Barriers to and Facilitators of Older People's Engagement With Web-Based Services: Qualitative Study of Adults Aged >75 Years.

BACKGROUND: The COVID-19 pandemic has accelerated the shift toward the digital provision of many public services, including health and social care, public administration, and financial and leisure services. COVID-19 services including test appointments, results, vaccination appointments and more were primarily delivered through digital channels to the public. Many social, cultural, and economic activities (appointments, ticket bookings, tax and utility payments, shopping, etc) have transitioned to web-based platforms. To use web-based public services, individuals must be digitally included. This is influenced by 3 main factors: access (whether individuals have access to the internet), ability (having the requisite skills and confidence to participate over the web), and affordability (ability to pay for infrastructure [equipment] and data packages). Many older adults, especially those aged >75 years, are still digitally excluded. OBJECTIVE: This study aims to explore the views of adults aged >75 years on accessing public services digitally. METHODS: We conducted semistructured qualitative interviews with a variety of adults aged ≥75 years residing in Greater Manchester, United Kingdom. We also interviewed community support workers. Thematic analysis was used to identify the key themes from the data. RESULTS: Overall, 24 older adults (mean age 81, SD 4.54 y; 14/24, 58% female; 23/24, 96% White British; and 18/24, 75% digitally engaged to some extent) and 2 support workers participated. A total of five themes were identified as key in understanding issues around motivation, engagement, and participation: (1) "initial motivation to participate digitally"-for example, maintaining social connections and gaining skills to be able to connect with family and friends; (2) "narrow use and restricted activity on the web"-undertaking limited tasks on the web and in a modified manner, for example, limited use of web-based public services and selected use of specific services, such as checking but never transferring funds during web-based banking; (3) "impact of digital participation on well-being"-choosing to go to the shops or general practitioner's surgery to get out of the house and get some exercise; (4) "the last generation?"-respondents feeling that there were generational barriers to adapting to new technology and change; and (5) "making digital accessible"-understanding the support needed to keep those engaged on the web. CONCLUSIONS: As we transition toward greater digitalization of public services, it is crucial to incorporate the perspectives of older people. Failing to do so risks excluding them from accessing services they greatly rely on and need.

Eliciting perspectives on remote healthcare delivery from service users with psychosis in the community: a cross-sectional survey study.

Introduction: The transition towards remote healthcare has been rapidly accelerated in recent years due to a number of factors, including the COVID-19 pandemic, however, few studies have explored service users' views of remote mental healthcare, particularly in community mental health settings. Methods: As part of a larger study concerned with the development of a remotely delivered psychosocial intervention, a survey was conducted with service users with psychosis (N = 200) from six NHS trusts across England to gain cross-sectional data about service users' opinions and attitudes towards remote interventions and explore how digital access varies across different demographic groups and geographical localities. Results: The majority of service users had access to technological devices and a quiet space to receive care. Age was a key factor in motivation to engage with remote care as older participants had less access to technological devices and the internet, and reported less confidence to learn how to use new technologies compared to younger participants. Differences in access and attitudes towards remote care were found across the different geographical localities. Over half of the participants (53.1%) preferred a hybrid model (i.e., mixture of face-to-face and remotely delivered treatment), with only 4.5% preferring remote treatment exclusively. Factors that both encourage and deter service users from engaging with remote care were identified. Conclusions: The findings of this study provide important information about the environmental and clinical barriers that prevent, or limit, the uptake of remotely delivered care for people with psychotic disorders. Although service users often have the ability and capacity to receive remote care, providers need to be cognisant of factors which may exacerbate digital exclusion and negatively impact the therapeutic alliance.

Digital inclusion: A mixed-method study of user behavior and content on Twitter.

