Women less than twenty years of age are already childbearing ‘teen parents’. What are the implications for midwifery.It is appreciated that women in different environments have different needs.
My field is Health Informatics, a field incorporating health sciences, information sciences and computer science.My particular interest is in eHealth and as a subset, mHealth.
I would like to focus on Generation Z, women who are already childbearing. Their information and communication needs are a reflection of the recently changed environment and make a case for midwives to understand and thoughtfully engage with new media.
Selwyn seesGen Z as “young people who were “digitally born in the late 20th and early 21st century.” Dates are guidelines.They have been called “digital natives” compared with people who are “digital imigrants” whose brain patterns were laid down during a time when social interaction was the norm. (Gary Small) People born at different times in history exhibit different generational characteristics and attitudes because of the many and varied social, cultural and economic influences on their lives.This data from Harvard (US) researchers tells us that these young people:know a life that is digitalThey Spend much of their time online andDon’t distinguish between ‘online’ and ‘offline’Also, Their digital identity and real-space identity are fused andTheir tendency to express themselves, relate to one another are digitally mediated.Commuters and mobile phones are primarily mediators of human to human reactions withConstant connection to media, andTheir information needs are virtually satisfied via a browser(Palfrey and Gasser, 2008) http://youthandmedia.org/ PALFREY, J. & GASSER, U. 2008. Born Digital: Understanding the First Generation of Digital Natives, New York, Basic Books.Selwyn, N. The digital native: myth and reality. In ASLIB Proceedings, 2009. 364-379
Our children are living in a stimulating period in history, and are exposed from birth to a connected world. They have an enormous capacity for learning.The concepts, languages and ways of thinking of children born in this digital age include: linear, creative and divergent thinking, a world of hyperlinks and tags, both a virtual and real world, enhanced sense of concepts; spatial, temporal and visual and a vast array of audio and visual sensory experiences.Their brains are literally wired differently as a result of their experiences. (Gary Small)Sir Ken Robinsonhttp://www.youtube.com/watch?v=zDZFcDGpL4U&feature=relatedDavid diSalvoNeuronarrativehttp://neuronarrative.wordpress.com/2008/12/15/the-brain-technology-built-an-interview-with-dr-gary-small/Dr Gary Smallhttp://www.youtube.com/watch?feature=player_embedded&v=NhLnoZFCDBM“iBrain: Surviving the Technological Alteration of the Modern Mind.” Gary Smallhttp://www.amazon.com/iBrain-Surviving-Technological-Alteration-Modern/dp/0061340332#reader_0061340332Newsweekhttp://www.newsweek.com/2008/10/13/reading-this-will-change-your-brain.html
On now to demonstrate the rapid increase in available technologies. The International Telecommunications Union monitors changes and this chart is self explanatory. The only decrease has bee in fixed land line connections.http://www.itu.int/ITU-D/ict/statistics/
You can see the recent and rapid increase in mobile cellular subscriptions for both 2G and 3G standards.Nearly the whole world has access to 3G cellular signals.The World in 2010 ITU facts and figures (International Telecommunications Union)
The Internet has fundamentally changed the way we communicate.The Internet has reached farther and faster than any previous communication technology. If you consider the average age of midwives in New Zealand is 47, and techological change has mainly accelerated in the last 5-6 years, accepting and adapting this this new environment is challenging.For example, it took 35 years for radio to reach 50 million listeners. 13 years for television, and four years for the Internet to reach the same number of people. http://www.cisco.com/interneteconomy/1998/
From large, heavy brick mobile phone to smartphones in less than 40 years, the state of the art device is small, elegant and feature filled. Likewise computers have become smaller with more capacity.The mobile internet is now via a small mobile multimedia electronic device with ability to make calls, send emails, surf the web, upload data, download data, watch movies, listen to music, podcasts, social network, house applications that customise and personalise functionality.The smartphone is a new information and communication device.Photo acknowledgementshttp://www.webdesignerdepot.com/2009/05/the-evolution-of-cell-phone-design-between-1983-2009/
This image highlights the trend.
Another major contribution to this current technical environment is the development of the web as a platform and framework. Coding and frameworks have developed rapidly to bring to us a NEW WORLD.THE VIRTUAL WORLD.Many of you are familiar with the web at the start of the New Millenium and have witnessed this transformation.For me, It has been very exciting indeed to be witness to this change.
Health care delivery has an opportunity to embrace the new borderless environment.I would like to bring to your attention the site PatientsLikeMe, which embodies many of the best attributtes of consumer participation and collaboration.
