The usage divide of digital health technology in age-friendly home modifications: an ethnographic study among older adults in rural China

Within the framework of age-friendly home modifications for older adults in rural China, the application of digital health technologies must transcend the narrow assumption that access alone guarantees use, shifting instead toward a comprehensive perspective that spans the continuum from access to effective utilization. The <i>skills divide</i> represents a fundamental barrier that undermines operational competence, while the <i>motivation divide</i> shapes willingness and readiness to engage with technology. The <i>support divide</i> provides the external conditions necessary to sustain both skills and motivation, and the <i>persistence divide</i> captures the temporal dynamics through which these dimensions evolve. Collectively, this multidimensional and dynamic <i>usage divide</i> explains why older adults in rural areas often fail to achieve effective use even after gaining access. It also reveals the mechanisms that determine whether technological availability is ultimately transformed into genuine empowerment. These findings contribute empirical evidence to refine rural age-friendly modification policies, narrow disparities in digital health technology use, and advance the dual goals of healthy aging and digital inclusion.