Objective: This study is the first to explore user behavior and characterize the content shared about digital inclusion on Twitter. Methods: This mixed-methods research consists of 14,000 tweets featuring the hashtag "#digitalinclusion," posted on Twitter over 15 months. A machine learning technique, latent Dirichlet allocation, was utilized to discover abstract topics within the tweets statistically. The algorithm identified important keywords and text associated with each topic by modeling the underlying word co-occurrence patterns in the dataset. A manual qualitative content analysis was applied to the qualitative data (1000 tweets). Results: Tweets containing #digitalinclusion are driven by four motives: 1) warning against the risks of digital exclusion; 2) tweets that promote actions to increase digital inclusion; 3) tweets that call for others to take action to improve digitalization; and 4) tweets that are neutral but fuel the debate by being active. Quantitative analysis revealed that users discussing digital inclusion come from various continents, including the USA, Europe, Africa, and Asia. There were 3931 unique user accounts, with individuals posting between one and 368 tweets. Approximately half of the tweets contained some embedded media. Conclusion: The study concludes that digital inclusion is a subject that engages Twitter users worldwide. Tweets that were associated with community and local initiatives and sustainable development had the highest engagement in terms of the number of retweets and likes. The interpretation is that digital inclusion is crucial for achieving equity in living conditions and enhancing access to health information and services. While initiatives to increase digital inclusion are underway, Twitter users call for more efforts to prevent growing digital exclusion. Twitter, as a social media platform, is valuable for studying the motivations that drive digital inclusion and help counter digital exclusion.

The age-based digital divide in an increasingly digital world: A focus group investigation during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Previous research has identified numerous benefits of information and communication technology (ICT) on the well-being of older adults. However, it has been increasingly recognized that older adults do not necessarily catch up with the rapidly digitalized society, known as the 'age-based digital divide'. The progress of digitalization has been accelerated during the COVID-19 pandemic, which may have widened the digital divide. This study aimed to gain a better understanding of their living experience and concerns about digital exclusion during the pandemic. The perceptions of older adults in Hong Kong, a highly digitalized, metropolitan city, towards the digital age and its impact on their daily living during the COVID-19 pandemic were explored. RESEARCH DESIGN AND METHODS: We conducted 12 focus group interviews with 77 community-dwelling older adults during the COVID-19 pandemic. Data were analyzed using thematic analysis, applying both organization, reduction, and refinement. RESULTS: Four themes were identified: 1) Diversified means to access community information; 2) Facilitated daily living through the usage of ICTs; 3) Concerns about age-related decline in function; and 4) Fear of digital exclusion and accelerated digitalization during the pandemic. The results indicate that ICT provided numerous benefits to the daily life of older adults, but our participants also expressed concerns about age-related losses and the fear of digital exclusion due to the ongoing digitalization of society. DISCUSSION AND IMPLICATIONS: Our findings indicated that older adults do not necessarily benefit from technological innovations, which are becoming more pervasive during the pandemic. To create age-friendly environments that cater to the needs of all members of society in the digital age, policymakers and service providers should provide diverse choices for older adults, rather than relying solely on one-size-fits-all technological solutions.

A multicentre cross-sectional observational study to determine the effect of living with frailty on digital exclusion from video consultations: (Access-VIGIL).

OBJECTIVES: Many older people regularly access digital services, but many others are totally excluded. Age alone may not explain these discrepancies. As health care services offer more video consultations, we aimed to determine if living with frailty is a significant risk factor for digital exclusion in accessing video consultations, and if this changes if a person has a support network to help with access. DESIGN: We undertook a muticenter cross-sectional survey across South West England. SETTING AND PARTICIPANTS: Patients in primary care, hospital at home, and secondary care services were enrolled between February 21 and April 12, 2022. METHODS: The primary outcome was complete digital exclusion defined as no individual access or network support access to video consultations. Secondary analysis looked at the person's digital exclusion when ignoring any network support. The association between frailty and outcomes was analyzed with logistic regression. In addition, older people's digital skills, motivation, and confidence were examined. RESULTS: 255 patients were included in the analysis. The median age was 63 years (interquartile range 43-77) with 148 (57%) women. Complete digital exclusion was rare (5.1%). Only 1 of 155 who were not frail (Clinical Frailty Scale 1-3) experienced complete digital exclusion compared with 12 of 99 (10.7%) who were living with frailty (Clinical Frailty Scale 4-8). There was no association between frailty and complete digital exclusion. Frailty was associated with individual digital exclusion when no network support was available to assist. CONCLUSIONS AND IMPLICATIONS: When taking into account a person's support network, complete digital exclusion from video consultation was rare. When no support network was available, frailty was associated with individual digital exclusion. Health care services should ask about a person's support network to help people living with frailty access video consultations.

