An exploratory and descriptive qualitative design was used in this study. One of the major advantages of content analysis is that it allows our R&D team to apply a mix of quantitative and qualitative research methods, which results in a more scientifically rigorous analysis. The research objectives guiding the whole research design and data collection process are:

(1)

Assess the telemedicine perception and needs from the district-based community for sake of building momentum in developing the age-friendly telemedicine.

(2)

Recommend a framework for continuous improvement on elderly mental health well-being

(3)

Arise public awareness and encourage community participation in capacity building for scaling up telemedicine

Focus groups research method have been widely used to examine participant’ experiences and perception with a scientific manner, and this method is chosen considering that the designed focus group setting is socially oriented, age friendly, and cohesively connected among the participants, therefore, could progressively lead to enhanced diversity, inclusion, and openness.

Participants

After the COVID-19 outbreak, elderly is especially vulnerable to social distancing policy posed by Hong Kong Government, particularly for those living alone, during the Hong Long’s fifth wave of the COVID-19 outbreak. Hospitalisation rates is high among those living with Non-Communicable Diseases (NCD). One in every 2.3 deaths by suicide in Hong Kong in 2021 involved the elderly and a suicide prevention group put part of the blame for the statistic on the long-running coronavirus pandemic [25].

Drawing on the previous evidence of negative psychological responses observed during previous epidemics (e.g. SARS, MERS, etc.) [22, 26, 27], concerns is increasingly surging among multisectoral stakeholders that there would be adverse effects of the COVID-19 pandemic on mental health and wellbeing. It’s evident that the governmental isolation rules in response to the health emergency, psychosocial consequences such anxiety, depression, and loneliness exacerbated the mental health challenges among aging proportion [28, 29], leading to negative effects on psychological  and physical health [23, 24, 30]. However, public survey evidence suggests older adults on average are more inclined to turn to digital service for self-help to experience more stable interventions compared with previous inflectors outbreak periods [25, 29, 31]. However, it is presently unclear about what kind of underlying factors accounted for the experiences reflected by elderly during and beyond the COVID-19 pandemic and how is the underling mechanism towards the telemedicine paradigm shift.

All our project respondents were community residents of Chinese origin, aged 60 s and above, normally residing in Hong Kong and can speak Cantonese at time of participation. Respondents were mostly recruited directly from the community with a minor proportion of elders who regularly visit District Elderly Community Centres (DECC).

Procedures

A structured questionnaire was used in the survey that consisted of multiple-choice questions to address three major aspects that could influence elderly perception of telemedicine: (1) socio-demographic characteristics, including age, gender, education level, living arrangement, employment status, and residential area; (2) self-related mental health status; (3) digital adoption of telemedicine during the past years. The survey can be found in Supplementary.

A total of 10 voluntary helpers were recruited as SMART Ambassador since Mar 2020 and they assisted the whole project development and follow up as a long-term commitment for smart aging service. To ensure the survey protocol would be standardized, several rounds of mandatory training sessions were held on before the survey and focus group discussion to support the helpers in delivering the surveys and focus group discussion. The running of focus group was carried out by a focus group leader (interviewer), and two to three SMART Ambassador (project assistants) depending on group size. The project team members were responsible for various duties including coordinating with elderly or caregivers for the interview schedules, facilitating question comprehension that participants had about the project, and supervising the signing of consent forms, organizing briefing sessions, setting up meeting rooms.

We begin the data collection phase since 2020 after establishing the SMART protocol and survey and interview guide, having relevant team member well trained for supporting the capacity building schemes, consultations with elderly, and research activities. Data were finally  collected via on-site visit in district-based parks, social and recreational activities centres from Mar 2021 to June 2021. The study used convenience sampling to recruit individuals aged 60 years and above from ten community-based facilities located in Hong Kong. The participants were recruited after getting their consensus, which involves the questionnaire included questions about demographics, lifestyle, and socioeconomic position, as well as telemedicine revenant variables examined, such as mental health and digital adoption of telemedicine. The data provided here were centered on factors associated with elderly telemedicine for mental health well-being perception, usage, expectations.

Focus group interview

A semi structured focus group interview guide was developed according to the study aims (details enclosed in the supplementary). The aim was to collect elderly and their caregivers’ response telemedicine specific to their own needs and the community. Furthermore, we elaborated the focus discussion objectives and impact when soliciting elderly’ voluntary help to join, and we also encourage them to bring their caregivers (relatives, domestic helper, center helpers, etc.). Once getting their consent to join, we also elaborate further the personal information protection principles to ensure confidentiality of participants are also explained. A consent form similar to the one used with the questionnaire interview was distributed to each participant for signature after the explanation by project coordinators.

Prior to each focus group discussion, each elderly participants have completed a brief questionnaire that asked about their demographic characteristics (age, gender, education, marital status, living arrangement). The focus group discussion is designed to be opened with an introduction of the study, the objectives of the discussion, and its implication and impact. One function room located in Tai Wai region (Near the railway station) was booked for participants in carrying out each focus group. A total of 1.5 to 2 hours were allocated for each group, with light refreshments offered to participants.

Each group interview implementation follows a standard procedure began with a brief introduction of the SMART Tech project and followed the purpose of the focus group interview and impact of how participants’ response  could contribute to the project and further to the elderly’s mental health wellbeing for society impact. Name tags with preferred name were provided to participants, interviewer, and assistants. In addition, iPad, water, and snake were prepared and used to facilitate the introduction each interview topic and warm discussion among participants. Project leader moderated the focus groups, at the same time, project assistants and SMART ambassadors facilitated the discussions and participant’s enquiries. All participants were given sufficient opportunity to share their views and comments with time constraint. Probing questions were used when appropraite, for example, “Could you please further describe the situation using a concrete example?” More specific questions were used to prompt participants to explore additional issues once an issue has been sufficiently explored. We conducted five group discussions in total and the discussion materials and consents forms have been enclosed in the supplementary.