Bridging the Digital Divide in Health for Older Adults: A Repeated Cross-Sectional Study of mHealth in Saudi Arabia

The COVID-19 pandemic significantly accelerated the adoption of mobile health (mHealth) applications, reshaping healthcare delivery while exposing critical barriers to usability and accessibility for older adults in Saudi Arabia. This study examines these challenges during and after the pandemic using a repeated cross-sectional design, focusing on issues such as limited digital literacy, accessibility concerns, and the evolving role of mHealth applications. To capture these dynamics, an initial survey (<italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">n</i> = 397) was conducted during the pandemic to understand how families of older adults navigated mHealth applications under mandatory usage requirements. This was complemented by direct interviews (<italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">n</i> = 5) and unstructured observations of real-world interactions to provide a nuanced view of older adults’ experiences. To evaluate the long-term impact of mHealth adoption post-pandemic, a second survey (<italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">n</i> = 129) was conducted, accompanied by a review of 21 mHealth applications. The findings reveal persistent barriers that hinder independent use, exacerbate reliance on others, and deepen digital inequities. These challenges highlight systemic design and infrastructure shortcomings that undermine equitable access. At the same time, the study highlight the role of families in bridging these gaps, fostering collaboration, and enabling older adults to access digital healthcare. As mHealth applications become integral to healthcare ecosystems, this study calls for the development of inclusive, user-centered designs and targeted interventions to enhance digital literacy, reduce disparities, and empower older adults in accessing equitable healthcare.