Greater Patient Than Staff Satisfaction Scores for Electronic Consent.

Background Informed consent is essential for surgical procedures, and using electronic consent (e-consent) has many benefits, including improved patient understanding and digitally enabled care. Following e-consent implementation at Princess Alexandra Hospital NHS Trust, Harlow, UK, we aimed to compare staff and patient satisfaction scores for the first time. Methodology Voluntary feedback was obtained via online questionnaires for patient and staff users. Average satisfaction scores were calculated, and comments were analysed using grounded theory and thematic analysis. Results Eight hundred and fifty-three counts of patient feedback and 36 counts of staff feedback were received. An average rating of e-consent for patients was 4.5 out of 5 and for staff was 2.8 out of 5. Fifty-one percent of patient comments and 25% of staff comments were positive. The main themes identified were information for patients, digital concerns, user experience, and functionality. There were conflicting positive and negative views from both groups within these themes. Conclusions E-consent enables informed consent for procedures, with greater satisfaction amongst patients than staff. The main factor that was appreciated by patients and staff is the ability of e-consent to facilitate fully informed consent.

Relationship between digital exclusion and cognitive impairment in Chinese adults.

Objective: We aimed to evaluate the relationship between digital exclusion, such as neither mobile payments nor WeChat use, and cognitive impairment in Chinese individuals aged 45 and older. Methods: A population-based cross-sectional study utilizing data from the fourth national survey of the China Health and Retirement Longitudinal Study (CHARLS). In the fourth wave of CHARLS, 10,325 participants aged 45 and older with complete information were included in this analysis. Self-reported mobile payments and WeChat usage constituted our exposure. Cognitive impairment was the primary outcome. Univariate and multivariate logistic regression were used to assess the relationships between cognitive impairment risk and digital exclusion. Results: Data were analyzed from 10,325 participants [mean (SD) age, 60.3 (9.1) years; 44.8% women], including 1,232 individuals with cognitive impairment and 9,093 cognitively normal individuals. The overall proportion of users who did not use either mobile payment or WeChat and those who only used WeChat were 81.3 and 6.7%, for cognitively impaired individuals 95.0 and 3.1%, and for cognitively normal individuals 79.5 and 7.2% [neither WeChat nor mobile payments vs. control unadjusted odds ratio (OR), 8.16; P < 0.001; only WeChat use vs. control unadjusted OR, 2.91; P < 0.001]. Participants who did not use either WeChat or mobile payments had an elevated risk for cognitive impairment after adjusting for a number of covariates (neither WeChat nor mobile payments vs. control adjusted OR, 3.48; P < 0.001; only WeChat use vs. control adjusted OR, 1.86; P = 0.021). Conclusion: Our study reveals a positive correlation between digital exclusion and cognitive impairment in Chinese adults, providing insights for promoting active digital integration among older adults. Further longitudinal research is needed to further validate this hypothesis.

Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study.

BACKGROUND: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults' capabilities of getting the services they need. Research on the predictors of older adults' internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. OBJECTIVE: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. METHODS: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. RESULTS: Those who had poor near (odds ratio [OR] 1.90, 95% CI 1.36-2.66) or distant vision (OR 1.81, 95% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95% CI 1.57-3.02) or distant vision (OR 2.14, 95% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. CONCLUSIONS: According to our results, older adults' impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly.

Ageing and Keeping Pace with Technology: A Grounded Theory Study on Blind Adults' Experiences of Adapting to New Technologies.

