JMIR Publications

ABSTRACT

Background:

Noncommunicable diseases (NCDs), particularly hypertension, diabetes, hyperlipidemia, and obesity, are on the rise among older adults in Singapore, emphasizing the need for effective screening, monitoring, and educational interventions. The traditional healthcare model, relying on in-person visits to review patients, poses risks of underreported cases and missed opportunities for early interventions to manage complications. Community-based telemonitoring programs present promising opportunities to extend telehealth services to underserved populations, thereby mitigating the digital divide and addressing health inequalities. With Asset-Based Community Development approach, the Community Telehealth Service (CTS), a multi-user telemonitoring program that combines both physical and digital elements, was designed by and for the older residents amidst the COVID-19 pandemic to complement the existing healthcare infrastructure and improve their access to healthcare services.

Objective:

This study aimed to evaluate the feasibility of CTS implementation in the Singapore community and identify key areas of improvement to motivate the uptake of community-based telehealth programs.

Methods:

CTS was deployed and evaluated in three phases progressively, with preliminary user feedback informing continuous enhancements to the program design in the subsequent phases. The feasibility of CTS was determined by its implementation and demand, integration with existing healthcare system, as well as service practicality and acceptability. The evaluation was conducted by analyzing the operating statistics, user feedback, and observations during program implementation.

Results:

Over the course of the three phases, CTS was operated for a total of 652 hours with 809 health screenings conducted and 147 health ambassadors trained. Cancellation and no-show rates were estimated to decline from 26.8% in Phase I to 15.6% in Phase II and 11.2% in Phase III. User feedback was dominantly positive, with a majority perceived CTS satisfactory and usable, and expressed interest in continuing using CTS as a community resource for health monitoring. Key areas of improvement include incorporating a broader spectrum of health assessments, offering more comprehensive educational health information, and enhancing the referral management system.

Conclusions:

This study affirmed the potential feasibility of CTS in the Singapore community. Moving ahead, the focus will shift towards sustaining the momentum of CTS through ongoing design-build-test-learn cycles to maximize the benefits of CTS and establish a solid evidence base for the effectiveness, acceptability, user retention, and cost benefits of community-based telehealth programs.