Barriers and facilitators of digital health use among older adults: Insights from parcipatory workshops

Abstract

Over the past two decades, substantial investments have been made in the digital transformation of healthcare, reshaping how health services are delivered, managed and experienced. While the use of digital health products, information and services is increasingly common, this shift introduces new challenges. For many, especially older adults, the growing reliance on digital technologies disproportionately limits access to care, reinforcing existing health inequalities. In response to this challenge, the Time-To-Engage project, funded by the la Caixa Foundation’s Social Research Program (LCF/PR/SR23/57000012), set out to understand what motivates older adults to engage with digital healthcare. As a part of this effort, we conducted an exploratory study examining individual and contextual factors that shape older adults' intention to use digital health technologies. The study involved 14 creative workshops in rural and urban areas across Portugal. A total of 103 participants (75% female; average age of 76.3±8.0; 55% with primary education) were recruited through community partners. They attended two-hour sessions facilitated by trained researchers, featuring group discussions guided by Persona and User-TaskEnvironment Analysis exercises. The Persona Exercise involved constructing archetypal profiles of older adults and identifying perceived costs and benefits of digital health technology. The User-Task-Environment Analysis Exercise mapped facilitators and barriers to community support for digital health adoption. Ideas were systematized using storyboards and mind maps. All sessions were transcribed and anonymised for content analysis. Drawing on the Digital Divide Model (digital technologies accesses and uses) and Planned Behavior Theory (attitudes, norms, behavioural control, intentions and behaviours), our analysis revealed that low perceived capability and negative attitudes are major barriers to digital health adoption. Conversely, material, technical, and social support, learning opportunities, and regular technology use are key facilitators of digital engagement. These findings underline the need for inclusive digital health strategies that empower older adults and help narrow the digital divide.