This study investigated blind adults' experiences of adapting to digital technologies. The authors' focus was on how they have been experiencing changes implied by digital transformation, which provided the starting point for assessing their prospects and/or limitations for self-development through new technologies in the future. The second point concerned designing technologies for blind adults by adding questions about their specific needs and expectations for digital device designers. To develop these main issues, we planned a qualitative grounded theory study in which 16 blind adults were individually interviewed. It aimed to provide rich descriptions of a selected phenomenon. The research analysis was conducted by using the sociological and philosophical methods, which provided insights into the social assessment of digital development for ageing by blind adults. The data analysis revealed five distinct categories that captured these experiences and expectations: (1) wishing to learn-"Digital technology gives me privacy and independence"; (2) having to learn-"If you do not have new digital devices or do not know how to use them, you end up on the margins of society"; (3) being socially excluded-"Designers of new technologies do not think about blind adults"; (4) fearing to stop understanding-"Technological development is too rapid, it is difficult to be on time while ageing"; and (5) waiting for the changes-"I hope my situation will change in the future". Together, these five categories form the basis of the core category "Ageing and keeping pace with technology", which encapsulates the initial adaptation experiences of the interviewees to the technological development. The findings indicate that the blind adults experienced digital devices as tools for improving their well-being, but they also saw them as posing the threat of being socially excluded because of new technology designs and accessibility barriers.

Digital exclusion as a potential cause of inequalities in access to care: a survey in people with inflammatory rheumatic diseases.

Objectives: COVID-19 led to rapid uptake of digital health care. We sought to examine digital access, health and digital literacy, and impact on confidence and satisfaction with remote consultations in people with inflammatory rheumatic diseases (IRDs). Methods: People with IRDs (n = 2024) were identified from their electronic health record and invited to participate in a cross-sectional survey, using short message service (SMS) and postal approaches. Data were collected on demographics, self-reported diagnosis, access to and use of internet-enabled devices, health and digital literacy, together with confidence and satisfaction with remote consultations. Ethical approval was obtained (Ref 21/PR/0867). Results: Six hundred and thirty-nine (639) people completed the survey [mean (s.d.) age 64.5 (13.1) years, 384 (60.1%) female]. Two hundred and eighty-seven (44.9%) completed it online. One hundred and twenty-six (19.7%) people reported not having access to an internet-enabled device. Ninety-three (14.6%) reported never accessing the internet; this proportion was highest (23%) in people with RA. One hundred and seventeen (18%) reported limited health literacy. Even in those reporting internet use, digital literacy was only moderate. People with limited health or digital literacy or without internet access were less likely to report confidence or satisfaction with remote consultations. Conclusion: Limited health and digital literacy, lack of digital access and low reported internet use were common, especially in older people with RA. People with limited health literacy or limited digital access reported lower confidence and satisfaction with remote consultations. Digital implementation roll-out needs to take account of people requiring extra support to enable them to access care digitally or risks exacerbating health inequalities.

Digital exclusion and functional dependence in older people: Findings from five longitudinal cohort studies.