Speeds and volumes of data transfer have recently increased because of ultrafast broadband via a fibreoptic cable, and also new cellular standards coming together into a new 4G standard that has yet to widely roll out, but already has been rolled out in Sweden, Norway, Ukraine and the United States.People are moving rapidly from 2G to 3G platforms, in both developed and developing countries. In 2010, 143 countries were offering 3G services commercially, compared to 95 in 2007.
Convergence, development and evolution have impacted on availability of new technologies.One feature of smartphones I would like to highlight is the ability to download and use applications which are applicable to the individual’s lifestyle and requirements.Applications are software downloads that personalise the smartphone.There are many medical and health apps. For example, the most popular app is Medscape, which has drug formularies and other functions.The American Medical Association produced their first app in April 2011 and has issued an ideas challenge.There are already thousands of apps available.Convergence, development and evolution have impacted on availability of new technologies.One feature of smartphones I would like to highlight is the ability to download and use applications which are applicable to the individual’s lifestyle and requirements.Applications are software downloads that personalise the smartphone.There are many medical and health apps. For example, the most popular app is Medscape, which has drug formularies and other functions.The American Medical Association produced their first app in April 2011 and has issued an ideas challenge.There are already thousands of apps available.
Technically, we have recently experienced a rapid phase of convergence, development and evolution.
Mindful of different world situations between countries, the well-known and often debated Maslow’s 1943 hierarchy of needs reflecting his theory of motivation is appropriate to recall.A.H. Maslow, A Theory of Human Motivation, Psychological Review 50(4) (1943):370-96.
“The term mobile health or mHealth, also written as m-health, describes the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems.There are many global initiatives in mHealth for developing countries.(Vodafone and the United Nations)“The term mobile health or mHealth, also written as m-health, describes the use of mobile telecommunication and multimedia technologies as they are integrated within increasingly mobile and wireless health care delivery systems (Istepanian & Lacal, 2003). It can also be described as “mobile computing, medical sensor, and communications technologies for health care” (Istepanian, 2004). While the term is familiar to those in biomedicine and informatics, it is only now being clearly defined and frameworks are being developed for the broader medical and public health communities, as well as for the general public and stakeholders in the mobile phone industry.”Mechael, P. M. 2009. The Case for mHealth in Developing Countries [Online]. MIT Press Available: www.mitpressjournals.org/doi/pdf/10.1162/itgg.2009.4.1.103 [Accessed April 30 2011].mHealth is defined as “an application of wire- less technologies to transmit and enable various data contents and information services, which are easily accessible by users through mobile devices such as mobile phones, smart phones, PDAs, laptops, and Tablet PCs” (UN Foundation & Vodafone Foundation, 2009).(Akter et al., 2011)
Because, the developing world has bypassed the fixed personal computer and leaped straight into mobile phone technology space.They are simple and cheap to use.http://www.abiresearch.com/press/3471-More+than+60%25+of+Handsets+Will+Have+Mobile+Browsers+in+2015
Direct voice communication plus Text and voice have proven important.Whereas in some developing countries Single Data entry at the point of care is possible, enabling Central monitoring of women. In New Zealand, it is not uncommon for midwives to enter the same data on paper and into computers.aIn developing countries there are currently 5 billion mobile phone subscriptions, nearly three times the amount in developed countries. Given the prevalence of mobile phone use and the overwhelming predominance (99%) of maternal deaths occurring in the developing world, what kind of potential does mHealth technology have to change the state of maternal health? According to the presenters at the Maternal Health Task Force Policy Series event on mHealth, the impact of mobile phone technology is far reaching, replicable, and cost-effective. (Mechael, 2009) MECHAEL, P. M. 2009. MoTECH: mHealth Ethnography Report [Online]. Dodowa Health Research Center for The Grameen Foundation. Available: http://bit.ly/1HaUeA [Accessed April 6 2011But one of the unexpected results of that, along with the development of cheap mobile telephony, is a proliferation and embrace of that tech by many more people, in more strata of society, than you'd see, for instance, in the U.S.http://www.womendeliver.org/updates/entry/mhealth-solutions-to-improve-maternal-health/
PatricialMechael and others concluded that: “m-health has a crucial, even inevitable, role to play in future healthcare, and the development and exploitation of m-health demands a top-down strategy or framework to match and encourage bottom-up innovation by healthcare practioners.mHealth is defined as “an application of wire- less technologies to transmit and enable various data contents and information services, which are easily accessible by users through mobile devices such as mobile phones, smart phones, PDAs, laptops, and Tablet PCs” (UN Foundation & Vodafone Foundation, 2009).(Akter et al., 2011) AKTER, S., D’AMBRA, J. & RAY, P. 2011. Trustworthiness in mHealth Information Services: An Assessment of a Hierarchical Model with Mediating and Moderating Effects Using Partial Least Squares (PLS). Journal of the American Society for Information Science and Technology, 62, 100-116 Mechael, P., Batavia, H., Kaonga, N., Searle, S., Kwan, A. & Goldberger, A. 2010. Barriers and Gaps Affecting mHealth in Low and Middle Income Countries: Policy White Paper [Online]. Columbia University; mHealth Alliance. pp. 79 The Earth Institute Available: http://www.globalproblems-globalsolutions-files.org/pdfs/mHealth_Barriers_White_Paper.pdf [Accessed April 30 2011].
