Non-Adherence in Patients on Peritoneal Dialysis: A Systematic Review

Background: It has been increasingly recognized that non-adherence is an important factor that determines the outcome of peritoneal dialysis (PD) therapy. There is therefore a need to establish the levels of non-adherence to different aspects of the PD regimen (dialysis procedures, medications, and dietary/fluid restrictions). Methods: A systematic review of peer-reviewed literature was performed in PubMed, PsycINFO and CINAHL databases using PRISMA guidelines in May 2013. Publications on non-adherence in PD were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Relevant data on patient characteristics, measures, rates and factors associated with non-adherence were extracted. The quality of studies was also evaluated independently by two reviewers according to a revised version of the Effective Public Health Practice Project assessment tool. Results: The search retrieved 204 studies, of which a total of 25 studies met inclusion criteria. Reported rates of nonadherence varied across studies: 2.6 1353% for dialysis exchanges, 3.9 1385% for medication, and 14.4 1367% for diet/fluid restrictions. Methodological differences in measurement and definition of non-adherence underlie the observed variation. Factors associated with non-adherence that showed a degree of consistency were mostly socio-demographical, such as age, employment status, ethnicity, sex, and time period on PD treatment. Conclusion: Non-adherence to different dimensions of the dialysis regimen appears to be prevalent in PD patients. There is a need for further, high-quality research to explore these factors in more detail, with the aim of informing intervention designs to facilitate adherence in this patient populatio

Validation of the English and Mandarin versions of the Fear of Cancer Recurrence Inventory in an Asian population

The Fear of Cancer Recurrence Inventory has shown adequate psychometric properties to assess for fear of cancer recurrence among cancer survivors. However, the use of the Fear of Cancer Recurrence Inventory in Asia is limited due to the paucity of validation studies. Participants include 331 cancer survivors who completed the English and newly developed Mandarin versions of the Fear of Cancer Recurrence Inventory. The results revealed that both versions of the Fear of Cancer Recurrence Inventory demonstrated satisfactory internal reliability, test–retest reliability, convergent validity, and concurrent validity. A confirmatory factor analysis provided support for the original seven-factor structure. The validated Fear of Cancer Recurrence Inventory is applicable to cancer survivors in Singapore

Bridging Connectivity Issues in Digital Access and Literacy: Reflections on Empowering Vulnerable Older Adults in Singapore

This article describes a ground-up initiative for a volunteer-run digital literacy program in Singapore targeting vulnerable older adults, focusing on the barriers faced in running this program and training these beneficiaries. It further offers possible solutions to overcome these hurdles, providing insight for individuals or organizations seeking to start similar ground-up initiatives

Smartphone Ownership, Digital Literacy, and the Mediating Role of Connectedness and Loneliness In Improving The Wellbeing among Community-Dwelling Singaporean Older Adults of Low Socio-Economic Status

Importance: Safe-distancing measures used during the COVID-19 pandemic may exacerbate social isolation and loneliness with their attending negative consequences. Digital technology may mitigate the negative impact of safe-distancing measures; however, older adults of low socioeconomic status (SES) who may not be digitally literate remain a vulnerable population. Objective: To examine the relationship between digital literacy and social connectedness, loneliness, wellbeing, and quality of life (QOL) amongst older adults. To identify demographic factors associated with smartphone ownership, digital literacy, and willingness to enroll in a home-based digital literacy program. Design: Cross-sectional study. Setting: Convenience sampling of older adults receiving financial aid or living in rental flat referred to a volunteer-led digital literacy program. Participants: 302 community dwelling older adults who are ≥55 years old. Main Outcomes: Smartphone ownership, self-reported digital literacy, willingness to enroll in a digital literacy program; social connectedness (Lubben Social Connectedness Scale, LSNS-6), loneliness (UCLA 3-item scale, UCLA-3), wellbeing (Personal Wellbeing Score), and QOL (EQ-5D-3L [utility index], EQ VAS). Results: Social digital literacy had a positive indirect effect on both the wellbeing and QOL (mediated by social connectedness and perceived loneliness) of older adults, while instrumental digital literacy had a negative indirect effect on the two outcomes. 59.9% of participants owned an internet-enabled phone (smartphone). The median digital literacy index is 3 (score ranging from 0 to 13). Older adults who are younger and more educated were more likely to own a smartphone; while older adults who are more educated, Chinese (ethnic majority), have a smartphone, and lower digital literacy index were more likely to enroll in a home-based digital literacy education program. Conclusions and Relevance: During the COVID-19 pandemic, community dwelling older adults of low SES are socially isolated, lonely, and have low digital literacy. Interventions to improve digital literacy (especially the social domain) may help to reduce social isolation and loneliness, ultimately improving wellbeing and QOL

Smartphone ownership, digital literacy, and the mediating role of social connectedness and loneliness in improving the wellbeing of community-dwelling older adults of low socio-economic status in Singapore