Background: Older people are more likely to be excluded from the digital world, and this has been linked to poor health outcomes. The extent and direction of the influence of digital exclusion on functional dependency is, however, not well understood. We aimed to investigate the association between digital exclusion and functional dependency among older adults from high-income countries (HICs) and low- and middle-income countries (LMICs). Methods: In this multicohort study, we pooled individual-level data from five longitudinal cohort studies that included nationally representative samples of older adults across 23 countries, including the Health and Retirement Study (HRS), the English Longitudinal Study of Aging (ELSA), the Survey of Health, Ageing and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). The digital exclusion was recorded as an absence from internet use by self-reported. We assessed basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and we used interval-of-need methods to categorize the functional dependency. We applied generalized estimating equations models fitting Poisson model to investigate the association of digital exclusion with difficulties in BADL or IADL and functional dependency, adjusting for the causal-directed-acyclic-graph (DAG) minimal sufficient adjustment set (MSAS), including gender, age level, labour force status, education, household wealth level, marital status, and co-residence with children. Findings: We included 108,621 participants recruited between 2010 and 2018 with a median follow-up of 3 phrases. Digital exclusion in older adults varied across countries, ranging from 23.8% in Denmark (SHARE) to 96.9% in China (CHARLS). According to the crude model, digital exclusion was significantly associated with functional dependency. In the MSAS-adjusted model, those associations remained statistically significant: HRS (incidence rate ratio [IRR] = 1.40, 95% confidence interval [CI] 1.34-1.48 for BADL; 1.71 [1.61-1.82] for IADL), ELSA (1.31 [1.22-1.40] in BADL and 1.37 [1.28-1.46] in IADL), SHARE (1.69 [1.61-1.78] in BADL and 1.70 [1.63-1.78] in IADL), CHARLS (2.15 [1.73-2.67] in BADL and 2.59 [2.06-3.25] in IADL), and MHAS (1.15 [1.09-1.21] in BADL and 1.17 [1.09-1.25] in IADL). In the subgroup analyses, the associations were more pronounced in the oldest-old (aged ≥ 80 years old). Interpretation: There is a substantial proportion of older adults who are excluded from the Internet, especially those in LMIC. Older people excluded from the Internet regardless of whether they live in HICs or LMICs are more likely to develop functional dependency. It should be made a priority to remove barriers to Internet access in order to assist older people in maintaining their independence and, consequently, to reduce the care burden associated with the ageing population worldwide. Funding: The National Natural Science Foundation of China (No. 71904004).

Disconnected in a pandemic: COVID-19 outcomes and the digital divide in the United States.

The COVID-19 pandemic has exacerbated inequalities related to the digital divide. With wide adoption of remote working and learning, telehealth, and virtual events and social activities, the technology have-nots and know-nots experienced substantial marginalization and elevated risks of COVID-19 exposure in daily lives. This study discusses the pathways through which digital exclusion could aggravate the impacts of the pandemic and explored the linkage between digital access and COVID-19 outcomes in U.S. counties. It finds that counties with higher percentages of digitally excluded populations have seen higher COVID-19 case and death rates throughout the pandemic and lower vaccination rates by January 2022.

Ageism in healthcare technology: the older patients' aspirations for improved online accessibility.

Objective: To identify concerns, barriers and facilitators impacting the use of patient portals by older patients as well as desired features in future updates. Materials and Methods: This is a cross-sectional study consisting of 2 focus group discussions culminating in an anonymous survey administered to women who were 65 years and older receiving urogynecologic care in Northwest Ohio. Results: Of the 205 women surveyed (91% response rate), providers and healthcare systems play the primary 2 roles (73% and 69%, respectively) in facilitating patients' use of patient portal systems and telehealth applications. Barriers to use revolved around technical difficulties (50%), privacy concerns (45%), and cost of technology (24%). The most important features desired were the ability to modify the text size within the application (47%) and an intuitive, simple interface (46%). Additional assistance for navigating technical challenges was suggested, specifically set-up of accounts (36%), saving and sharing information with caregivers (35%), and sign-in and navigation of portals (32%). Conclusion: The paucity of age-aligned medical access software and products may lead to worsening of digital exclusion and disparities in healthcare. Portal application developers and healthcare systems must advance efforts that consider the needs of those who may be older when designing patient portals.

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review.

BACKGROUND: Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed. OBJECTIVE: This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms. METHODS: Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including "gray literature," to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups. RESULTS: A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed. CONCLUSIONS: Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910.

Self-efficacy and Use of Digital Health Care and Social Welfare Services Among Incarcerated People: Cross-sectional Survey Study.

