technology-media-telecommunications-blog/2021/digital-consumer-trends-touch-less-healthier-wiser.html

27.

Paré

Leaver

Bourget

. Diffusion of the digital health self-tracking movement in Canada: results of a national survey. J Med Internet Res 2018; 20: e177.

28.

Fogarty

Lovell

Lagenberg

, et al. Deficit Discourse and Strengths-based Approaches: Changing the Narrative of Aboriginal and Torres Strait Islander Health and Wellbeing . 2018.

29.

AIHW. Older Australians: Older Aboriginal and Torres Strait Islander people. Camberra: AIHW, 2022.

30.

Maxwell

O’Shea

Stronach

, et al. Empowerment through digital health trackers: an exploration of Indigenous Australian women and physical activity in leisure settings. Ann Leisure Res 2021; 24: 150–167.

31.

Matsuno

Budge

. Non-binary/genderqueer identities: a critical review of the literature. Curr Sex Health Rep 2017; 9: 116–120.

32.

LimeSurvey Project Team / Carsten Schmitz. LimeSurvey: An Open Source survey tool. Hamburg, Germany: LimeSurvey Project, 2012.

33.

Pew Research Center. The Whys and Hows of Generations Research. 19 July 2022 2015. Washington DC.

34.

ABS. Aboriginal and Torres Strait Islander Population, 2016. Camberra: Australian Bureau of Statistics, 2016.

35.

Kerrigan

Herdman

Thomas

, et al. ‘I still remember your post about buying smokes’: a case study of a remote Aboriginal community-controlled health service using Facebook for tobacco control. Aust J Prim Health 2019; 25: 443–448.

36.

Brar

. The use and impact of digital technologies for and on the mental health and wellbeing of Indigenous people: a systematic review of empirical studies. Comput Human Behav 2022; 126(19). DOI: 10.1016/j.chb.2021.106988.

37.

Chou

Gaysynsky

Trivedi

, et al. Using Social Media for Health: National Data from HINTS 2019. J Health Commun 2021; 26: 184–193. DOI: 10.1080/10810730.2021.1903627

38.

Warburton

Chambers

. Older Indigenous Australians: their integral role in culture and community. Australasian J Aging 2007; 26: 5. https://doi.org/10.1111/j.1741-6612.2007.00213.x

39.

Warburton

McLaughlin

. Passing on Our Culture: How Older Australians from Diverse Cultural Backgrounds Contribute to Civil Society. J Cross-Cultural Gerontol 2007; 22: 47–60. DOI: 10.1007/s10823-006-9012-4

40.

Busija

Cinelli

Toombs

, et al. The Role of Elders in the Wellbeing of a Contemporary Australian Indigenous Community. Gerontologist 2020; 60: 513–524. DOI: 10.1093/geront/gny140

41.

Park

. Digital inequalities in rural Australia: A double jeopardy of remoteness and social exclusion. J Rural Stud 2017; 54: 399–407.

42.

Dimock

. Defining generations: Where Millennials end and Generation Z begins, https://www.pewresearch.org/fact-tank/2019/01/17/where-millennials-end-and-generation-z-begins/ (2019, accessed 4 June 2022 2022).

43.

Prensky

. Listen to the natives. Educ Leadersh 2005; 63(4): 8–13.

44.

Margolies

Strub

. Music community, improvisation, and social technologies in COVID-era Musica Huasteca. Front Psychol 2021; 12: 14.

Mature aged Aboriginal and Torres Strait Islander adults are using digital health technologies (original research)

Abstract

Background

Objective

Methods

Results

Conclusions

Keywords

Introduction

Social media

mHealth

Aims

Methods

Ethics

Aboriginal and Torres Strait Islander governance

Design

Results

Social media use

Acquiring health information

Sharing health information

Trusted source of health information

Fitness tracker use

Discussion

Strengths and limitations

Knowledge to action

Conclusion

Footnotes

Acknowledgements

Contributorship

Declaration of conflicting interests

Ethical approval

Funding

Guarantor

ORCID iD

Statement related to gender and age language in this manuscript

Notes

References