Perspectives of Knowledge Management in Urban Health pp 95-114

Part of the Healthcare Delivery in the Information Age book series (Healthcare Delivery Inform. Age, volume 1)

A Pervasive Wireless Knowledge Management Solution to Address Urban Health Inequalities with Indigenous Australians

  • Nilmini Wickramasinghe
  • Indrit Troshani
  • Steve Goldberg


A recent study by Adelaide Aboriginal and Torres Straight Islander Health (Gallaher et al., In Our Own Backyard: Urban Health Inequalities and Aboriginal Experiences of Neighbourhood Life, Social Capital and Racism, 2009) revealed some alarming findings concerning the health status of these groups. One of the key health areas that requires attention is that of chronic diseases in general and diabetes in particular. We propose using a wireless knowledge-based system developed by INET for enabling effective and efficient monitoring of patients with diabetes. We argue that systematic use of this solution can improve self-management and lead to positive healthcare outcomes. Key aspects of the wireless diabetes solution to facilitate self-management of diabetes patients are highlighted. Adoption facilitators and barriers, assessment criteria, and policy implications are also discussed.


Urban health inequalities Indigenous Australians Australian aborigines Australian Torres Strait Islander people Diabetes Self-management Pervasive technologies Wireless Healthcare 


  1. ABS (2003) Population Projections, Australia, 2002-2101, Cat. No. 3222.0, Canberra: Australian Bureau of Statistics.Google Scholar
  2. ABS (2006) National Aboriginal and Torres Strait Islander Health Survey 2004-05. ABS Cat. no. 4715.0, Canberra: ABS.Google Scholar
  3. AIHW (2007) National Indicators for Monitoring Diabetes: Report of the Diabetes Indicators Review Subcommittee of the National Diabetes Data Working Group: AIHW cat. no. CVD 38, Canberra: AIHW.Google Scholar
  4. AIHW (2008) Diabetes: Australian Facts 2008, Canberra: Australian Institute of Health and Welfare.Google Scholar
  5. AIHW, A. (2005) The health and welfare of Aboriginal and Torres Straits Islander peoples. ABS cat. no. 4704.0. AIHW cat. no. IHW 14, Canberra: ABS & AIHW.Google Scholar
  6. Balas, E.A., Krishna, S., Kretschmer, R.A., Cheek, T.R., Lobach, D.F. and Boren, S.A. (2004) “Computerized knowledge management in diabetes care”, Medical Care Vol. 42, No. 6, pp 610–621.PubMedCrossRefGoogle Scholar
  7. Bodenheimer, T., Lorig, K., Holman, H. and Grumbach, K. (2002) “Patient self-management of chronic disease in primary care”, Journal of American Medical Association (JAMA) Vol. 288, No. 19, pp 2469–2475.CrossRefGoogle Scholar
  8. Britt, H., Miller, G.C., Charles, J., Pan, Y., Valenti, L., Henderson, J., Bayram, C., O’halloran, J. and Knox, S. (2007) General Practice Activity in Australia 2005-06, Cat. no. GEP 16, Canberra: AIHW.Google Scholar
  9. Campbell, S., Braspening, J., Hutchinson, A. and Marshal, M. (2003) “Research methods using in developing and applying quality indicators in primary care (improving the quality of health care)”, British Medical Journal Vol. 326, pp 816–819.PubMedCrossRefGoogle Scholar
  10. Catanzariti, L., Faulks, K. and Waters, A.-M. (2007) National Diabetes Register: Statistical Profile 1999-2005, AIHW cat. no. CVD 39, Canberra: AIHW.Google Scholar
  11. Chau, S. and Turner, P. (2006) “Utilisation of mobile handheld devices for care management at an Australian aged care facility”, Electronic Commerce Research and Applications Vol. 5, pp 305–312.CrossRefGoogle Scholar
  12. Colagiuri, S., Colagiuri, R. and Ward, J. (1998) National Diabetes Strategy and Implementation Plan, Canberra: Diabetes Australia.Google Scholar
