Based on capital theory to exploring the digital health divide and determinants among urban and rural older adults in China: Cross-sectional study

Background The rapid development of Information and Communications Technology has made eHealth a transformative force in healthcare. However, it has also exacerbated the “digital health divide.” While urban older adults benefit from easier access to digital health information and services, their rural counterparts face significant barriers in leveraging eHealth advantages. Objective Guided by capital theory, this study investigates the digital health divide and its determinants among urban and rural older adults. The findings aim to inform targeted interventions that promote digital health equity. Methods Exploring the digital health divide among urban and rural older adults in China: a cross-sectional study based on capital theory. Analysis of variance is used to validate the digital health divide among urban and rural older adults, while structural equation modeling examines contributing factors. Additionally, the Blinder-Oaxaca decomposition method identifies the primary drivers of these disparities. Results Three levels of the digital health divide exist among urban and rural older adults: digital access divide (F = 11.39, p < 0.01), digital usage divide (F = 39.53, p < 0.001), and digital outcome divide (F = 30.20, p < 0.001). The influence of these divides propagates along the digital chain, with digital access divide significantly affecting digital usage divide (β=0.060, p < 0.05) and digital usage divide further impacting digital outcome divide (β=0.363, p < 0.001). Among these, digital usage divide is the most pronounced, primarily driven by disparities in cultural capital (β=0.221, p < 0.001), social support (β=0.361, p < 0.001), economic capital (β=0.111, p < 0.01), and habits (β=0.248, p < 0.001). Blinder-Oaxaca decomposition further reveals that cultural capital (33.9%) and social capital (22.5%) are the key contributors to the urban–rural digital usage divide among older adults. Conclusion To address these divides among urban and rural older adults, interventions in policy, motivation, economy, culture, and society are recommended.