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Abstract

Background: The rapid expansion of digital health services (DHS) highlights the need to assess their accessibility and effectiveness, particularly among older adults. Despite increasing digitalization, many older individuals still face barriers, including limitations in digital competence and access. Objective: This study examines the use, barriers, and perceived benefits of DHS among individuals aged 75 and older in Finland. Methods: A nationwide survey was conducted in March 2023 using both electronic and paper questionnaires. In addition to descriptive analysis, regression analysis was performed to identify variables associated with perceived benefits of digital health services. Results: Of the 1124 responses (1011 electronic, 113 paper), 1100 were fully completed. Overall, 84% of respondents had used DHS, with usage being higher among those under 85 years (87%) than those over 85 (57%). The majority of respondents (82%) reported using the national Omakanta service, which grants access to personal health information. Digital competence and the number of services used were the strongest predictors of perceived benefits, alongside higher satisfaction, service frequency, and female gender. Conclusions: DHS adoption among older adults, especially in Finland, may be higher than previously reported. However, digital social services remain underdeveloped. Addressing the digital divide is essential to ensuring equitable access.

Keywords

digital technology telemedicine delivery of healthcare social welfare elderly

Introduction

Many countries are aiming to serve citizens online, utilizing digital technology to enhance health and social care. Digital health services (DHS) include a wide range of technologies and solutions, including telehealth platforms, mobile health apps, wearables, and artificial intelligence.^1–3 DHS can be defined as the use of information and communication technologies in healthcare products, services, and processes.⁴

Digital alternatives rapidly expanded in health and social care during the COVID-19 pandemic of 2020. However, thorough evaluation is now necessary to ensure their effectiveness and affordability, while also promoting equitable access and addressing the needs of specific population segments. Notably, existing reviews often overlook the affordability and acceptability of digital technology among older adults.⁵

DHS are recognized as a means to enhance patient health outcomes and engage patients as active co-creators of their well-being.^6,7 Older adults’ usage of DHS has been researched over the years.^8–10 However, considering the impact of rapidly developing DHS, the COVID-19 pandemic, the requirement to avoid social contact during it, and the rapidly increasing number of aging people, it is essential to regularly update research on older adults’ use of DHS.^11,12

Based on earlier studies, reduced physical and cognitive function due to aging can impact the usability experiences of DHS.^13,14 Age and digital competence significantly influence the use of online services, with younger and more digitally competent individuals being more likely to use them.¹⁵ Especially the perceived usefulness appears to have a strong correlation with older adults’ acceptance of DHS¹⁶ and older adults perceive fewer benefits of DHS compared to the younger population.^17,18

Older adults have shown less interest in using technology for their daily needs and communication compared to younger people.^14,19 Several previous studies have indicated that fewer than half of older adults utilize DHS or the internet in general.^5,20–23 Digital skills or capability, along with a lack of internet access, have been recognized as important factors affecting the use of DHS, especially among older adults.^5,24 Heponiemi et al.¹¹ found that older adults are at risk of digital exclusion, and that strong digital competence can mitigate age-related declines in online service use, although this effect diminishes around the age of 80. Jansson et al.²⁵ also found that self-efficacy in using DHS increases as usage increases. Since age remains a significant barrier to the acceptance of digital devices, understanding the specific challenges older adults face when using digital technologies is essential.²⁶ Understanding the reasons behind older adults’ reluctance to use DHS, alongside their perceived benefits, can help identify solutions to enhance their willingness and capability to use these services. This is particularly important from the perspective of developing and providing effective health and social care.²⁷

Creating value through DHS involves comprehending the perceived benefits for users,⁷ and in this case, older adults. This understanding enables health providers to tailor DHS in ways that motivate older adults to use them. A study by Laukka et al. emphasized the importance of involving older adults in the development of DHS and eHealth strategies.²⁷

Kainiemi et al. recommended that future research should consider the complex and multifaceted factors influencing the use and perceived benefits of digital health and social care.¹² While their study identified several associations, namely sociodemographic characteristics, variables related to area of residence, use of the internet, and physical, cognitive, psychological, and social functioning,¹² our research aims to extend these findings by exploring a broader range of factors, including prior use of DHS, satisfaction with DHS, and digital competence. In addition, we aimed to explore a wider range of perceived benefits.

