Wandering at the crossroads of using a smartphone among nursing home residents: A qualitative descriptive study

Abstract

Background

The Internet has been integrated into various aspects of senior life. However, the popularity of digitization does not mean that digital devices are well-inclusive. It is considered important to explore the willingness of nursing home residents to use smartphones in the context of the development of “Digital China.”

Objectives

To explore the perceptions and concerns of smartphone use in nursing home residents.

Method

The study employed a descriptive qualitative design. A purposive sample of 22 nursing home residents was recruited as participants. Semi-structured interviews were conducted to collect data between April 2024 and June 2024. Interviews were transcribed, and analyzed by the qualitative content analysis method.

Results

Nursing home residents were wandering at the crossroads of smartphone use. Four specific categories emerged: (1) Positive appraisal of smartphones’ value; (2) Internal cognitive biases in smartphone use; (3) Objective constraints on smartphone use; and (4) Practical strategies for digital inclusion. Their cognitive biases involved low perceived usefulness, lack of basic knowledge, and technological anxiety; and the objective constraints were physical aging, unfriendly operating systems, and poor digital inclusion environments. Residents expected instrumental digital support including visual smartphone use guidelines, peer or intergenerational beside guidance, and digital life scenarios.

Conclusions

This study clarifies the subjective and objective challenges encountered by nursing home residents in using smartphones. It provides fresh insights from the perspective of nursing home residents for developing environmentally sensitive digital inclusion intervention strategies.

Keywords

Older adults nursing home smartphone use digital inclusion qualitative research

Introduction

Nowadays, the Internet has been integrated into various aspects of senior life, profoundly changing the ways of production and living. As of June 2024, China has more than 1.099 billion Internet users, and 14.3% of them are senior Internet users.¹ The Internet penetration rate has reached 52.95% among older adult population in China.¹ However, the popularity of digitization does not mean that digital devices are well-inclusive. Instead, the trend towards digitalization is depriving the older adult population of many opportunities for equitable access to rights and welfare.² Therefore, the International Telecommunication Union encourages attention to the digital needs of older adults in order to facilitate active aging.³

Digital device use is a key breakthrough in promoting digital inclusion in older adults. However, as an important access point for digital devices, the popularity of smartphones among older adults remains controversial. Some researchers indicated that smartphones have expanded the social connections of older adults and helped them access more medical as well as social resources.^4,5 Other researchers were concerned that smartphones may cause digital addiction among older adults, which could lead to a reduction in their offline activities.^6,7

The barriers to the use of digital devices are not merely issues of technical operation, but also influenced by a combination of older adults’ physiological, psychological, and environmental factors. First, the “age-related blind spots” in technical design and online services are not senior-friendly. The non-inclusive design of digital interactions and the complexity of interface functionality have discouraged users from engaging with digital devices.⁸ Furthermore, the quality of network services determines the usage intention of older users. Gallo et al. indicated that misinformation and fake online news harm the well-being of senior Internet users, and emphasized that the technological paradox is widening the gap in the digital divide among older adults in developing countries.⁹ Second, the declining physiological functions directly affect senior users’ ability to use digital devices, particularly in sensory functions and motor abilities.¹⁰ Third, psychological barriers of senior users to digital technology cannot be ignored, which stem from the fear of unknown risks. Fox et al. pointed out that mistrust of digital devices, perceived high risk, and privacy concerns can impede senior users’ willingness to use.¹¹ Fourth, insufficient support has also exacerbated digital isolation among older adults. Some researchers identified that perceived isolation or helplessness,¹² living alone,¹³ and lack of social assistance¹⁴ are negative factors affecting digital device use. Ma et al. emphasized the importance of family and peer support in improving the digital literacy of older adults.¹⁵ Indeed, the use of digital devices is a complex phenomenon in older adults. It is therefore essential to explore their perceptions of their own engagement with these technologies.

As the issue of population aging becomes more prominent, the need for nursing home care is projected to increase.¹⁶ Given that healthcare is increasingly reliant on technology-based tools, the digital divide stands to further exacerbate existing inequalities in access to healthcare.¹⁷ Compared to community-dwelling seniors, nursing home residents probably experience more challenges in using smartphones. The decline in cognition and memory makes them difficult to learn and operate smartphones. Also, no family or friends are around to provide digital assistance.¹⁸ In this era of universal access to the Internet, we should not lose sight of how nursing home residents feel about digital inclusion. To date, there does not seem to be enough evidence to explain what influences smartphone use among nursing home residents. Some unknown factors, including the impact of the complex digital inclusion environment in nursing homes or other potential sociocultural factors on smartphone use, have not been fully explored. Additionally, the attitudes of nursing home residents towards smartphone use, as well as the types of digital assistance they expect, are still unknown to us. To fill this gap, this study aimed to elicit the perspectives and concerns of smartphone use in Chinese nursing home residents, providing guidance for developing digital inclusion intervention strategies.