Introduction During the COVID-19 pandemic, safe-distancing measures resulted in many community-dwelling older adults being socially isolated and lonely, with its attending negative impact on wellbeing and quality of life. While digital technology may have mitigated this, older adults of low socioeconomic status (SES) are more likely to be digitally excluded and hence susceptible to the adverse effects of social isolation and loneliness. This study aims to understand the factors that affect digital literacy, smartphone ownership, and willingness to participate in a digital literacy program (DLP), and to test the hypothesized relations between digital literacy, social connectedness, loneliness, wellbeing, and quality of life amongst community dwelling older adults of low SES. Materials and methods A questionnaire assessing digital literacy, social connectedness, wellbeing and quality of life was administered. Socio-demographic variables, pre-existing internet-enabled, and willingness to participate in a home-based DLP was also collected. Logistic regression was used to identify demographic factors associated with digital literacy, smartphone ownership, and willingness to enroll in a DLP. Serial mediation analysis was also performed using a structural equation model framework. Results A total of 302 participants were recruited. Female gender, older age, lower education levels were associated with lower digital literacy. Those who owned a smartphone tended to be younger and better educated. Older adults who were better educated, of Chinese descent (the ethnic majority in Singapore), and who had lower digital literacy, were most willing to enroll in the digital literacy education program. Social-use digital literacy had a positive indirect effect on well-being ( Discussion The results suggest there are demographic barriers to participation in DLPs and highlight the benefit of focusing on enhancing social-use digital literacy. Further study is needed to evaluate how well specific interventions to improve social-use digital literacy help to reduce social isolation and loneliness, and ultimately improve wellbeing and quality of life

Smartphone ownership, digital literacy, and the mediating role of social connectedness and loneliness in improving the wellbeing of community-dwelling older adults of low socio-economic status in Singapore

During the COVID-19 pandemic, safe-distancing measures resulted in many community-dwelling older adults being socially isolated and lonely, with its attending negative impact on wellbeing and quality of life. While digital technology may have mitigated this, older adults of low socioeconomic status (SES) are more likely to be digitally excluded and hence susceptible to the adverse effects of social isolation and loneliness. This study aims to understand the factors that affect digital literacy, smartphone ownership, and willingness to participate in a digital literacy program (DLP), and to test the hypothesized relations between digital literacy, social connectedness, loneliness, wellbeing, and quality of life amongst community dwelling older adults of low SES.Info-communications Media Development Authority (IMDA)Ministry of Health (MOH)National Medical Research Council (NMRC)Published versionThis research is supported by the Singapore Ministry of Health’s National Medical Research Council under the Fellowship Programme by SingHealth Regional Health System, Population-based, Unified, Learning System for Enhanced and Sustainable (PULSES) Health Centre Grant (NMRC/ CG/C027/2017_SHS), the Healthy, Empowered and Active Living (HEAL) fund and the Infocomm Media Development Authority Digital for Life Fund

Building Digital Literacy in Older Adults of Low Socioeconomic Status in Singapore (Project Wire Up): Nonrandomized Controlled Trial

BackgroundIn a rapidly digitalizing world, the inability of older adults to leverage digital technology has been associated with weaker social connections and poorer health outcomes. Despite the widespread digital adoption in Singapore, older adults, especially those of lower socioeconomic status (SES), still face difficulties in adopting information and communications technology and are typically digitally excluded. ObjectiveWe aimed to examine the impact of the volunteer-led, one-on-one, and home-based digital literacy program on digital literacy and health-related outcomes such as self-reported loneliness, social connectedness, quality of life, and well-being for older adults of low SES. MethodsA nonrandomized controlled study was carried out in Singapore between July 2020 and November 2021 involving 138 digitally excluded community-dwelling older adults aged ≥55 years and of lower SES. Older adults awaiting participation in the program served as controls. Older adults under the intervention were equipped with a smartphone and cellular data, underwent fortnightly to monthly digital literacy training with volunteers to learn digital skills, and digitally connected to their existing social networks. Primary outcome was the improvement in self-reported digital literacy. Secondary outcomes included improvements in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, EQ-5D-3L and EQ visual analogue scale scores, and Personal Wellbeing Score. ResultsThere were significant improvements in digital literacy scores in the intervention group as compared to controls (mean difference 2.28, 95% CI 1.37-3.20; P<.001). Through multiple linear regression analyses, this difference in digital literacy scores remained independently associated with group membership after adjusting for differences in baseline scores, age, gender, education, living arrangement, housing type, and baseline social connectivity and loneliness status. There was no statistically significant difference in University of California, Los Angeles 3-item loneliness scale, Lubben Social Network Scale-6, Personal Wellbeing Score, or EQ-5D Utility and visual analogue scale score. ConclusionsThis study adds to the growing research on digital inclusion by showing that a volunteer-led, one-on-one, and home-based digital literacy program contributed to increase digital literacy in older adults of low SES. Future studies should look into developing more older adult–friendly digital spaces and technology design to encourage continued digital adoption in older adults and, eventually, impact health-related outcomes