In addition to understanding the perceived benefits of DHS among older adults, it is crucial to investigate the reasons why they may choose not to use these services. Most studies focus on the experiences with a specific digital technology in a particular setting, making it difficult to find research that describes the overall use and experiences of DHS among older adults.

Our study aims to provide a comprehensive overview of the most commonly used DHS among older adults, their experiences and perceived benefits, and reasons for not using the DHS. As in Finland, the social and health care services are integrated, we include the use of social services in our study. Incorporating social services offers a novel perspective, as many countries are striving to integrate health and social services, while the majority of the published studies focus solely on the use of digital services in healthcare. Our research questions are: (1) What types of DHS do the 75 years and older use, (2) What are the barriers limiting the use of the DHS, and (3) What are their experiences and perceived benefits of the DHS?

Methods

Study design

The study employed a survey methodology to collect data, utilizing both electronic and paper-based questionnaires. The survey instrument comprised sections encompassing demographic information, multiple-choice items, and open-ended prompts. Data collection occurred over a period spanning from March 19 to March 31, 2023, in partnership with the Union for Senior Services (VALLI).

Participants and recruitment

The participants in the study were Finnish individuals aged 75 years and over, and they were recruited from across Finland. Participant recruitment was conducted by VALLI through targeted email outreach to professionals engaged in elderly care, volunteer workers in this field, Finnish elderly councils, and administrators of various pensioner and senior associations. These stakeholders facilitated the distribution of the survey by sharing an internet link or providing the option to download the survey in PDF format for completion. Alternatively, participants could request VALLI to dispatch the survey as a hard copy. Furthermore, VALLI disseminated an electronic newsletter specifically tailored for leaders of its member organizations offering elderly services. VALLI also facilitated participant enrollment through events tailored specifically for seniors.

In Finland, written informed consent is not routinely required for anonymous, non-interventional survey studies where no personal data are collected. In accordance with the national research ethics guidelines (TENK), informed consent was obtained implicitly: participants received full written study information before participation, and completing the questionnaire constituted consent.

Data collection

We considered the questionnaire research as the most suitable method for exploring the usage and user experiences of DHS among older adults. We developed the questionnaire collaboratively by the research team in conjunction with an expert from VALLI. Drawing upon the National FinSote Survey²⁸ conducted by the Finnish Institute for Health and Welfare (THL), inquiries were tailored to encompass aspects of health and social care, as well as electronic engagement with these services. Additionally, the questionnaire incorporated items from a previous survey on digital inclusion among older adults, conducted by VALLI in 2022.²⁹ The older adults actively contributed to refinement of the digital inclusion survey and the survey was pilot-tested by older adults before its launch. Their involvement extended to shaping the survey structure and facilitating the adaptation of digital terminology to enhance accessibility for older demographics.

The survey responses were collected anonymously between 19 and 31 March 2023. We utilized various formal and informal organizations working among older adults to reach out to the potential respondents. VALLI and the research group recruited the participants via targeted emails sent to professionals working with older adults, volunteer workers in elderly care, Finnish elderly councils, and various pensioner and senior associations. The research group evaluated the representativeness of the recruitment by considering factors such as the inclusion of older adults with different types of services (e.g., assisted living) and geographic distribution. These professionals and organizations distributed the questionnaire as an internet link, or in a downloadable PDF format for participants to fill out, or asked VALLI to send out the paper version. They also offered assistance to the respondents if required. VALLI also sent an electronic newsletter specifically targeted at leaders of member organizations providing elderly services and recruited some participants for the study during events for seniors. Electronic submissions were automatically logged within the Questback system, with resultant data presented to the research team in Excel format. Paper-based questionnaire responses were manually transcribed into the Questback system by the research team. Our questionnaire (Appendix 1.) consisted of four sections: three sections with structured questions and a fourth with open-ended questions. In this article, we focus on the structured parts. The first section gathered participant demographic information, including age, gender, place of residence, and any potential constraints (sensory limitations, mobility restrictions, or financial limitations) related to the use of DHS services.