Methods

Design

To gain an intuitive understanding of the perceptions of Chinese nursing home residents on the use of smartphones, this study chose the qualitative descriptive approach, in which the phenomenon of interest was described using everyday language. This approach is particularly useful in obtaining rich, direct, and first-hand descriptions of a phenomenon, especially when there is limited information available.¹⁹ During this study, we followed the standards for consolidated criteria for reporting qualitative studies (COREQ): a 32-item checklist (Additional file 1).²⁰

Participants

Purposive sampling was used to recruit participants from four nursing homes, including two private, one public, and one public-private partnership, located in Fujian, China between April 2024 and June 2024. To achieve maximum differential sampling, we recruited a heterogeneous sample of nursing home residents with different levels of education, marital status, residential form, nursing homes, and length of smartphone use. Under the assistance of nursing home staff, we explained the study information to the nursing home residents, including a letter of invitation, study purpose, eligibility criteria, potential risks, participation requirements, rights to confidentiality, consent, the right to withdraw from the study at any time, and the investigator's contact information. To be eligible for participation, participants had to be long-term residents of the nursing home aged 60 and above, could express their ideas clearly, and had experience of using smartphones. The sample size of participants was determined by data saturation where no new categories from participants’ experiences emerged.²¹

Data collection

Data were collected through face-to-face semi-structured interviews, which were conducted in the participant's private room at their convenience. To discuss the core objective of the experiences of smartphone use among nursing home residents, we designed a semi-structured interview guide. It was initially developed by the researchers (QH, HX) based on literature review^9,15 and field observation, then validated by two senior professionals. The interview guide was pretested with two participants to ensure its appropriateness and viability. The pretest data were not included in the final result analysis.²² The final interview guide covered the following areas: (1) What do you think about using a smartphone in daily life? (2) Have you had any difficulty using your smartphone? If so, how did you go about resolving these difficulties? (3) What factors do you think influence older adults to use smartphones? (4) What suggestions do you have for assisting older adult in using a smartphone? Probing questions were also employed to deepen the interviews.

To ensure consistency in the interview process, each interview was conducted by the same researcher (QH). He was a doctoral candidate in geriatric nursing with extensive background knowledge of qualitative research and practical experience in nursing homes, as well as proficient communication skills. Prior to the formal interview, all the participants signed the informed consent which contained an explanation of the study's objectives, procedure, potential benefits, and risks. The researcher began the interview with an informal talk aimed at establishing a trusting relationship with the participants. In addition, we ensured in advance that all participants had no previous relationship with the researcher. During the interview, participants were encouraged to share their personal experiences and provide additional comments on the topic. The researcher tried his best to listen to the participants and observe at all times, adjust the interview rhythm, complete records, and maintain objectivity and neutrality. Field notes recording the participants’ facial expressions and body language as well as the researcher's reflections were collected. Audio recordings were maintained throughout the interviews. Each interview duration ranged from 25 to 50 min, depending on the participant's willingness. Sampling and data collection continued until theoretical saturation was achieved, which is defined as the point where no new conceptual insights emerged from iterative data analysis.²³ After 20 participants, saturation was judged complete; two confirmatory interviews were conducted, and no further categories appeared.

Data analysis

The recording data were transcribed verbatim within 24 h after the data collection. To maintain the credibility of the transcripts, the records were returned to the participants for correction after the transcription was completed. Data analysis was performed using the qualitative content analysis approach.²⁴ First, two researchers (QH, HX) read through the transcripts several times to obtain a sense of the whole. Then the text about the participants’ experiences of using smartphones were highlighted and combined into one text that constituted the unit of analysis. Next, the unit of analysis was coded and condensed into meaning units; through interpretation of the content, main categories and sub-categories were identified. To increase the breadth and reliability of the analysis, a manual for coding was developed. The research group discussed the categories in-depth until a consensus was reached on the relevant coded data in all categories. The transcripts were originally in Chinese. Excerpts presented here were translated into English by QH and revised by HX.

Study rigor

To ensure the rigor of this study, credibility, confirmability, and transferability were controlled in this study.²⁴ Credibility was ensured by investigator triangulation and peer debriefing.²⁵ Ambiguities or controversies related to categories and sub-categories were thoroughly reviewed by three geriatric nursing researchers (QH, YL, and HX). Final categories and sub-categories were finalized at the end of the peer review meeting. Confirmability was ensured by member checks and searching for opposing evidence. All members, including participants, researchers, and peer experts, had the chance to explore and share their perspectives on the process and results of this study. Additionally, the detailed quotations allow readers to assess the applicability of the categories in their contexts, thereby ensuring the transferability.

