Tele-healthcare in Remote Villages of Sai Kung

Sai Kung District Community Center, Hong Kong

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Sai Kung District Community Center (“SKDCC”) is committed to breaking the barriers of geographical dispersion and inconvenience in rural areas with technology, anticipating the perception of rural areas of Hong Kong as enticing alternatives to urban regions. By channeling community capital into the rural community, they are realizing their mission: “to connect and mobilize community resources, to love and care our folks and nature across Sai Kung.”

In joint efforts with ZeShan, SKDCC is providing primary healthcare services for village residents in a new program: Tele-healthcare and Medication Guidance Pilot Project in Sai Kung Rural Communities. The concerns of rural residents often remain in the periphery of the government’s attention, and is hardly addressed by healthcare resources currently provided by the government. One particular pain point is the difficulty rural residents face in reaching mainstream services and resources, especially the elderly population. This situation has only been exacerbated by the current COVID-19 epidemic, where it has become more difficult for them to update their health status, get medical follow-ups, and receive necessary treatment. SKDCC’s program aims at filling this service gap.

While the concept behind this project was not created from scratch, it not been realized due to a lack of resources specifically allocated by Hong Kong’s system to improve the aforementioned situation in rural areas. So far, the program has addressed 40 cases through the provision of 173 home-visit sessions by doctors, nurses, and pharmacists. A total of 221 sessions were conducted for tele-nursing consultation, caregiver consultation and case follow-up.

ZeShan and SKDCC are both striving to make stronger impacts on society, optimistic from the attention and media coverage on this pressing issue brought about by this program. We are hopeful that the outcome evaluation will shed new light on both the social and healthcare sectors to improve the effectiveness of primary healthcare in rural areas.

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Let Them Fly

Illuminant, Hong Kong

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Established in 2018, Illuminant (registered as The Illuminant Company Limited) is a social enterprise dedicated to introducing the Japanese model of elderly care into Hong Kong.  The concept behind this model is to create an environment and care culture in which older adults can give full play to their own potentials and capacity, enabling the ageing community to look after themselves and enjoy their late years.  Its Chinese name “鐵樹銀花” literally translates to “silver flowers blossoming on iron trees”, an analogy that comes to mean “older people enjoying their life despite being frail”.  

Illuminant derives its stream of income from movie screenings, experiential learning courses, training workshops, and talks, all of which are driven by the aim to enhance and improve the quality of care in elderly homes and family homes across Hong Kong. J-Care, their flagship virtual reality training program, is the first of its kind in Hong Kong, through which people can immerse themselves in a world afflicted by dementia. Through the simulated first-person experience of dementia, participants are able to personally experience the difficulties faced by dementia patients in different scenarios that arise due to different symptoms of the condition. Accompanied by a trainer’s guidance and explanation throughout the simulation, participants emerge from the experience equipped with a better understanding of dementia patients’ needs and feelings. Illuminant’s programs have the potential to reduce the stigma and fear toward different ageing-related conditions in our society, with greater hopes of eliminating the social exclusion experienced by these vulnerable communities.

In 2018, ZeShan Foundation supported the first screening of the Japanese Kaigo movie “Care-Nin” (“照護人 1”) and an accompanying training session, which was well received by practitioners and policy makers in elder care.  In 2021, ZeShan also supplemented Illuminant’s material and staff costs to upgrade both the hardware and software behind their virtual reality program, which also indirectly helped to subsidize the organization’s financial shortage during a period of business re-strategizing. With the goal to broaden the reach of the J-Care concept to a wider professional and public audience, this more advanced VR program will enable the organization to more effectively deliver content remotely in online and mobile learning modes.

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The Japanese Kaigo Movie “Care-Nin” promotes the profession and the value of frontline carers, and brings out an important message that “having dementia does not mean your life is coming to an end.”

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Carers experiencing dementia perspectives through VR devices

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Neque porro quisquam est qui dolorem ipsum quia dolor sit amet, consectetur, adipisci velit…Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.