Patricia Mechael does not mention the consumer’s role in the exploitation of eHealth perhaps because she is primarily looking at eHealth and mHealth in developing countries. I would add the additional influence of the healthcare consumer in industrialised countries. I feel this model is more applicable to New Zealand women.
This is self explanatory.GOVERNOR, J., NICKULL, D. & HINCHCLIFFE, D. 2009. Web 2.0 Architectures, O'Reilly Media Inc.P80
Where do you sit on this one?
One result is this experience.
Text4babyThis initiative provides timely education for pregnant women.It is a public private cooperative.This is an opt in service in the United states. Women and put their due date of delivery and receive information appropriate to their stage of gestation and these texts cover pregnancy and the first year after birth. Started in Feb 2010 and now has over 157,000 users, with 95% of users saying they would recommend the service.
I would like to SHOWCASE BreastfeedingNZBreastfeedingnz is a New Zealand Government initiative encouraging breast feeding and using four of the most popular applications for social networking.Growth over the last year has been steadily upwards with Facebook the preferred environment over Twitter.http://www.moh.govt.nz/breastfeeding
There are now, many possible computer mediated channels for information and communication.
Face to face communication may be only one of many possible channels that could be used during the antenatal period.
McLuhan sees new media as an extension of man.[Marshall McLuhan the Canadian philosopher,] “sees man becoming a slave because he subconsciously chooses to ignore and disregard the fact that understanding the new web of media is incumbent to his survival and prosperity.”Chirag Mehta, 2002http://chir.ag/papers/mcluhan.shtmlThe phrase: “We shape our tools and our tools shape us.” is from McLuhan. “With a new way of thinking we create new models of reality.’The products of modern science are not in themselves good or bad; it is the way that they are used that determines their value." According to McLuhanWomen have always given birth but the culture surrounding the birth changes, as we are reminded by viewing birthing practices in the 1950s.
Some midwives consider they already have the complete range of skills necessary to provide the total maternity service for well women and their babies.Do these skills extend to knowledge of facilitating information and communication using new and currently available tools?Pre-conceptual carePregnancy testingAntenatal health carePreparation for birthing and parentingCare during labour, including the facilitation of birthManagement of any necessary emergency measures until appropriate medical assistance is availableSupport and facilitation of breastfeedingPostnatal care for mother and baby for four to six weeks after birthContraceptive/family planning care and educationTransfer to ongoing well child services (as appropriate) following completion of the childbirth continuumConsultation or referral to the medical specialists if additional health care needs necessitate their input at any stage in the continuum This may include a haematologist, cardiologist, endocrinologist, obstetrician, paediatrician and so on. BUT HOW IS THIS ACHIEVED???????????
Midwives are charged with health promotion, prevention of complicationsand surveillance of well women.Do you think information and communication technologies are sufficiently considered, in the light of Gen Z’s profile?Whose responsibility is this?“A major part of the midwife’s role is providing the information and support the woman needs to make her own decisions.”A midwife helps the woman identify problems and gives her information, options, and the authority to make her own choices (19).”This article was originally published in the July/August 1999 edition of the Journal of Nurse-Midwifery (now the Journal of Midwifery and Women's Health). Frye A. Holistic midwifery: A comprehensive textbook for midwives in homebirth practice, volume I, care during pregnancy. Portland, Oregon: Labrys Press, 1995.
Are midwives gatekeepers of information or are they facilitators?
There are inherent issues around privacy and security of data but Gen Z may view these differently. It is not straightforward and ongoing improvements will come.
Digital natives have new and different skills from digital immigrantsPeople born at different times in history exhibit different generational characteristics and attitudes because of the many and varied social, cultural and economic influences on their lives.This data from Harvard (US) researchers tells us that these young people:know a life that is digitalThey Spend much of their time online andDon’t distinguish between ‘online’ and ‘offline’Also, Their digital identity and real-space identity are fused andTheir tendency to express themselves, relate to one another are digitally mediated.Commuters and mobile phones are primarily mediators of human to human reactions withConstant connectionTheir information needs are virtually satisfied via a browser(Palfrey and Gasser, 2008) http://youthandmedia.org/ PALFREY, J. & GASSER, U. 2008. Born Digital: Understanding the First Generation of Digital Natives, New York, Basic Books.Selwyn, N. The digital native: myth and reality. In ASLIB Proceedings, 2009. 364-379
Does your organisation’s strategic planning document include reference to thoughtfully engaging with women-centred information and communication technology?
