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Towards designing for equity: active citizen participation in eHealth

Christopher R. Jones (St George's Healthcare NHS Trust, London, UK)
Ricardo B. Cardoso (Microgravity Center, PUCRS, Porto Alegre, Brazil)
Edison Hüttner (Microgravity Center, PUCRS, Porto Alegre, Brazil)
Helena W. Oliveira (Microgravity Center, PUCRS, Porto Alegre, Brazil)
Marlise A. dos Santos (Microgravity Center, PUCRS, Porto Alegre, Brazil)
Maria Helena Itaqui Lopes (Microgravity Center, PUCRS, Porto Alegre, Brazil)
Thais Russomano (Microgravity Center, PUCRS, Porto Alegre, Brazil)

Transforming Government: People, Process and Policy

ISSN: 1750-6166

Article publication date: 5 October 2012



Reducing inequity in accessing healthcare among rural and remote populations remains a problem. Internationally, eHealth is now touted as a potential solution, with a range of diverse approaches and impacts. Yet, the equity gains of implementing eHealth are often not realized due to a lack of effective strategies for citizen participation. The purpose of this paper is to present the background to, and results of, a multidisciplinary eHealth assistance project in a remote region of the Brazilian Amazon, highlighting the importance of citizen participation within planning processes.


The project was conducted in three phases – pre‐mission, mission, and post‐mission. Discussions were held between health teams and local community leaders, and were coordinated by government health organizations in partnership with the Amazon State University. A multidisciplinary team visited five remote communities in the Brazilian Amazon, where participants underwent clinical assessment using eHealth technologies within pharmacy, cardiology, dermatology, and/or odontology. Analysis and second opinion were provided by relevant specialists and the results were delivered electronically to local healthcare teams.


A total of 111 patients were evaluated with an average age of 54 years. There were several important findings following specialist second opinion, which improved the quality of care they received. These comprise identifying drug interactions and patients requiring further investigation for cardiological and dermatological complaints, including suspected malignancy.

Research limitations/implications

Due to a breakdown in communication, data from the post‐mission phase are lacking, particularly regarding treatment outcomes. Furthermore, the authors did not perform an analysis of cost‐effectiveness. If eHealth technologies are to become part of routine clinical practice it is important that the financial implications are acceptable.


This project demonstrates how equity can be designed for with a multidisciplinary approach to eHealth activities in rural and remote environments within Brazil. Such activities typically focus on one particular area, yet primary healthcare facilities see patients with a variety of problems.



Jones, C.R., Cardoso, R.B., Hüttner, E., Oliveira, H.W., dos Santos, M.A., Helena Itaqui Lopes, M. and Russomano, T. (2012), "Towards designing for equity: active citizen participation in eHealth", Transforming Government: People, Process and Policy, Vol. 6 No. 4, pp. 333-344.



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