Digital exclusion and its perceived barriers among elderly patients in healthcare scenarios: a qualitative study

This study aimed to explore experiences of digital exclusion and their perceived contributing factors among elderly patients in digital healthcare scenarios of medical institutions and to provide a theoretical basis and practical guidance for the development of age-friendly intervention strategies. This qualitative study was conducted at a tertiary general hospital in Shandong Province. A purposive sampling method was used to enrol elderly patients aged 60 years and older who had attempted or been required to use digital medical services but could not complete them independently and needed assistance. Face-to-face semistructured in-depth interviews were conducted. Interview data were transcribed and analysed using the Colaizzi seven-step method with the support of NVivo 15.0 software. The sample size was determined by the principle of data saturation. A total of 16 elderly patients (mean age = 70.19 years) were interviewed until data saturation was achieved. Five core themes and 11 subthemes were extracted: physical barriers (declining vision/hearing, reduced finger dexterity and memory impairment), psychological barriers (technological fear and low self-efficacy, fear of operational errors, and loss aversion), economic constraints, technological barriers (complex interfaces, cumbersome procedures, and unclear guidance), and social barriers (insufficient intergenerational support, inadequate on-site assistance, limited age-friendly digital skills training, and imperfect peer mutual aid). In addition, five core needs were identified: simplified operation, on‑site guidance, security assurance, tailored skills training, and emergency support. Digital exclusion among elderly patients is a systematic dilemma that arises from the interplay of physical, psychological, economic, technical, and social barriers. Psychological barriers represent an important but often overlooked set of factors. The findings suggest that age-friendly digital transformation, along with an integrated family–hospital–community support system, may be a key approach to promote digital inclusion for elderly people in healthcare, although these recommendations require further validation in larger and more diverse populations.