Ethical approval

This study was approved by the Fujian Medical University Biomedical Ethical Committee ([2024] BECFJMU(194)). All methods were performed in accordance with the Declaration of Helsinki. The recording data were accessed and translated in accordance with DeepL's terms of use and all relevant institutional/national regulations. The participants were guaranteed anonymity, confidentiality, and voluntary participation. All audio recordings were saved in a password-protected computer until each interview was transcribed and verified against the tapes.

Results

A total of 24 nursing home residents were recruited, and face-to-face interviews were conducted with 22 participants. Prior to the formal interviews, two residents withdrew from this study because they had to be transferred to the hospital due to poor health. Participants’ sociodemographic data were described by frequencies, percentages, and means, as appropriate, and are presented in Table 1.

Table 1.

Participant characteristics (N = 22).

Variables	Total (N = 22)
Age (year)
Mean (SD)	86.73 ± 4.38
Gender N (%)
Male	10 (45.45%)
Female	12 (54.55%)
Education N (%)
Primary school or below	4 (18.18%)
Junior middle school	6 (27.27%)
Senior high school	8 (36.36%)
Bachelor degree	3 (13.64%)
Masters degree	1 (4.55%)
Marital status N (%)
Unmarried	1 (4.55%)
Married	8(36.36%)
Divorced	0
Widowed	13(59.09%)
Residential form N (%)
Living alone	7 (31.82%)
Live with family	9 (40.91%)
Live with others	6 (27.27%)
Length of smartphone use (Hours/day) N (%)
<1	9 (40.91%)
1–2	4 (18.18%)
2–3	4 (18.18%)
>3	5 (22.73%)

Four categories were derived from the data collected via the content analysis. The four interrelated categories reveal the perceptions regarding digital inclusion for nursing home residents. The first category, Positive appraisal of smartphones’ value, elicited the positive attitudes of nursing home residents towards using smartphones. The second category, internal cognitive bias in smartphone use, focused on describing nursing home residents’ misconception on using smartphones. The third category, objective constraints on smartphone use, explained the multifaceted objective constraints in smartphone use among nursing home residents. The final category, practical strategies for digital inclusion, articulated suggestions from nursing home residents on how to provide digital assistance. The frequency report table of research categories in this study is shown in Supplemental Table 1. The thematic map was developed to reflect the wandering of nursing home residents in digital inclusion (Figure 1). As one participant said, “It is like being at a crossroads, I am not sure where to go with digital inclusion for nursing home residents.”

Figure 1.

A thematic map revealing the perceptions of smartphone use among nursing home residents.

Positive appraisal of smartphones’ value

Most participants held a positive attitude towards using smartphones, believing that smartphones bring convenience and fun to their lives in nursing homes, and that smartphones have extremely high practical value and emotional value.

Best buddy

When asked to talk about smartphones, some participants stated that smartphones enable them to connect with the outside world and enrich their life in nursing homes. The smartphone is their real best buddy always there to support them. Participant 16 shared, “I cannot live in a boring nursing home without a smartphone. It is just like the best friend or a family member since it accompanies me whenever I need. With a smartphone, the world seems small…… It supports me in having a good time here.” He was a long-term resident who had lived in the nursing home for 17 years and has been exposed to the Internet since his retirement.

Surprisingly, some participants perceived that they were emotionally supported by a smartphone. Participant 15 mentioned “After moving to this nursing home, I lost the connection with my family and friends. I feel lonely, even if other residents are by my side. My smartphone is a kind of emotional support and enriches my spiritual life.” This participant, whose children had not visited her for a long time, had been using her smartphone for recreation.

Mobile treasure box

Participants usually used “social communication,” “entertainment,” and “digital healthcare” to describe what a smartphone is used for. They considered smartphones as a mobile treasure box because it met their various life needs, such as chatting, shopping, listening to music, reading news, and watching funny videos. As one participant said, “Smartphones are really handy once you learn how to use them. They’ve got everyone's phone numbers, fun apps, and helpers for daily life. Stick them in your pocket, and it feels like you don’t have to worry about a thing. Ain’t it just like a ‘mobile treasure box’?” (Participant 7).

Additionally, Participant 9 expressed that smartphones have multifaceted positive impacts on life in nursing homes. “Oh man, I cannot go a day without my smartphone … I need it to chat with others; I have to use it to buy stuff; even when I am sick, I rely on it to search health information.”

