Awareness, want, and adoption of digital health services among older adults in China: a cross-sectional study

Background: Population ageing is increasing the demand for chronic disease management, long-term care, and continuous health services, and has become a major public health challenge. This issue is particularly salient in China, where by 2020 adults aged 60 years and older and 65 years and older accounted for 18.70% and 13.50% of the total population, respectively, while digital health services have expanded rapidly. However, older adults do not automatically benefit from digital transformation, and the digital divide remains widespread. Clarifying the key discontinuities in older adults' progression from awareness to want and actual adoption of digital health services is important for promoting digital health equity. Methods: This cross-sectional survey used systematic sampling to recruit 451 patients aged 60 years and older with chronic diseases from tertiary hospitals in Jinan, Shandong. Based on a three-stage framework of awareness, want, and adoption, matrix analysis of the awareness-want-adoption gap was used to examine the digital divide across three functional dimensions of digital health services: access to medical information, convenient medical services, and online health management. A structural equation model was further developed to examine the effects of eHealth literacy, patient activation, and health status on digital health service use. Results: Older adults showed a pattern of relatively high awareness and want but low actual adoption of digital health services. Overall awareness and want rates were 45.60% and 46.27%, respectively, whereas the adoption rate was only 18.27%. Among the three functional dimensions, online health management had the lowest adoption rate (8.87%) and the largest usage gap (75.23%). Structural equation modeling further showed that eHealth literacy was an important determinant of digital health service use and was significantly associated with both behavioral intention and actual adoption. Conclusion: The main challenge in digital health service use among older adults lies not only in service availability, but also in the marked discontinuity between awareness and actual adoption. Promoting digital health equity for older adults requires interventions targeting barriers in specific functional domains, particularly online health management, while also improving eHealth literacy, accessibility, and usability.