Digital divide: A qualitative study on older adults’ digital health literacy in non-first-tier cities in China

As China faces the dual challenge of rapid digitalization and an aging population, disparities in digital health literacy among older adults threaten equitable access to health services. This qualitative study investigates the lived experiences of community-dwelling older adults in non-first-tier Chinese cities in navigating digital health services, aiming to understand the personal, cognitive, and environmental factors influencing their engagement. Grounded in phenomenological methodology, semi-structured interviews were conducted with ten older adults aged 60 to 77. Data were analyzed using Colaizzi’s seven-step method, guided by the Health Promotion Model and Orem’s Self-Care Deficit Theory. Three major thematic domains emerged: (1) motivational barriers to adopting digital health, such as negative self-efficacy and reliance on traditional healthcare models; (2) constraints in functional and digital health literacy, including memory decline, technological challenges, and fear of online fraud; and (3) the influence of external environmental factors, including familial support, lack of formal training, and the inadequacy of existing service platforms. While participants acknowledged the convenience and potential of digital health, most lacked the confidence, skills, or contextual support to utilize such services meaningfully. These findings highlight the need for age-sensitive design, targeted literacy interventions, and community-based training programs to bridge the digital divide and promote health equity among older adults. The study offers practical insights for policy and practice in digital public health and gerontological care.