The second section of the questionnaire collected information regarding the use of smart devices and the internet. The initial question inquired whether the participant used DHS services at all, with response options of yes or no. If the participant answered no, the questionnaire included only reasons for not using the services and concluded at that point. The reasons for not using the services were examined by age group. If the response to the first question was yes, the questionnaire proceeded by asking the questions related to the digital competence: use of the Internet, proficiency in using the Internet, and cybersecurity skills. The third section of the survey inquired about participants’ experiences with DHS. We used the Likert-scale (1–5) for the responses and an option: “If you cannot evaluate digital services, choose the option ‘neither agree nor disagree’”.

We asked about the use of DHS during the last 12 months. The most commonly used services were described, along with the satisfaction of each service graded using the Finnish school grading system (4–10). Practically 4 means fail and 10 means excellent.

Data analysis

We performed a descriptive analysis of the respondents’ age and gender. The number and proportion of the most commonly used DHS were assessed. We calculated the averages and standard deviations of the responses to the questions or statements. In addition, we visually presented the average perceived benefits of the DHS. Finally, we examined the associations between survey responses and the perceived benefits. First, the average perceived benefits (questions 2c) were calculated for each respondent, and the normality of the distribution was assessed by the Shapiro-Wilk normality test. Second, we formed the digital competence by summing ‘yes’ responses to questions 2b, 3b, and 4b. We also calculated the average satisfaction with various services as a single variable, and measured use of services by summing the number of services the respondent had used in the last 12 months.

We first included all relevant variables in a regression model to analyse the associations of each variable with the average of perceived benefits. These variables included age, sex, population size of the home city, limitations in using the service (yes/no), average satisfaction with services, digital competence and the number of DHS used in the last 12 months. Based on the associations, the final variables for the multivariate regression analysis were selected by removing the variables that had the lowest significance.

The data was analysed using SPSS version 28.0.0.0.

Results

Characteristics

We received 1124 responses (1011 electronic and 113 paper), of which 1100 were completely answered and included in the analysis. Of the included respondents, 64% were 75–79 years old and 68% were women (Table 1). The responses were all over Finland, covering small municipalities (<1000 inhabitants) and the biggest cities, and geographically from the southern regions to Lapland.

Table 1.

The age and sex of all respondents of the survey focusing on digital health services in Finland in 2023. Only completely answered questionnaires are included.

Age (years)	Male (%)	Female (%)	No answer (%)	Total
75–79	210 (19.1)	494 (44.9)	2 (0.2)	706 (64.2%)
80–84	95 (8.6)	168 (15.3)	4 (0.4)	267 (24.3%)
85–89	28 (2.5)	70 (6.4)	1 (0.1)	99 (9.0%)
90–94	6 (0.5)	15 (1.4)		21 (1.9%)
95–99	1 (0.1)	6 (0.5)		7 (0.6%)
Total	340 (30.9)	753 (68.5)	7 (0.6)	1100

Among the respondents, 164 (15%) reported some form of limitation or disability in using DHS, but 99 of them were using DHS. Approximately 90% provided detailed information about their limitations: visual or hearing limitation (113 respondents), movement restriction or disability that prevents the use of digital devices (32), or financial situation limiting acquisition or maintenance of digital devices (23). Multiple limitations were reported by 19 respondents.

Utilization of DHS

In total, 84% (n = 920) of the respondents had used or were using some DHS. The use was higher among people under 85 years (87%) than among those over 85 years (57%). Almost all the respondents, who didn’t use DHS, reported not using digital services in general (14.1%). Other most commonly mentioned reasons for not using DHS were the inability to use digital services (7.3%) and finding the digital services difficult to use (5.7%) (Table 2). 86% of the respondents who didn’t use DHS reported the reason for not using it.

Table 2.

The reasons for not using digital health services among the survey population in Finland. The respondents could choose multiple options.

