JMIR Publications

ABSTRACT

Background:

The transformation of digital health technologies has reshaped how healthcare is delivered, particularly in primary care. However, despite the advantages of these innovations, older adults remain among the most resistant users. Traditional technology adoption models may not fully capture the complexity of this reluctance, which is shaped not only by usability challenges but also by emotional, psychological, and identity-related concerns. Innovation Resistance Theory (IRT) offers a complementary framework focused on understanding barriers to adoption rather than solely on facilitators.

Objective:

To map and synthesize evidence on older adults’ resistance to digital health technologies in primary care through the lens of IRT, and to examine how empirically observed resistance factors align with, extend, or refine IRT’s functional and psychological barriers.

Methods:

A scoping review combined with concept-driven thematic synthesis was conducted. Empirical studies published between 2014 and 2025 were identified through systematic searches across five databases: PubMed, CINAHL, Ovid Medline, Web of Science, and Scopus. Inclusion criteria focused on studies examining barriers or resistance to digital health use among older adults aged 60 and above in primary care settings. The search was guided by terms related to “older adults”, “digital health”, “eHealth”, “telemedicine”, and “technology resistance”. After screening and reviewing the full texts, data were extracted into a structured matrix, and findings were organized according to the five dimensions of the IRT: usage, value, risk, tradition, and image barriers.

Results:

Of 4,976 identified records, seventeen studies met the inclusion criteria. Functional barriers included usability challenges, interface complexity, and age-related impairments. Psychological resistance was frequently linked to emotional discomfort, symbolic misalignment, and concerns about the loss of relational care. Value and risk concerns included distrust in diagnostics accuracy, concerns regarding privacy and data security, and skepticism about care quality. Traditional preferences for face-to-face interactions and generational digital divides further reinforced image-based resistance. A key finding was the interaction between barriers, where low self-efficacy and technology anxiety create feedback loops that reinforce avoidance behaviors.

Conclusions:

Resistance to digital health among older adults is not simply a lack of adoption but a complex, emotionally grounded process involving functional, psychological, and identity-based barriers. Interventions must go beyond technical usability to rebuild emotional trust, preserve the relational aspects of care, and align digital solutions with the values and expectations of older adults. Innovation Resistance Theory offers a comprehensive framework for understanding these multifaceted dynamics and serves as a valuable guide for policy development, user-centered design, and future research Clinical Trial: None