Are you ready to provide Gen Z-centred care?Digital natives have defined a new culture of communication – no longer dictated by time and place, or even how one looks at the moment, unless they are video-chatting or posting photographs. (Gary Small)Will they be satisfied with face to face communication, hard copy handouts and the odd phone call as the midwife selected channels for information and communication?Small, G. & Vorgan, G. 2008. iBrain: Surviving the Technological Alteration of the Modern Mind, New York, HarperCollins.
Women less than twenty years of age are part of a new generation with information and communication characteristics and needs unlike generations of women before them. Women who fit this demographic profile are already childbearing ‘teen parents’. Convergence of hardware, applications and services has spawned a raft of new communication channels that could be considered for use in midwifery care delivery. Developing countries are already exploiting mobile technologies. Can we learn from the current solutions being discussed and implemented? I think we can.Is it important and what are the implications for midwifery?
Are midwives planning to consider the different characteristics and needs of Gen Z women?
1<br />Are midwives planning to consider the different characteristics and needs of Gen Z women?<br />Dallas Knight <br />PhD Candidate<br />University of Otago, New Zealand<br />
At the end of this session participants should: <br />Understand Gen Z are different<br />Realise technology is changing and it is changing society<br />Be aware of some implications for the future of midwifery care<br />3<br />objectives<br />
Mobile phones in the developing world(simple and cheap)<br />about 70% of the world’s 5 billion mobile phones are in the developing world<br />90% of the worlds population has access to a mobile signal<br />by 2015 about 60% of mobile phones are expected to be web enabled<br />http://www.abiresearch.com/press/3471-More+than+60%25+of+Handsets+Will+Have+Mobile+Browsers+in+2015<br />18<br />
In developing countries cheap mobile technology is empowering<br />http://www.womendeliver.org/updates/entry/mhealth-solutions-to-improve-maternal-health/<br />19<br />
mHealth<br />“mHealth has a crucial and even inevitable role in future healthcare, and <br />the development and exploitation requires a top-down strategy or framework to match and encourage a bottom-up innovation by healthcare practitioners.”<br />Patricia Mechael<br />http://www.globalproblems-globalsolutions-files.org/pdfs/mHealth_Barriers_White_Paper.pdf [Accessed April 30 2011].<br />20<br />
Women</li></li></ul><li>“Organisations that do not embrace the Web’s natural communication-oriented strengths will fail when they enter into competition with those that do.”<br />GOVERNOR, J., NICKULL, D. & HINCHCLIFFE, D. 2009. Web 2.0 Architectures, O'Reilly Media Inc. P80<br />22<br />
Mobile Internet?<br />Yes. Ubiquitous Information<br />24/7 communication <br />Oh No!!!<br />Yes!<br />(Gen Z)<br />23<br />
Here we are in a virtual conference room courtesy of Otago Polytechnic, facilitator, Sarah Stewart. Sue Hickton and others (thanks)<br />24<br />Western Australia<br />New Zealand<br />
In the United States of America<br />A private/public-federal government co-operative<br />http://www.text4baby.org/<br />text4baby<br />25<br />
What about Skype?<br />Does all communication need to be face to face?<br />http://www.mi.sanu.ac.rs/vismath/jadrbookhtml/part48.html<br />28<br />
29<br />Technology is not a solution<br />Solutions are found when the use of tools is maximised<br />
Midwives care for ‘well women’<br />“It is the midwife who has the complete range of skills necessary to provide the total maternity service for well women and their babies.”<br />(Maggie Banks, New Zealand midwife)<br />BANKS, M. 2011. Reclaiming Midwifery Care as a Foundation for Promoting 'Normal' Birth [Online]. Birth International. Available: http://www.webcitation.org/5yH3wRYsZ [Accessed April 28 2011]<br />30<br />
Women’s needs<br />Information and communication needs for well women during pregnancy and postnatally are integral to midwifery service facilitation.<br />Is the use of information and communication technologies sufficiently considered?<br />By whom?<br />31<br />
Image of “making ‘Dontcha Wish Your Cell Phone Was Hot Like Me?’ courtesy of ARI on Flickr. <br />34<br />
Are there implications for midwifery?<br />Do you and your organisation consider <br />‘women-facing’ technologies<br />over ‘midwife-facing’ <br />technologies?<br />Women-centred approach to service delivery maximising attributes of new ICT<br />35<br />