"I'm still struggling with it, and it scares me": A qualitative analysis of older adults' experiences with digital health portals during and after COVID-19.

Objective: The scaling of digital health platforms, accelerated by the COVID-19 pandemic, has globally reshaped the delivery of healthcare services, presenting both opportunities and challenges. Ensuring equitable access, especially for digitally disadvantaged groups, is a critical concern, and this study explores older adults' perspectives on digital health platforms during and after the COVID-19 pandemic and examines their strategies for coping with the general challenges of the digitalization of health. Methods: A total of 77 older adults (aged at least 65), including both internet users and non-users, participated in 11 focus group sessions in Slovenia between September and December 2022. Hybrid thematic analysis was used to develop an understanding of the challenges confronted by older adults in the digital health landscape. Results: Three key themes emerged from the focus group sessions, which highlight digital inequalities that impact access to digital health platforms and their services: the challenges of digitalized health services, coping with these challenges, and the outcomes of health service digitalization. The "digital health paradox" is evident, in which opportunities are provided for some while access is limited for those unwilling or unable to use digital health platforms. Proxy users, often family or friends, help bridge this gap. Conclusions: Ensuring the availability and viability of traditional health service access is crucial for empowering older adults to choose between digital health platforms and alternatives. Recognizing the importance of traditional approaches is vital, and healthcare providers and policymakers should prioritize inclusivity to ensure a diverse and equitable healthcare system for older adults and vulnerable populations.

Determinants of the intention to use mHealth in the future: Evidence from an intervention study of patients with chronic diseases in Slovenia.

BACKGROUND: Mobile health (mHealth) implementation is crucial for developing sustainable healthcare systems, but it faces the challenge of user acceptance. Extending traditional acceptance models allows for the cognitive, emotional and social aspects of engaging with mHealth to be captured, creating a more comprehensive understanding of users' intentions to use it in the future. User-centred intervention studies based on users' real experiences with mHealth are essential for accurate assessments and for improving upon studies that rely merely on anticipated mHealth use. METHODS: An intervention study was conducted with 103 patients with at least one chronic condition (type 2 diabetes and/or arterial hypertension) who had used an mHealth service for three months. They were recruited through purposive sampling at a community health centre in Slovenia. Path analysis was applied to the survey data collected after a three-month testing period to validate an explanatory model with eight hypotheses. RESULTS: The intensity of mHealth use affected usability, which in turn affected acceptability, the psychosocial impacts of engagement with mHealth and intention for future use. The results showed that the intensity of mHealth use did not affect mHealth acceptability. Likewise, acceptability did not affect the psychosocial impacts of engagement with mHealth or the intention for its future use. Notably, perceptions of the psychosocial impacts of mHealth had no significant effect on the intention for future use. CONCLUSION: Usability and intensity of use play a central role in the post-intervention usage of mHealth, offering valuable insights for policymakers and healthcare providers involved in the delivery of mHealth-based treatment to patients with chronic diseases.