  13. Coon, P. and Zulkowski, K. (2002) “Adherence to American diabetes association standards of care by rural health care providers”, Diabetes Care Vol. 25, 2224–2229.PubMedCrossRefGoogle Scholar
  14. Craig, M.E., Fernia, G., Broyda, V., Lloyd, M. and Howard, N.J. (2007) “Type 2 diabetes in Indigenous and non-Indigenous children and adolescents in New South Wales”, Diabetes Medicine Vol. 367, pp 497–499.Google Scholar
  15. Da (2007) Diabetes Facts, New South Wales: Diabetes Australia.Google Scholar
  16. Dixon, T. and Webbie, K. (2005) Diabetes-related deaths 2001–2003. AIHW Bulletin No. 32. Cat. no. AUS 69, Canberra: AIHW.Google Scholar
  17. Dixon, T. and Webbie, K. (2006) The National System for Monitoring Diabetes in Australia (AIHW Cat. No. CVD 32), Canberra: Australian Institute of Health and Welfare.Google Scholar
  18. Downer, S.R., Meara, J.G., Da Costa, A.C. and Sethuraman, K. (2006) “SMS text messaging improves outpatient attendance”, Australian Health Review Vol. 30, No. 3, pp 389–396.PubMedCrossRefGoogle Scholar
  19. Ehealthimpact (2006) Study on Economic Impact of eHealth: Developing an evidence-based context-adaptive method of evaluation for eHealth, Bonn: Information Society and Media.Google Scholar
  20. Eley, R., Fallon, T., Soar, J., Buikstra, E. and Hegney, D. (2008) “The status of training and education in information and computer technology of Australian nurses: a national survey”Journal of Clinical NursingVol. 17, pp 2758–2767.PubMedCrossRefGoogle Scholar
  21. Francis, C.F., Feyer, A.-M. and Smith, B.J. (2007) “Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects”Australian Health ReviewVol. 31, No. 4, pp 499–509.PubMedCrossRefGoogle Scholar
  22. Gallaher, G., Ziersch, A., Baum, F., Bentley, M., Palmer, C., Edmondson, W. and Winslow, L. (2009) In Our Own Backyard: Urban Health Inequalities and Aboriginal Experiences of Neighbourhood Life, Social Capital and Racism, Adelaide: Flinders University of South Australia.Google Scholar
  23. Gallego, G., Fowler, S. and Van Gool, K. (2008) “Decision makers’ perceptions of health technology decision making and priority setting at the institutional level”Australian Health ReviewVol. 32, No. 3, pp 520–526.PubMedCrossRefGoogle Scholar
  24. Goldberg, S. (2009) “An Evolution of using social networks in chronic disease management”, Proceedings of the 22nd Bled eConference: Facilitating an Open, Effective and Representative Society, Bled, Slovenia.Google Scholar
  25. Goldberg, S.E.A. (2002a) Building the Evidence for a standardized Mobile Internet (wireless) Environment in Ontario, Canada, January Update, Internal INET Documentation, Ontario, Canada: INET.Google Scholar
  26. Goldberg, S.E.A. (2002b) HTA Presentational Selection and Aggregation Component Summary. Internal INET Documentation, Ontario, Canada: INET.Google Scholar
  27. Goldberg, S.E.A. (2002c) Wireless POC Device Component Summary, Internal INET documentation, Ontario, Canada: INET.Google Scholar
  28. Goldberg, S.E.A. (2002d) HTA Presentation Rendering Component Summary, Internal INET documentation, Ontario, Canada: INET.Google Scholar
  29. Goldberg, S.E.A. (2002e) HTA Quality Assurance Component Summary, Internal INET documentation, Ontario, Canada: INET.Google Scholar
  30. Gururajan, R. and Murugesan, S. (in press) “Wireless solutions developed for the Australian healthcare: A review”, Proceedings of the 4th International Conference on Mobile Business, Sydney, Australia.Google Scholar
  31. Harvey, P.W., Petkov, J.N., Misan, G., Fuller, J., Battersby, M.W., Cayetano, T.N., Warren, K. and Holmes, P. (2008) “Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes”, Australian Health Review Vol. 32, No. 2, pp 330–338.PubMedCrossRefGoogle Scholar
