Heterogeneity of Digital Exclusion Behavior Among Older Patients Throughout the Entire Medical Treatment Process in Smart Healthcare Scenarios: Latent Profiles and Influencing Factors
This cross-sectional study of 795 older patients in Shandong Province utilized latent profile analysis to identify three distinct subgroups of digital exclusion behaviors—ranging from autonomous adaptation to healthcare-provider dependence—and determined that demographic, socioeconomic, and digital literacy factors significantly influence these profiles, thereby supporting the need for stratified, age-friendly interventions in smart healthcare settings.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the modern world, healthcare is rapidly shifting toward digital systems. Hospitals now offer online appointment booking, self-service bill payment, and digital access to medical records, aiming to make care faster and more efficient. This shift relies on the assumption that patients can navigate these tools. However, for many older adults, this transition creates a significant barrier. The concept of "digital exclusion" describes the situation where people are unable to use these technologies, not because they lack access to the internet, but because the systems are too complex, their physical abilities have declined, or they lack the necessary skills. While some older adults manage to adapt, others find themselves completely unable to participate in the digital side of their own care. This exclusion is not a simple matter of being "tech-savvy" or "tech-illiterate"; it is a nuanced problem that varies greatly from person to person. Understanding these differences is crucial, because a solution that works for one group may fail entirely for another.
A team of researchers in China set out to map this landscape by studying nearly 800 older patients who had recently been discharged from a major hospital. They wanted to move beyond the idea that all older patients face the same digital hurdles. Instead, they asked whether there are distinct groups of people who struggle in different ways. To find the answer, they surveyed patients across the entire medical journey, from the moment they first tried to book an appointment online to the time they checked their test results after leaving the hospital. The researchers asked detailed questions about how these patients handled twenty different digital tasks, such as registering for a visit, paying bills, or viewing their medical records. They also gathered information about the patients' lives, including their education, income, how long they had used smartphones, and whether they lived alone or with family.
The analysis revealed that older patients do not fall into a single category of difficulty. Instead, they naturally cluster into three distinct groups, each with its own pattern of behavior and needs. The largest group, making up 84 percent of the patients, consists of those who face moderate digital exclusion. These individuals generally cannot complete digital tasks on their own, but they have a reliable safety net: family members. They delegate the work to spouses or children who handle the online registration and payments for them. While this support prevents them from being completely locked out, it places a heavy burden on their families and can slow down the hospital workflow.
A second, smaller group, representing about 12 percent of the patients, experiences only mild digital exclusion. These are the older adults who are quite capable of using technology. They can independently handle most tasks, such as checking lab results or paying bills, but they still stumble when faced with the most complex administrative procedures, like verifying insurance details or navigating multi-step admission processes. They are not helpless, but the current systems are still too complicated for them to navigate with full confidence.
The third group is the smallest, comprising only about 4 percent of the patients, yet they face the most severe challenges. These individuals experience what the researchers call severe digital exclusion. Neither they nor their family members can manage the digital tasks. They are entirely dependent on hospital staff to guide them through every step or to perform the tasks for them at a manual window. Without this direct human assistance, they would be unable to access essential services. This group often includes women and those with multiple chronic health conditions, who may find the combination of physical limitations and complex interfaces insurmountable.
The study also uncovered the factors that push patients into these different groups. Education, income, and where a person lives played a major role. Those with higher education, urban residences, and higher incomes were much more likely to be in the independent group. Conversely, lower income and rural living were linked to greater reliance on family or staff. The number of chronic diseases a person had also mattered; those with more health issues were more likely to fall into the severe exclusion group, likely because their physical and cognitive energy is already stretched thin by managing their health. Interestingly, simply owning a smartphone was not enough. What mattered more was how long a person had used the device and how many different digital health services they had actually tried. Patients who had used smartphones for years and had experience with various apps were better equipped to handle hospital systems.
Perhaps the most significant finding is that the current "one-size-fits-all" approach to digital hospitals is insufficient. The researchers found that the barriers are not uniform. A solution designed to help the independent group, such as simplifying a menu, might not help the family-dependent group, who need a way to securely manage a relative's account. Similarly, a solution for the family-dependent group might not address the needs of the severely excluded, who require dedicated, one-on-one human support. The study suggests that hospitals need to adopt a layered strategy. They should create specific tools for family members to act as agents, streamline complex processes for the moderately independent, and ensure that staff are available to provide direct, patient guidance for those who cannot manage the systems at all.
This research highlights that digital inclusion is not just about handing out devices or providing internet access. It is about understanding the diverse realities of older patients. By recognizing that there are different types of digital exclusion, hospitals can move away from generic solutions and build a healthcare system that truly accommodates the wide range of abilities found in an aging population. The goal is to ensure that no patient is left behind, whether they need a little extra clarity, a family member's help, or a staff member's hand.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.