Reason	75–79	80–84	85–89	90–94	95–99	Total (%)
I do not use digital services in general	73	31	33	16	2	155 (14.1)
I cannot use digital services	33	14	22	10	1	80 (7.3)
I find digital services difficult to use	33	15	11	4	0	63 (5.7)
I find digital devices difficult to use	24	11	9	5	0	49 (4.5)
I don’t want to use digital services	18	8	9	4	1	40 (3.6)
I don’t trust digital services, or I fear being deceived	20	7	6	3	0	36 (3.3)
I cannot authorise myself in digital services	14	8	6	4	1	33 (3.0)
I do not have access to a telecommunications network and/or a digital device	5	8	12	4	0	29 (2.6)
I don’t understand the language in digital services	12	7	5	3	0	27 (2.5)
Digital services don’t have my mother tongue	2	0	0	0	0	2 (0.2)
Other reason	10	3	1	2	1	17 (1.5)

Most of the respondents (82%) have been using the national Omakanta (MyKanta) service that provides citizens with access to their personal health information (e.g., prescriptions, medicines, texts from visits, and inpatient episodes).³⁰ Of the respondents, 29% had used digital services for transactions, and over 20% had also used some synchronous digital service (remote consultations and contacts) either with a health care or social care professional (Table 3). The transactions include activities such as scheduling appointments, inquiring about care-related information, and ordering medical supplies. The third common usage was for symptom or wellbeing assessments (20%). On average, respondents had used 1.8 (SD = 1, 7) different services.

Table 3.

Most commonly used digital services and the average grade of the satisfaction of the service among 75-years old and older in Finland.

Have you used the following digital services?	Yes (%)	Satisfaction (scale 4–10, average ± SD)
Personal client/patient data register (Omakanta^a)	902 (82)	8.1 ± 1.0
Municipality/Region service for transactions	317 (29)	7.7 ± 1.3
Symptom check (Omaolo^b)	221 (20)	7.5 ± 1.3
Remote healthcare consultation (doctor/nurse)	220 (20)	7.8 ± 1.2
Services of the social insurance institution of Finland	180 (16)	7.4 ± 1.5
Occupational health services	127 (12)	7.6 ± 1.3
Wellbeing check	96 (9)	7.6 ± 1.4
Senior-info	70 (6)	7.5 ± 1.3
Digital patient pathways	64 (6)	7.7 ± 1.2
Social welfare applications	28 (3)	7.0 ± 1.5
Remote social worker contact	23 (2)	7.0 ± 1.5
Other social care service	18 (2)	6.4 ± 1.9
Remote home care	17 (2)	6.8 ± 1.8
Remote social counselor contact	16 (1)	6.5 ± 1.5
Social counselor chat	12 (1)	6.8 ± 1.7

^aOmakanta (MyKanta) service that provides citizens with access to their personal health information (e.g., prescriptions, medicines, texts from visits, and inpatient episodes).

^bOmaolo is a Finnish digital health platform that provides users with personalized health assessments, self-diagnosis tools, and guidance for appropriate care based on symptoms.

Perceived benefits

The perceived benefits were studied only among the respondents who had used DHS. The greatest perceived benefits were “facilitates the use of service regardless of time and place” (3.8 ± 0.9) and “saves my time and speeds up the process of transactions” (3.7 ± 1.0) measured by the Likert scale (Figure 1). All the responses were slightly positive (average > 3), and the claim “helps in taking care of the health, well-being, or functional capacity of a loved one” was seen least beneficial (3.1 ± 0.9). For four questions, the biggest share of answers was “neither agree nor disagree”.

Figure 1.

The perceived benefits of the digital health services. The question was “What is your opinion on the following statements regarding the benefits of digital services in health and social care? If you cannot evaluate digital services, choose the option ‘neither agree nor disagree’”.

