Barriers of digital health self-management in older adults with multimorbidity using a novel user-focused approach: a systematic review

Abstract An international ageing population places growing pressure on the ability of healthcare systems to support their needs. Digital Health Technologies (DHT) offer potential to support Older Adults with Multimorbidity (OAwM) in managing their health, yet this population remains underrepresented in digital health use. Despite advances in technology and investment, the age-related digital divide remains and continues to widen. To investigate this divide, this study identifies and examines the limitations of DHT from the perspective of OAwM. The systematic review followed the PRISMA guidelines. Seven databases were searched for articles published between 2013 and 2023, resulting in eight studies meeting the inclusion criteria. Eleven recurrent barriers were identified. Mapping these barriers to stages of OAwM’s interaction with DHT revealed that OAwM face greater challenges during the Pre-use phase compared to the In-use phase. This review highlights that OAwM face stage-specific barriers in DHT use, often arising from misalignment between technology design and users’ physical, cognitive, and contextual realities. The findings offer guidance for future DHT design, particularly in addressing challenges related to physical and cognitive limitations, low perceived value, lack of trust, and healthcare professionals’ support. This review provides new insights suggesting that research should shift focus upstream, emphasising adoption and onboarding rather than concentrating solely on post-adoption usability improvements. Future design approach should go beyond creating solutions for older adults. DHT should be developed with and from the perspective of OAwM, accounting for their unique needs and everyday contexts to support engagement and sustained use.