BACKGROUND: The digitization of health care and social welfare services creates many opportunities for the rehabilitation of incarcerated people and their preparation for release from prison. A range of digital platforms and technology solutions have been developed that offer multiple opportunities to handle private matters either by video conference, email, or some other digital format during imprisonment. However, incarcerated people have limited access to digital health care and social welfare services, and face challenges related to shortcomings in their digital skills and self-efficacy. OBJECTIVE: This article assessed the significance of incarcerated people's self-efficacy in terms of their sense of control over the use of digital health care and social welfare services. METHODS: A cross-sectional study was conducted using a questionnaire. Research data were collected from 11 prisons in different parts of Finland, and a total of 225 incarcerated people responded to the survey. Statistical analyses were conducted using the Pearson product-moment correlation coefficient, 2-tailed t test, linear regression analysis, and Hayes bootstrapping method. RESULTS: The results showed the significance of both general and internet-specific self-efficacy, which appear to be more important for the use of digital health care and social welfare services than factors related to a person's socioeconomic background or sentence. Age was negatively correlated with perceived control over the use of digital health care and social welfare services. Furthermore, the study emphasized the importance of support from family and friends, as well as prison employees. CONCLUSIONS: The digitalization of prisons offers many opportunities, but special consideration should be given to how the digitization of health care and social welfare services responds to the needs of incarcerated people in terms of their integration into society and the prevention of recidivism. During imprisonment, attention should be paid to strengthening the digital skills of incarcerated people, with support provided by prison employees. In addition to providing guidance on the use of individual digital services, the study recommends strengthening the general digital skills of incarcerated people, as well as developing their life management skills.

Elderly Forgotten? Digital Exclusion in the Information Age and the Rising Grey Digital Divide.

Background: Information and Communication Technology (ICT) is being spread at an unprecedented rate across the globe. Yet, new research suggests that digital divide is not only continuing but also deepening at the same time. After access to basic ICT equipment, it is now the lack of skills and quality of hardware and software that leads to a continuing digital divide. Digital divide which is specifically related to elderly is known as grey digital divide. Objectives: The focus of this paper is to review and analyze recent relevant research on grey digital divide which is fast emerging as a major challenge in the era of ageing. A side objective is to raise implications for theory and practice discourses to minimize grey digital divide. Method: Literature on digital divide and grey digital divide is reviewed to gather relevant knowledge on the grey digital divide. The articles were filtered according to the relevance for grey digital divide in the present age. Literature review spanned over a 5 years' timeline to discuss the current trends on the topic. Results: Results indicate a rising problem of ageing, mainly in developed countries. Grey digital divide constitutes a major challenge for elderly to participate and benefit from the digital revolution. Elderly face problems for basic tasks such as booking tickets or renewing bus cards to claiming old-age benefits because most of the systems are digitized. Another challenge is the social exclusion faced by elderly because they cannot connect with peers through digital networks due to lack of digital skills. This situation is also observed in developing countries, although in developing countries elderly get immediate help from family members due to the family system of joint living. Implications and future directions: A practical implication of this research can be a full-scale fieldwork in different countries of the world to further understand the grey digital divide. Joint collaboration between ICT and healthcare industry may result in revolutionizing of ergonomic ICT products and services which are elderly-friendly. It would be interesting to know how culture impacts grey digital divide across various countries.

The role of age and digital competence on the use of online health and social care services: A cross-sectional population-based survey.

OBJECTIVE: Online health and social care services are getting widespread which increases the risk that less advantaged groups may not be able to access these services resulting in digital exclusion. We examined the combined effects of age and digital competence on the use of online health and social care services. METHODS: We used a large representative population-based sample of 4495 respondents from Finland. Paper-based self-assessment questionnaire with an online response option was mailed to participants. The associations were analyzed using survey weighted logistic regression, exploring potential non-linear effects of age and controlling for potential sex differences. RESULTS: Higher age, starting from around the age of 60 was associated with a lower likelihood of using online services for receiving test results, renewing prescriptions and scheduling appointments. Good digital competence was able to hinder the age-related decline in online services use, but only up to around the age of 80. CONCLUSIONS: Our results suggest that older adults are at risk of digital exclusion, and not even good digital competence alleviates this risk among the oldest. We suggest that health and social care providers should consider older users' needs and abilities more thoroughly and offer easy to use online services. More digital support and training possibilities should be provided for older people. It is equally important that face-to-face and telephone services will be continued to be provided for those older people who are not able to use online services even when supported.