The composite measure of perceived benefits was normally distributed and had high internal consistency (Cronbach’s alpha 0.897), and a linear regression model could be used. Neither the population of the respondents’ home city (p = 0.632) nor the limitations for using the service (p = 0.197) showed associations with the perceived benefits. Therefore, we included gender, age (75–84 and 85−), digital competence, use of digital services, and satisfaction with the services in the regression model (Table 4). The average digital competence score among respondents included in the regression analysis was 7.1 (SD = 1.4). The overall adjusted R Square was 0.193, and all selected variables, despite of age, had a statistically significant association with the perceived benefits. Given the sample size, number of predictors, and effect size, the statistical power of the model exceeded 0.99, indicating an excellent ability to detect the observed effect. Digital competence and a higher number of used services had the strongest association with perceived benefits. Additionally, higher satisfaction with the services, greater use of the services, and gender (female) were also positively associated with perceived benefits.

Table 4.

The associations of survey variables with the perceived benefits of the digital health services among 75-years and older in Finland (n = 942).

Model summary
Model	R	R²	Adjusted R²	Std. error of the estimate	F	Sig
1	0.436^a	0.19	0.193	0.61759	29.446	<0.001

Coefficients
Model	Predictor	Unstandardized B	Standardized B	Sig.	95% confidence interval for B
1	(Constant)	1.337		0.027	−1.540, 2.164
	Digital competence	0.138	0.288	<0.001	0.102, 0.173
	Number of digital health services used in last 12 months	0.051	0.185	<0.001	0.031, 0.072
	Gender (Male)	−0.144	−0.098	0.007	−0.248, −0.040
	Satisfaction with services	0.075	0.143	<0.001	0.038, 0.112
	Age	0.017	0.053	0.147	−0.006, 0.039

^aDependent Variable: Perceived Benefits of Digital Services.

Discussion

Principal results

In our study 84% of the older adults used DHS. The majority of respondents reported using the national Omakanta (MyKanta) service, and almost one-third reported using DHS for transactions. Other most common uses of DHS included synchronous digital services with professionals and wellbeing assessments. The least used DHS were those related to social services.

At a higher level, the results of this study provide the most up-to-date picture of older adults’ utilization, perceived benefits, and new factors related to these benefits in Finland. Overall, Finnish older adults are active users of DHS, and their use has increased rapidly over the past years.³¹ One reason for the high level of activity among Finnish older adults may be the Finnish government’s strong commitment to digitalizing public and private services.³² Findings of our study may support countries where the use of DHS among older adults is still less developed.^23,32

In our study, we found that the use of digital services is more common among those under 85 years old (87%) compared to those over 85 (57%). A practical implication is that, for example, in home care, it is worth actively promoting the development of various services, including DHS to support independent living, particularly for the 75–85 age group.

Finally, the most perceived benefits were that DHS facilitate the use of services regardless of time and place, save older adults’ time, and speed up the process of transactions. The least beneficially perceived claim was that DHS would help in taking care of the health, well-being, or functional capacity of a loved one. Better digital competence, higher satisfaction with the services, higher use of the services, and being female were positively associated with the perceived benefits.

Comparison with prior work

In our study, a significantly higher rate than previous studies in other countries, which often report less than 50% adoption.^5,20–22 For example, in Singapore, which has the highest internet availability worldwide, only 21.4% of the older adults aged over 60 years were users of health-related digital technology.²³ In Finland, nearly half of those aged 70+ used digital services independently, increasing to 62% by 2023.^12,33 The differences between two highly digitalized countries and the notable increase in the use of DHS among Finnish older adults may be explained by the recent healthcare reform in Finland, which, amongst other things, has led to an expansion in the availability of DHS.³⁴ As a result, there might have been increased efforts in training and supporting the older adults to utilize the DHS.³⁵

The issue of digital exclusion among older adults has been widely discussed^11,36–40 and our study aligns with earlier research. However, this exclusion cannot be generalized to the entire older population, although the share of people not using DHS is significantly higher among them. The potential for DHS use among older adults may be much greater than earlier studies indicate. Since older adults found DHS difficult to use, it would be beneficial to focus on developing a more user-friendly DHS by involving older adults in the development process.⁴¹

Most commonly used features were checking personal health information from a national service (82%), using a digital service for transactions, and using some synchronous DHS to communicate with health or social care professionals. Interestingly, most of the studies seem to focus on digital technologies to facilitate remote delivery of care⁵ although other types of services, such as digital personal health data access or symptom checks, may be equally popular or even more so. Both our study population and Singapore’s older adults showed a preference for communicating with healthcare professionals.²³

In our study, older adults showed a lower preference for using digital services related to social care. This might be because digital healthcare services are more common compared to social care services.⁴² More investigation is needed into social care services, especially in countries where health and social care are integrated.

