Digital Inclusion Pathways and Influencing Factors Among Older Adults in Outpatient Settings: A Grounded Theory Study

Yulu Chen,1,* Qianyu Yin,2,* Tingting Zhou,3 Sijia Gu,4 Liling Xie,5 Mingzhao Xiao,5 Longqiong Wang,5 Qinghua Zhao5 1Daytime Medical Center, Women’s and Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 2Department of Nursing, The Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 3Department of Nursing, The Affiliated Hospital of Guizhou Medical University, Guizhou, People’s Republic of China; 4Department of Nursing, The First Branch of The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China; 5Center of Nursing Research, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Longqiong Wang, Center of Nursing Research, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86 138 8300 9509, Email [email protected] Qinghua Zhao, Center of Nursing Research, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of China, Tel +86 18602308866, Email [email protected]: Smart healthcare services in hospitals play a critical role in enhancing efficiency and quality. However, older adults often face varying degrees of challenges in accessing, adapting to, and using these technologies because of the effects of the Silver Digital Divide, including factors such as physical functioning, smart device access, and digital health literacy. This study aims to investigate the experiences, attitudes, and perceptions of older adults in outpatient regarding smart healthcare service in order to develop an explanatory digital inclusion pathway and construct a comprehensive path model for older adults.Patients and Methods: We conducted semi-structured interviews with 27 older adults in outpatients in Chongqing, China to understand their experiences, attitudes, and perceptions of attending smart healthcare services through theoretical sampling. Interviews were recorded, transcribed, and translated to English; content was analyzed based on grounded theory to examine the role of each influencing factor in relation to digital inclusion and modeling digital inclusion pathways. The stimuli–organism–response theoretical framework was used to guide path model construction.Results: Interview data of 27 older adults in outpatient settings were analyzed by exploratory interpretation, obtaining 79 initial concepts, 22 subcategories, seven main categories, and three dimensions, and constructing a theoretical model of the path of digital inclusion of older adults. Physical function, digital health literacy, personal perception, and digital attitudes demonstrated a direct impact on the digital inclusion of older adults. The support of smart devices, service scenario, social environments, and demographic attributes indirectly affect the digital inclusion of older adults.Conclusion: This study identifies five pathways to enhance older adults’ digital inclusion in outpatient smart healthcare, offering age-friendly insights for system design, medical service quality, and public health policy. These findings aim to bridge the silver digital divide, advance equitable healthcare transformation, and support the development of smart hospitals.Keywords: older adults, smart healthcare service, digital inclusion, path analysis, grounded theory