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It is a long established fact that a reader will be distracted by the readable content of a page when looking at its layout. The point of using Lorem Ipsum is that it has a more-or-less normal distribution of letters, as opposed to using ‘Content here, content here’, making it look like readable English. Many desktop publishing packages and web page editors now use Lorem Ipsum as their default model text, and a search for ‘lorem ipsum’ will uncover many web sites still in their infancy. Various versions have evolved over the years, sometimes by accident, sometimes on purpose (injected humour and the like).

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including versions of Lorem Ipsum.

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Geron-Infusion Education (Phase 1)

HKU & PolyU, Hong Kong

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An ageing population has shifted global demographics, in turn creating demand for diverse professionals who possess both the knowledge of ageing consumers’ interests and characteristics, and the necessary skills to adapt to their service and product needs. Incorporating ageing-related content into curricula has been found to be effective in enabling students in diverse disciplines to acquire the knowledge necessary to meet these changing societal needs, which place universities in a critical position to respond to ageing populations through new approaches in teaching, research, and community engagement.

In support of the cultivation of gerontology education and workforce development, the Geron-Infusion Education (GIE) initiative was jointly developed and implemented in September 2018 by the Hong Kong Polytechnic University under the Infusion Active Ageing Education project (GIE-IAAE) and the University of Hong Kong under the Campus Ageing Mix Project for University Students (GIE-CAMPUS). The GIE initiative adopted a ‘soft-socialisation approach’, encouraging academic staff to bring active ageing content into their curricula, while also integrating research into the process of feasibility testing and emphasizing the systematic evaluation of impact at the individual, departmental, and institutional levels.

Research objectives

1)       Identify and form a group of scholar leaders in the university to initiate Geron-Infusion activities through innovative programmes.

2)       Test the feasibility of the ageing infusion approaches to equip students with gerontology knowledge and skills.

3)       Promote the integration of gerontology (active ageing infusion education) into formal curricula in different disciplines at the university.

4)       Enhance the university’s institutional capacity to identify innovative ways to nurture future academic and social leaders to face an ageing society in Hong Kong and globally.

Geron-Infusion education models

In this 2-year pilot study, two theoretical GIE models were developed and tested, each designed to suit the institutional context of PolyU and HKU respectively.

An action-oriented approach, the PolyU IAAE model encompasses four sequential components: 1) Identification of academic champions, who are taught the benefits and value of the approach in promoting their application of ageing-related knowledge and skills in their disciplines; 2) Active infusion of related educational content into course curricula, with gerontology experts and academic champions co-creating inter-generational and discipline-specific educational activities; 3) Activity implementation; and (4) Evaluation.

Taking on an evidence-based approach, the GIE-CAMPUS presents Geron-Infusion in a three-tiered concentric model, extending outward from curricular, to institutional, then societal. At the curricular level are four pillars: 1) intergenerational contact-based education, 2) multilayer, nested teaching and learning activities; 3) collaborative leadership, and 4) stakeholder partnership. The next tier emphasizes four aspects of institutional buy-in: 1) mission and vision alignment, 2) supportive educational infrastructure, 3) faculty champions engagement, and 4) student upholding. Finally, the societal tier refers to the societal impacts of population ageing. Six strategies were used to aid the implementation of the GIE-CAMPUS model: 1) a community-based participatory approach, 2) accumulating good practice and reusable teaching and learning resources, 3) maintaining relationships and communication with stakeholders, 4) partnering and co-creating with champions on innovative curricular activities, 5) university and departmental leadership buy-in, and 6) sustaining and motivating Geron-Infusion with additional resources.

Evaluation Methodology

Faculty were identified and nurtured to take on the role as leaders and champions of the GIE project, who through in-depth interviews, evaluated changes in learning outcomes and curricula throughout the initiative.

Pre- and post- course questionnaires were administered to students to evaluate the effectiveness of GIE, which targeted four factors: 1) knowledge about ageing measured by Palmore’s Facts on Ageing Quiz, 2) gerontological skills, 3) attitude towards older people measured by the Chinese version of Kogan’s Attitude Toward Older People, and 4) professional interest in working with older people.

Exploring impact beyond the institutional setting, a “Productive Interactions” framework was developed to assess the societal impacts of GIE by measuring the direct and indirect interactions between different stakeholders. An interaction is considered productive when it leads to efforts by stakeholders to apply their research to broader societal goals.

