BACKGROUND Older adults with chronic diseases are key beneficiaries of digital health technologies, yet adoption remains inconsistent, particularly in rural areas and among certain demographic groups, such as older women. OBJECTIVE This systematic review aimed to identify barriers to and facilitators of digital health adoption among older adults with chronic diseases, with particular attention to rural-urban differences, co-design, and equity-relevant factors. METHODS This updated review built on a previously published review by extending the search to include PsycArticles, Scopus, Web of Science, and PubMed databases for studies published between April 2022 and September 2024. Gray literature from August 2021 onward was also included. Studies were eligible if they reported barriers to or facilitators of digital health adoption among adults aged ≥60 years with chronic diseases. Findings were mapped to the capability, opportunity, and motivation–behavior model and analyzed using the PROGRESS-Plus (place of residence; race, ethnicity, culture, and language; occupation; gender and sex; religion; education; socioeconomic status; and social capital–plus) equity framework. Quality was assessed using the Mixed Methods Appraisal Tool, and all results are reported in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS In total, 12 studies from the original review were retained, with 17 new peer-reviewed studies added, yielding a total of 29 studies in addition to 30 documents identified in the gray literature search. Barriers included limited digital literacy and physical and cognitive challenges (capability); infrastructural deficits and usability challenges (opportunity); and privacy concerns, mistrust, and high satisfaction with existing care (motivation). Facilitators included tailored training and accessible design (capability), health care provider endorsement and hybrid care models (opportunity), and recognition of digital health benefits (motivation). Health care providers emerged as both facilitators and barriers, positively influencing adoption when engaged and trained but hindering it when lacking confidence or involvement. Comparative analysis of rural and urban contexts was limited by inconsistent reporting of equity-relevant variables. However, gray literature suggested that rural users face additional infrastructural challenges but express higher satisfaction with local care, potentially reducing motivation for digital uptake. Gender differences were observed in 5% (3/59) of the peer-reviewed studies and gray literature sources, with older women showing lower adoption and differing outcome priorities. Co-design enhanced adoption, especially when involving not just older adults but also health care providers and community stakeholders. CONCLUSIONS Digital health adoption among older adults is shaped by capability, opportunity, and motivation factors. Effective and equitable digital health strategies must address infrastructural and literacy barriers, engage health care providers through training and co-design, and ensure multistakeholder involvement. This review highlights that greater attention to standardized reporting of demographic variables, especially gender and rurality, is essential in digital health research to support inclusive implementation. CLINICALTRIAL PROSPERO International Prospective Register of Systematic Reviews CRD42024586893; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024586893 INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.3399/bjgp25X742161
Hepburn et al. (Wed,) studied this question.