Invisible gaps: Socioeconomic inequalities in online health information seeking among older adults

Abstract Background As public health moves increasingly online, older adults risk being left behind - not only due to access barriers but also because of deeper differences in how health information is sought, trusted, and understood. This study examines how socioeconomic status, digital skills, and perceived trust shape online health information-seeking behavior (OHISB) among Estonians aged 50+, revealing critical gaps in digital health inclusion. Methods The study used a mixed-methods approach: qualitative data from focus groups and interviews with older adults (n = 28, aged 65+) and a national cross-sectional survey of adults aged 50 + (n = 501). The survey assessed OHISB frequency, source types, digital competence, trust in information, and socioeconomic background. Statistical analyses (χ², Spearman's rho) and thematic coding were applied. Results Participants with higher education and income reported more frequent OHISB and greater use of institutional websites, health portals, and credible sources (p < .001). Lower-income or less-educated respondents more often relied on general search engines, news media, or family and friends. Nearly half (47%) reported using only the first search results found online. Trust in information was closely linked to self-rated digital competence. Women preferred curated portals; men used Wikipedia and general searches (p < .01). Use of reliable sources was associated with greater COVID-19 vaccination readiness (ρ = .25, p < .001). Conclusions Older adults face not just a digital access divide, but a trust and skills divide that mirrors broader social inequalities. Public health strategies must address these disparities through targeted digital literacy efforts, simplified access to credible sources, and user-centered design that includes older people as co-creators of digital health environments. Key messages • Older adults’ access to credible online health information is shaped by education, income and digital confidence, creating invisible divides in public health equity. • To close digital health gaps, public health must invest in skills, trust-building and user-centred design tailored to older adults’ needs and contexts.