  32. Hunt, D., 2007. Urgent health system reform needed to tackle disease epidemic, says head of new University of Melbourne centre [online]. University of Melbourne. Available from: [Accessed Access Date 2008].
  33. Icic (2008). Improving Chronic Illness Care: The Chronic Care Model.Google Scholar
  34. Istepanian, R.S.H., Jovanov, E. and Zhang, Y.T. (2004) “Guest Editorial: Introduction to the special section on m-health: beyond seamless mobility and global wireless healthcare connectivity”, IEEE Transactions on Information Technology and BiomedicineVol. 8, No. 4, pp 405–414.CrossRefGoogle Scholar
  35. Istepanian, R.S.H. and Lacal, J.C. (2003) “Emerging mobile communication technologies for health: some imperative notes on m-health”, Proceedings of the 25th Annual International Conference of the IEEE EMBS, New York.Google Scholar
  36. Kenagy, J.W., Berwick, D.M. and Shore, M.F. (1999) “Service quality in health care”, Journal of American Medical Association (JAMA)Vol. 281, No. 7, pp 661–665.CrossRefGoogle Scholar
  37. Khambati, A., Warren, J., Grundy, J. and Hosking, J. (2008) “A model driven approach to care planning systems for consumer engagement in chronic disease management”, Proceedings of the HIC 2008 Australia’s Health Informatics Conference, Health Informatics Society of Australia Ltd (HISA).Google Scholar
  38. Knuiman, M.W., Welborn, T.A. and Bartholomew, H.C. (1996) “Self-reported health and use of health services: a comparison of diabetic and nondiabetic persons from a national sample”, Australian and New Zealand Journal of Public HealthVol. 20, No. 3, pp 241–247.PubMedCrossRefGoogle Scholar
  39. Mirza, F., Norris, T. and Stockdale, R. (2008) “Mobile technologies and the holistic management of chronic diseases”, Health Informatics JournalVol. 14, No. 4, pp 309–321.PubMedCrossRefGoogle Scholar
  40. Neville, G., Greene, A., Mcleod, J. and Tracy, A. (2002) “Mobile phone text messaging can help young people with asthma”, British Medical JournalVol. 325, pp 600.PubMedCrossRefGoogle Scholar
  41. Norris, A.C. (2002) Essentials of Telemedicine and Telecare, Chichester: Wiley.Google Scholar
  42. Opie, A. (1998) “Nobody’s asked me for my view: users’ empowerment by multidisciplinary health teams”, Qualitative Health ResearchVol. 18, pp 188–206.CrossRefGoogle Scholar
  43. Poulton, B.C. (1999) “User involvement in identifying health needs and shaping and evaluating services: is it being raised?” Journal of Advanced NursingVol. 30, No. 6, pp 1289–1296.PubMedCrossRefGoogle Scholar
  44. Radin, P. (2006) “To me, it’s my life: medical communication, trust, and activism in cyberspace”, Social Science and MedicineVol. 6, pp 591–601.Google Scholar
  45. Rao, S. and Troshani, I. (2007a) AMC-ER Challenges and Rewards: Experiences of Australian Content Exporters, Adelaide, South Australia: Australian Mobile Content – Export Research Initiative, m.Net Corporation Ltd.Google Scholar
  46. Rao, S. and Troshani, I. (2007b) AMC-ER Initial Selection of Content, Markets, and Distribution Channels for the Australian Mobile Content – Export Research Initiative, Adelaide, South Australia: m.Net Corporation Ltd.Google Scholar
  47. Rasmussen, B., Wellard, S. and Nankervis, A. (2001) “Consumer issues in navigating health care services for type I diabetes”, Journal of Clinical NursingVol. 10, pp 628–634.PubMedCrossRefGoogle Scholar
  48. Reach, G., Zerrouki, D., Leclercq, D. and D’ivernois, J.F. (2005) “Adjusting insulin doses: from knowledge to decision”, Patient Education and CounselingVol. 56, No. 1, pp 98–103.PubMedCrossRefGoogle Scholar
  49. Rowland, D. (2003) “An ageing population: emergence of a new stage of life?” in S. Khoo & P. Mcdonald (eds.) The Transformation of Australia’s Population: 1970-2030Sydney: UNSW Press, 239–265.Google Scholar