In our survey, 15% of the respondents reported some kind of limitation or disability in using DHS, but the majority of them were using DHS. Earlier studies have recognized cognition, awareness, confidence, motivation, physical ability, and perceptual problems as potential barriers to use among older adults.^5,14 As our study shows, only a small proportion of disabilities completely prevent the use of DHS. Further studies should pay attention to how to support people using DHS despite disabilities.

The greatest barrier limiting the use of DHS relate to the avoidance of using digital services in general. Furthermore, Frishammar et al.⁴³ have identified attitudes, specifically disbelief about the potential of digital care, political concerns, and a general lack of interest in digitalization, as significant barriers to the adoption of digital services. Difficulties of either using digital devices or digital services were commonly mentioned as a barrier in this and earlier studies.^43,44 Based on a systematic review,⁴⁴ the enablers and barriers of DHS may be classified into two themes, namely usability and perceived usefulness. Prioritizing enhanced technical solutions, usability, and alignment with user needs is essential to foster favourable user experiences and provide effective client support.⁴⁵ Improved system usability may bolster older adults’ confidence in managing their health-related affairs online, consequently leading to heightened usage.⁴⁶

In addition, the lack of trust towards DHS was mentioned quite often. Security concerns have also been recognized in earlier studies.^13,43,47 In a recent study, it was found that older adults have expressed fear of being scammed.²⁷ The trust towards DHS may relate to personal, technological, or institutional factors, and by understanding the enablers of increasing trust, this barrier may be partially manageable.⁴⁸ It would be important to provide older adults with sufficient information and training,³⁵ which should also concern security issues.

Overall, the older adults reported high satisfaction with DHS and perceived them as beneficial. The greatest perceived benefits were “facilitates the use of service regardless of time and place” and “saves my time and speeds up the process of transactions”. Thus, our study supports the findings that DHS improve access to services among older adults.^12,49,50 The users also felt DHS were improving the collaboration with professionals. In interpreting the perceived benefits, the big share of respondents answering “neither agree nor disagree” has to be considered. This may relate to the still limited use of various DHS and, therefore unclear benefits for many older adults.

Another study conducted among older adults in Finland found that only 22% completely or somewhat agreed that DHS helped them assess the need for services.¹² In contrast, our study showed a much higher proportion, with just over 50% of older adults perceiving that DHS helped them assess their service needs and facilitated the search for and selection of suitable services. The 2-year difference in the data collection periods might partially explain this discrepancy.

Kainiemi et al. also highlighted the importance of understanding the factors associated with these perceived benefits.¹² In our study, we found that better digital competence, higher satisfaction with the services, higher use of the services, and gender (female) had a positive association with the perceived benefits. Understanding these factors behind the perceived benefits may help increase the use of digital services, identify which segments are most likely to benefit from them, and consider demographics when segmenting older adults.^12,27 Heponiemi et al.¹⁸ found the skills as the central element for perceived benefits. Especially older adults without prior experience in using DHS would benefit from more intensive training and support.²⁷ Finally, in our study, the females perceived greater benefits compared to the males, which differs from the earlier studies showing no difference between genders.^18,51

Limitations

Our study was conducted in Finland, a country with high educational levels, extensive internet use, and advanced digitalization. Our results related to the popularity of DHS use among older adults cannot be generalized to other countries. However, our study reveals the potential of DHS among older adults if the digital competence and infrastructure are supportive. Further population-level studies are needed to gain a deeper understanding of the mechanisms influencing DHS use.

