Previously submitted to: JMIR Aging (no longer under consideration since Sep 21, 2026)
Date Submitted: Sep 6, 2026
Open Peer Review Period: Sep 21, 2026 - Sep 21, 2026
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Urban–Rural Differences and Underlying Mechanisms of Digital Health Technology Use Among Older Adults With Chronic Diseases: A Qualitative Study Guided by the UTAUT Framework
ABSTRACT
Background:
China is experiencing rapid population aging, with rural areas facing particularly pronounced aging challenges. Chronic diseases substantially affect the health and quality of life of older adults, and digital health technologies have emerged as important tools for chronic diseases management. However, the urban–rural digital divide may further exacerbate inequities in healthcare services. Existing research has largely focused on general older populations, with limited attention to older adults living with chronic diseases and insufficient exploration of the contextual mechanisms contributing to urban–rural disparities in digital health technology use.
Objective:
This study aimed to compare urban–rural differences in digital health technology use among older adults with chronic diseases and explore how the constructs of the Unified Theory of Acceptance and Use of Technology (UTAUT) shaped digital health technology use across different contexts. It also sought to identify contextual factors beyond the UTAUT framework that contributed to digital health technology use.
Methods:
A qualitative study guided by the UTAUT framework was conducted. Using purposive sampling and maximum variation sampling, 18 older adults with chronic diseases from urban and rural communities in Beijing (8 urban participants and 10 rural participants) were recruited. Data were collected through semi-structured in-depth interviews until information saturation was achieved. Interview data were coded using NVivo 12 software and analyzed following a six-step thematic analysis approach. Comparative analysis was subsequently conducted to identify similarities and differences in digital health technology use between urban and rural participants.
Results:
(1) The use of different types of digital health technologies showed substantial heterogeneity among older adults with chronic diseases. Home-based health monitoring devices were the most commonly used technologies, followed by health education videos, whereas online medical platforms showed relatively limited adoption. (2) The four core UTAUT constructs demonstrated strong explanatory value for digital health technology use behaviors among older adults with chronic diseases in both urban and rural contexts. (3) Beyond the original UTAUT constructs, the analysis identified three additional contextual factors: technology acceptance attitudes, willingness to recommend, and accumulated digital skill capital.
Conclusions:
This study provided insights into the mechanisms underlying urban–rural disparities in digital health technology use among older adults with chronic diseases, and proposed an analytical framework that incorporates the characteristics of China’s urban–rural structure, thereby extending theoretical understanding of digital health technology adoption among aging populations. The findings offer empirical insights for developing age-friendly digital health interventions and tailored strategies to promote equitable access to healthcare services in diverse community settings. Clinical Trial: NA
Citation
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