  50. Rudi, R. and Celler, B.G. (2006) “Design and implementation of expert-telemedicine system for diabetes management at home”, Proceedings of the International Conference on Biomedical and Pharmaceutical Enginering 2006 (ICBPE2006), IEEE, 11-14 December 2006, Singapore.Google Scholar
  51. Russell, L.B., Churl Suh, D. and Safford, M.M. (2005) “Time requirements for diabetes management: too much for many?” The Journal of Family PracticeVol. 54, No. 1, pp 52–56.PubMedGoogle Scholar
  52. Skulimowski, A.M. (2006) The Challenges to the Medical Decision Making System posed by mHealth. Available.: Kraków, Poland: Centre for Decision Sciences and Forecasting, Progress & Business Foundation, Institute for Prospective Technological Studies (IPTS).
  53. Tabrizi, J.S., Wilson, A.J., Coyne, E.T. and O’rourke, P.K. (2008) “Review of patient-reported type 2 diabetes service quality”, Australian Health ReviewVol. 32, No. 1, pp 23–33.PubMedCrossRefGoogle Scholar
  54. Thow, A.M. and Waters, A.-M. (2005) Diabetes in culturally and linguistically diverse Australians: identification of communities at high risk. Cat. no. CVD 30, Canberra: AIHW.Google Scholar
  55. Tong, B. and Stevenson, C. (2007) Comorbidity of cardiovascular disease, diabetes and chronic kidney disease in Australia, AIHW cat. no. CVD 37, Canberra: AIHW.Google Scholar
  56. Van Eyk, H. and Baum, F. (2002) “Learning about interagency collaboration: Trialling collaborative projects between hospitals and community health services”, Health and Social Care in the CommunityVol. 10, No. 4, pp 262–269.PubMedCrossRefGoogle Scholar
  57. Vanjara, P. (2006) “Application of mobile technologies in healthcare diagnostics and administration”, in A. Lazakidou (ed.) Handbook of Research on Informatics in Healthcare and MedicineHershey, PA: Idea Group, pp 113–130.Google Scholar
  58. Wellard, S.J., Rennie, S. and King, R. (2008) “Perceptions of people with type 2 diabetes about self-management and the efficiency of community based services”, Contemporary NurseVol. 29, No. 2, pp 218–226.PubMedCrossRefGoogle Scholar
  59. Wickramasinghe, N. and Goldberg, S. (2003) “The wireless panacea for healthcare”, Proceedings of the 36th Hawaii International Conference on System Sciences, Hawaii, 6–10 January, IEEE.Google Scholar
  60. Wickramasinghe, N. and Goldberg, S. (2004) “How M=EC2 in healthcare”, International Journal of Mobile CommunicationsVol. 2, No. 2, pp 140–156.CrossRefGoogle Scholar
  61. Wickramasinghe, N., Misra, S. (2004) “A wireless trust model for healthcare”, International Journal of e-HealthVol. 1, pp 60–77.CrossRefGoogle Scholar
  62. Wickramasinghe, N. and Schaffer, J. (2006) “Creating knowledge driven healthcare processes with the intelligence continuum”, International Journal of Electronic HealthcareVol. 2, No. 2, pp 164–174.PubMedGoogle Scholar
  63. Wickramasinghe, N., Schaffer, J. and Geisler, E. (2005) “Assessing e-health”, in T. Spil & R. Schuring (eds.) E-Health Systems Diffusion and Use: The Innovation, The User, and The User IT ModelHershey, PA: Idea Group.Google Scholar
  64. Yu, P., Li, H. and Gagnon, M.-P. (2008) “Health IT acceptance factors i n long-term care facilities: a cross-sectional survey”, International Journal of Health InformaticsVol. In Press (doi:10.1016/j.ijmedinf.2008.07.006), No.
  65. Zigbor, J.C. and Songer, T.J. (2001) “External barriers to diabetes care: addressing personal and health systems issues”, Diabetes SpectrumVol. 14, pp 23–28.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Nilmini Wickramasinghe
    • 1
  • Indrit Troshani
  • Steve Goldberg
  1. 1.School of Business IT and LogisticsRMIT UniversityMelbourneAustralia

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