Currently submitted to: JMIR Formative Research
Date Submitted: Jun 5, 2026
Open Peer Review Period: Jun 8, 2026 - Aug 3, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Distinguishing Capability from Willingness in Video-Based Care: A Cross-Sectional Task‑Based Digital Proficiency Study Among Older Adults
ABSTRACT
Background:
Equitable adoption of video-based care among older adults remains unachieved. Although telehealth readiness is often treated as a single construct, patient ability to complete video visits and willingness to use video-based care may reflect distinct mechanisms with differing implications for digital medicine design.
Objective:
To examine how task-based digital proficiency related to perceived capability (“can”) and willingness (“will”) to engage in video-based care among older adults, and to characterize capability-willingness phenotypes to informed targeted telehealth strategies.
Methods:
We constructed a cross-sectional, mixed-methods study of adults aged ≥65 years participating within a longitudinal registry study (Rochester Older Adult Registry). Participants completed one of three survey modes assessing task-based digital proficiency, perceived capability to complete a video visit, and willingness to use video-based care if recommended. Digital task proficiency was measured using a 15-item index capturing applied skills needed to complete video visits. Multivariable logistic regression examined associations between digital task proficiency, capability, and willingness, with adjustment for sociodemographic factors, internet access, functional status, and availability of trusted help. Capability-willingness phenotypes were descriptively characterized and contextualized using qualitative inquiry.
Results:
Greater digital task proficiency was strongly associated with perceived capability to complete a video visit (adjusted OR per SD increase=2.16, 95% CI 1.59-2.93), independent of age, education, internet access, availability of trusted help, clinically-derived frailty and activities of daily living. In contrast, while digital task proficiency was associated with willingness in unadjusted analyses, this relationship attenuated after accounting for capability (adjusted OR= 1.23, 95% CI 0.90-1.68). Capability remained a predictor of willingness, suggesting that capability as an intermediary between task proficiency and ability to participate in video-based care. Four capability-willingness phenotypes were identified with distinct experiential barriers and enablement opportunities.
Conclusions:
Telehealth adoption among older adults reflects at least two separable dimensions: patient perceived capability (“can”) and willingness (“will”). Task-based digital proficiency drives capability, whereas willingness is shaped by perceived clinical fit, patient preferences, and care experience. Distinguishing these dimensions provides a framework for more precise, equitable digital medicine strategies that move beyond skill-building towards personalized enablement pathways.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.