JMIR Publications

ABSTRACT

Background:

Older adults with chronic disease are key beneficiaries of digital health technologies, yet adoption remains inconsistent, particularly in rural areas and among certain demographic groups, such as older women who are less likely to engage with digital health compared to men.

Objective:

This systematic review aimed to identify barriers and facilitators to digital health adoption among older adults with chronic disease, with particular attention to rural-urban differences, co-design, and equity-relevant factors.

Methods:

This updated review builds on a previously published review by extending the search to include PsycArticles, Scopus, Web of Science, and PubMed for studies published between April 2022 and September 2024. Grey literature from August 2021 onward was also included. Studies were eligible if they reported barriers and/or facilitators to digital health adoption among adults aged 60+ with chronic disease. Findings were mapped to the Capability, Opportunity, and Motivation Model of Behaviour (COM-B) and analysed using the PROGRESS-Plus equity framework. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT), and all results are reported in line with PRISMA guidelines.

Results:

Twelve studies from the original review were retained, with 17 new peer-reviewed studies added, yielding a total of 29 studies, in addition to 30 documents identified in the grey literature search. Barriers identified included limited digital literacy, physical and cognitive challenges (Capability), infrastructural deficits and usability challenges (Opportunity), and privacy concerns, mistrust, and high satisfaction with existing care (Motivation). Facilitators included tailored training and accessible design (Capability), provider endorsement and hybrid care models (Opportunity), and recognition of digital health benefits (Motivation). Healthcare providers emerged as both facilitators and barriers—positively influencing adoption when engaged and trained but hindering it when lacking confidence or involvement. Comparative analysis of rural and urban contexts was limited by inconsistent reporting of equity-relevant variables. However, grey literature suggested rural users face additional infrastructural challenges but express higher satisfaction with local care, potentially reducing motivation for digital uptake. Gender differences were observed in three peer-reviewed studies and grey sources, with older women showing lower adoption and differing outcome priorities. Co-design enhanced adoption, especially when involving not just older adults but also healthcare providers and community stakeholders.

Conclusions:

Digital health adoption among older adults is shaped by capability, opportunity, and motivation factors. Effective and equitable digital health strategies must address infrastructural and literacy barriers, engage healthcare providers through training and co-design, and ensure multi-stakeholder involvement. This review highlights that greater attention to standardised reporting of demographic variables, especially gender and rurality, is essential in digital health research to avoid one-size-fits-all approaches and support inclusive implementation. Clinical Trial: Not applicable