Participants were recruited extensively through email distribution, potentially introducing bias towards individuals who use digital devices. To mitigate this bias, participants were recruited extensively face-to-face at various events, providing an opportunity for respondents to complete a paper-based questionnaire. Respondents were self-selected, and volunteers may differ from non-volunteers. In addition, our survey was limited to the Finnish-speaking population. We also wanted to keep the survey short and didn’t include many background variables.

Thus, although our efforts it was not possible to ensure full representativeness of the survey, the proportion of DHS users may be higher than the reality. However, the proportion of DHS users is significantly higher than in earlier studies, and we believe that the use of DHS among older adults is higher than earlier studies indicate and should be actively updated in different contexts.

It is also noteworthy that a substantial proportion of respondents reported using digital occupational health services. This finding should be interpreted with caution. Some respondents may still be employed, especially as entrepreneurs. Additionally, some may be referring to the same private healthcare provider they previously accessed through occupational health coverage. There is also the possibility of response errors.

The survey targeted individuals aged 75 years and over, a demographic that may include individuals with conditions such as dementia, potentially introducing recall bias. To minimize bias in question wording, the survey questions were developed with input from a professional at the Union for Senior Services, who possessed experience in designing surveys for older adults. Older adults also participated in the planning and development of the survey template.

Conclusions

The potential share of DHS users among older adults, especially in Finland, may be significantly higher than earlier studies indicate. In our study, 84% of the people 75 years and over were DHS users. DHS users were mostly satisfied with the services, and the greatest perceived benefits were the ability to access services anytime and anywhere, and the time-saving aspect that speeds up transactions. The findings suggest that efforts to enhance digital competence and develop user-friendly DHS could further support their use among older population. Further studies should focus on a more detailed analysis of mechanisms enabling and supporting DHS use among older adults. At the same time, the digital divide has to be considered to enable equal services for the whole population.

Supplemental material

Supplemental material - The use and perceived benefits of digital health services among Finnish older adults: Survey study

Supplemental material for The use and perceived benefits of digital health services among Finnish older adults: Survey study by Paulus Torkki, Sanna Lakoma, Suvi Hiltunen, Miia Jansson, Anne Kouvonen, Henna Härkönen, Marja Harjumaa, Riikka-Leena Leskelä, Paula Pennanen, Anastasiya Verho, Susanna Martikainen and Elina Laukka in Health Informatics Journal

Footnotes

Acknowledgements

We acknowledge the Prime Minister’s Office for funding of the study and members of the Steering group: Vesa Jormanainen, Virva Juurikkala, Saara Leppinen, Mikko Martikainen, Taina Mäntyranta, Sirkku Pikkujämsä, Laura Pitkänen, Minna Saario, and Tiina Tikka.

ORCID iD

Paulus Torkki

Ethical considerations

As the survey was conducted anonymously it did not require formal ethical approval. The project was overseen by a steering group from the Finnish Ministry of Social Affairs and Health and the Ministry of Finance, ensuring that data collection adhered to current regulations and obtaining approval when necessary. They determined that ethical approval was not needed for the survey because the Medical Research Act and the Personal Data Act do not require ethical approval for surveys that do not process personal data in a way that allows individuals to be identified.

Consent to participate

All the participants provided their informed consent by responding to the survey. Before answering the survey, participants received written information about the study and research aims, along with data protection.

Consent for publication

Manuscript does not include any individual person’s data.

Author contributions

PT was responsible for this study’s conceptualisation, methodology, formal analysis, and writing (the original draft, review and editing). SL was responsible for its methodology, data collection, formal analysis and writing (review and editing). SH, MJ, AK, HH, MH RL, PP, AV and SM contributed to its writing (review and editing). EL was responsible for its conceptualisation, methodology, data collection, writing (review and editing) and supervision.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Open Access funding provided by University of Helsinki (including Helsinki University Central Hospital). Prime Minister’s Office (VN/29015/2021).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and analysed during the current study are not publicly available, but they are available from the corresponding author on reasonable request.*

Supplemental material

Supplemental material for this article is available online.

Appendix

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