Life after lockdown: The experiences of older adults in a contactless digital world.

Introduction: The digital response to the Coronavirus (COVID-19) pandemic and its effects on the lives of older adults has been well-documented, but less is known about how they experienced the post-lockdown re-emergence into a relatively contactless digital society. Methods: We report the findings from a qualitative survey (n = 93) and subsequent interviews (n = 9) with older adults aged 50+, where they describe their struggles with some of the newly implemented digital interactions. These struggles cover a range of settings but include using contactless payments, QR codes and apps to facilitate transactions in cafes, bars, and restaurants. Results: A thematic analysis of our data revealed the intrinsic (e.g. digital literacy) and extrinsic (e.g. malfunctioning technology) factors that limited social inclusion for these participants, and that sometimes even led to moments of public humiliation. Discussion: Our findings shed light on some of the motivational factors that underpin the age-related digital divide, whilst also highlighting the role of self-directed agism in limiting motivations to learn new digital routines.

The experiences of socially vulnerable groups in England during the COVID-19 pandemic: A rapid health needs assessment.

OBJECTIVES: This rapid health needs assessment was undertaken to urgently identify the needs of socially vulnerable groups arising during the first wave of cases of the COVID-19 pandemic in England. The objective was to develop recommendations for policy makers and stakeholders to mitigate adverse impacts on socially vulnerable groups throughout the COVID-19 response and recovery period. STUDY DESIGN: Rapid health needs assessment. METHODS: The needs assessment employed qualitative methods to systematically collect data about the knowledge and views of key informants through semi-structured interviews and focus groups. Participants were either topic experts providing services to socially vulnerable groups who routinely face barriers to healthcare access or experts by experience. Participants included people experiencing homelessness, sex workers, people from Gypsy, Roma and Traveller communities and people facing challenges due to their immigration status. Data was collected over a week period in April/May 2020 and followed by thematic analysis to examine interview transcripts. RESULTS: Forty-two participants were included in the study, half of whom were experts by experience. Challenges with accessing and following COVID-19 information and government guidance were described as affecting all groups, due to exclusion from digital technology, translated resources, tailored support and adequate housing. Altered delivery of healthcare services, such as the closure of outreach and drop-in services, remote consultations, and online patient registration, were noted by interviewees as worsening existing barriers to accessing healthcare. Being charged for NHS care remained a key fear for migrants. All groups' access to income, education and social support were reported as being impacted by service closures and job losses, putting them at higher risk of destitution. Isolation, loneliness and deteriorating mental health were frequently reported. CONCLUSIONS: This assessment has highlighted the disproportionate impact of the COVID-19 pandemic on socially vulnerable groups and demonstrated a plethora of unmet needs. As the effects of COVID-19 continue, it is imperative that the needs of these groups are urgently and explicitly addressed and prioritised. This is essential to promote engagement with test and trace services, enable isolation adherence, and achieve high vaccine uptake in socially vulnerable populations.

Commentary: Technology, power and inequalities - achieving a humane approach to the digital divide - a commentary on Aboujaoude and Gega (2021).

This paper provides a critical reflection on how a myopic focus by researchers on internet addiction as a possible explanation for children's behaviour has led to a missed opportunity to probe the impact of digital exclusion for children with a range of complex vulnerabilities. Holt reflects upon the work of Aboujaoude and Gega (2021), Missing the forest for the trees: How the focus on digital addiction diverted attention away from wider adverse effects. Screen time is far more complex; it's use in child protection as a form of surveillance is linked to poverty, inequality and risk. Importantly, the focus of international research must explore both digital exclusion and how this can be managed, and the increased use of digital surveillance, to provide an important lens in respect of power and inequalities in society.