JMIR Publications

ABSTRACT

Background:

Digital literacy and internet access are increasingly recognised as “super social determinants of health” because of their influence on wider social determinants of health. Older people are more likely to experience digital exclusion, with research suggesting several factors influencing digital engagement.

Objective:

To explore the barriers and facilitators older adults reported regarding their digital engagement.

Methods:

A cross-sectional population-based questionnaire was administered to adults aged 65+ to explore digital engagement and identify characteristics associated with digital exclusion. Optional free-text responses were analysed using the capability, opportunity, motivation and behaviour (COM-B) model and Theoretical Domains Framework (TDF) to examine barriers and facilitators influencing digital engagement. Comments were coded using deductive framework analysis across the TDF domains. Coding was undertaken by multiple researchers to ensure consistency, with discrepancies resolved through discussion. Domain-specific comments were narratively summarised to describe recurring patterns, similarities and differences in participants’ experiences of digital engagement.

Results:

1,114 survey participants provided free-text responses. Analysis identified barriers and facilitators across all TDF domains. The most prominent were Environmental context and resources, Beliefs about capabilities, Social influence, and Cognitive and interpersonal skills. Environmental context comments highlighted cost, poor connectivity, limited access to digital resources, and preferences for offline services as influencing digital engagement. Social support facilitated digital engagement but also highlighted concerns around dependency on others. Beliefs about capabilities focused on confidence in using technology and varied considerably. Perceived capability was influenced by familiarity, usability, and the ability to troubleshoot problems independently. Cognitive and interpersonal skills affected participants’ ability to learn and engage with digital technologies independently.

Conclusions:

This study highlights the complexity of factors influencing older adults’ digital engagement. Framed around the COM-B model, findings indicated that opportunity and motivation were discussed more frequently than capability. While access to technology remains important, digital inclusion also depends on confidence, perceptions of technology, social influences, and equitable access. Findings suggest that interventions should extend beyond improving access alone and adopt a multi-level approach to facilitating digital engagement amongst older people involving service designers, policymakers, health and social care professionals, and community organisations.