Results 

Together, the PolyU IAAE and HKU CAMPUS engaged 18 faculty members from 11 disciplines, who integrated ageing-related content into 13 courses. Faculty champions gave positive feedback towards GIE regarding its relevance and benefits, expressing enthusiasm towards a continued improvement and implementation of GIE in their respective courses.

Between 2018 and 2020, the GIE reached a total of 643 students, of which 396 completed both pre- and post-course questionnaires, resulting in a response rate of 61.6%. Results from both institutions indicate that after the implementation of GIE, significant improvements were observed in gerontological skills, attitudes towards older people, and professional interest in working with older people. The two-year project enhanced opportunities for students to experience ageing-related teaching and learning, as well as to have direct contact with older adults and community stakeholders. The GIE had equipped students to become competent workforce professionals in an ageing society, and has strengthened the formal curricula of different academic departments in ways that align with ongoing socio-demographic changes.

Beyond infusing active ageing content and teaching methods into curricula, the initiative involved the placement of over 200 older adults into formal teaching and learning settings. This has fostered collaboration with local communities, including elderly services agencies, NGOs, industries, enterprises, secondary schools, and the general public, as well as regional and international organisations and research networks.

More broadly, research teams, faculty champions, and senior champions have successfully nurtured ageing literacy by accumulating innovative teaching and learning resources through the GIE. Resulting is the institutionalisation of gerontological competencies through the launch of a new Common Core cluster and transdisciplinary minor, The Human Lifespan.

Conclusion

The GIE is the first initiative in the world to use an ageing-infusion education approach to bring active ageing content into a diverse range of disciplinary curricula at higher institutions. The GIE pilot implemented at PolyU and HKU achieved all four of its objectives, and has made significant progress in increasing sensitivity, interest, and exposure to Geron-Infusion, as well as in advancing the leadership and capacity of tertiary institutions to respond purposefully to an ageing demographic worldwide. Both qualitative and quantitative data provide evidence in support of the GIE project’s impacts on faculty, students, institutions, and the community.

Tested under two different institutional contexts with varying levels of institutional and faculty management buy-in, the success of the two piloted GIE models—IAAE and CAMPUS—demonstrate its viability as pragmatic frameworks for Geron-Infusion curricula. Findings from students and faculty members demonstrate that both models are effective to some extent, yet highlight the importance of adaptability to the institutional context and capacity.

Contributing to its success, the PolyU IAAE and HKU CAMPUS overlapped in three factors: 1) co-creation of Geron-Infusion activities by the research team and faculty champions; 2) bringing older citizens into the classroom, whereby students have direct, personal, and positive contact with older people; and 3) building partnerships with diverse local stakeholders including professional parties, enterprises, community agencies, and organisations.

Identified challenges that impede the GIE’s ability to succeed include faculty resistance to the concept or the execution of Geron-Infusion education, low response from students in data collection, management of senior champions, and civil unrest and turbulence due to the 2019 social movements and the COVID-19 pandemic. Although some faculty members endorsed the continuation of Geron-Infusion in their future curricula, it is uncertain how long it can be sustained due to faculty and course coordinator turnover, unprecedented situations, declining faculty buy-in, and/or competing priorities. Moreover, rather than engaging with faculty members individually, knowledge and experience sharing should be encouraged between faculty champions, strengthening interconnections and communication among GIE participants within and across different universities.

Consolidating identified good practices, a public online teaching and learning e-toolkit on Geron-Infusion education has been developed to support faculty members from different disciplines in designing and downloading their self-created Geron-Infusion education plans. In addition to sharing insight on feasibility, implementation strategies, benefits, and impacts to the various stakeholder groups in Hong Kong and international networks, the GIE initiative can also bring together global initiatives for identifying and refining future Geron-Infusion and age-inclusive approaches in higher education in Asia and worldwide to meet the opportunities and challenges of ageing populations.

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PolyU-IAA team

Faculty of Law_ Outreach Legal Talks Initiative (OUTLET)_ HKU legal talk

GIE-CAMPU​S project legal talk for older adults in the community, co-organized  student-led and extracurricular project Outreach Legal Talks Initiative of Faculty of Law, HKU.

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