JMIR Publications

ABSTRACT

Background:

The potential benefits of incorporating digital technologies into health care are well documented. For example, virtual care technologies can improve access for patients with limited mobility and those living in remote or under-resourced locations. However, this may put people who are older and/or from socially deprived areas at risk of experiencing further health inequities.

Objective:

Explore factors influencing engagement with digital health technologies of people at the intersection of being older and socially deprived.

Methods:

We conducted semi-structured interviews with people with who were 70 years or older and/or living in a socially deprived area, with chronic kidney disease as the clinical context. We thematically analysed interview transcripts using the Unified Theory of Acceptance and Use of Technology as a theoretical framework.

Results:

We interviewed 26 participants, 13 of whom were both 70 years or older and living in a socially deprived area. Across participants, we identified two main themes from the interview data. The first showed that some individuals did not use digital health technologies due to a lack of engagement with digital technology in general. The second theme indicated that people felt that digital health technologies were ‘not for them.’ We identified the following key engagement factors, with the first two particularly impacting participants who were both older and socially deprived: lack of opportunities in the workplace to become digitally proficient; lack of appropriate support from family and friends; negative perceptions of age-related social norms about technology use; and reduced intrinsic motivation to engage with digital health technology because of a perceived lack of relevant benefits. Participants on the intersection of older age and social deprivation also felt significant anxiety around using digital technology and reported a sense of distrust towards digital health care.

Conclusions:

We identified factors that may have a more pronounced negative impact on the health equity of older people living in socially deprived areas compared to their counterparts who only have one of these characteristics. Successful implementation of digital health interventions therefore warrants dedicated strategies for managing the digital health equity impact on this group. Future studies should further develop these strategies and investigate their effectiveness, as well as explore the influence of related characteristics, such as educational attainment and ethnicity.