Internal cognitive bias in smartphone use

The interviews showed that participants were prone to cognitive bias towards smartphone use regarding perception of smartphone usability, cognitive short circuit, and smartphone anxiety. This can lead to an increased cognitive load on smartphone use and seriously affect the smartphone experience.

Just like a landline

For some participants, smartphones are just like landlines and are merely used to receive calls. This reflects their lack of adaptation and acceptance of new technologies.

A smartphone has many functions, but I usually use it to receive or answer calls from my family. I prefer a landline to a smartphone. I feel uncomfortable to explore other features. For me, they are like decorations. (Participant 2)

Participant 19, a new user who just switched from a cellphone to a smartphone a month ago, said, “My needs for a smartphone are just being able to make and receive calls, and that's enough. I don't know how to use the other functions of my smartphone, and I basically don't use them in daily life.”

Perceiving a smartphone as useless

Some participants failed to perceive the usefulness of a smartphone. They did not think they need to access to rich digital functions in daily life. They did not realize the benefits gained from smartphones.

Usually, I can just make phone calls to my family. I do not think there is any other place where I need to use my smartphone … I do not know much about the other functions of my smartphone. (Participant 17)

In addition, some participants presented that they would not spend time to learn how to use smartphones for it is not useful. Instead, they would prefer to do other things, such as household chores, or visiting neighbors.

Participant 4, a mahjong enthusiast who played mahjong with friends every day, said, “I think it is a waste of time and energy to learn how to use smartphones. There are other things waiting for me to do during the daylight hours … Learning smartphones does not seem beneficial to me.”

Feeling overwhelmed by a smartphone

Participants sometimes confused about how to use smartphones. Specifically, they cannot find what they are looking for in the smartphone, or they do not know which instruction icons they should click on to be allowed. Some participants described that “my mind went blank” or “I felt overwhelmed.” One participant shared, “When I open a software application, ads pop up. I don’t know how to close them. I feel blank about what to do next with my smartphone.” (Participant 14)

When asked why they experience blank moments, the participants explained that it was due to a lack of basic understanding of the various icons on smartphones, leading to confusion about different functions. “I cannot identify these icons. I do not know which icon is the right one to click” (Shrugged his shoulders). “So confused about their functions and meanings” (Participant 1).

Feeling anxious while using a smartphone

Some participants were concerned that any mis-operations may damage their smartphone and cause device malfunctions. The worries caused them to withdraw from interacting with smartphones.

I fear to damage my smartphone and mess up its functions. I feel this way … So, I operate my smartphone very cautiously. (Participant 11)

Moreover, most seniors have developed a strong awareness of fraud prevention. However, the anti-fraud mindset may worse smartphone use anxiety. “My wife is worried about smartphone security too much. She has stored some money in her WeChat account. Whenever she uses her smartphone, she is anxious about being scammed or having her account hacked” (Participant 8).

Objective constraints on smartphone use

Regarding using a smartphone, most participants want to but cannot. They complained about physical aging, age-unfriendly smartphone systems, and poor digital inclusion environment in nursing homes.

Physical aging

Physical aging severely impaired the ability to use smartphones in elderly individuals. Some participants reported that they were unable to see the icons on smartphones clearly, and as a result, they frequently touched the screen unintentionally due to perceptual impairments.

My eyesight is really poor. I cannot see the words on my smartphone clearly. Sometimes, I tap the screen, but it takes a long time to get a response. I do not know what is going on … It is hard when you get old. (Participant 5)

Some participants stated that physical aging created a sense of self-negation and further weakened their intention to act. One participant explained, “Learning new things is very challenging for older adults … I am too old to learn smartphones. So I usually try to avoid using it” (Participant 20).

In addition, participants were often frustrated by learning how to use smartphones due to memory decline. They lacked confidence in using such devices, and in some cases, even showed resistance to engaging with them.

Oh, my poor memory. I cannot remember how to use a smartphone even if someone teaches me …. It is really frustrating. I do not want to use it any more. (Participant 12)

Unfriendly operating system

The unfriendly system of smartphones severely affects user experience for older adults. Spam ads and malware nuisance made the smartphone system run sluggishly. Participants were worried about this.

My smartphone's operating system is really not user-friendly at all. Those pop-up ads keep popping up out of nowhere. If my hand shakes a little and I tap the wrong thing without thinking, it will jump straight to another page. And then it just starts downloading all this junk software. (Participant 22)

Participant 16, who was admitted to hospital due to hypertension, stated that the unfriendly system of smartphones made her upset, which was detrimental to her health.

Oh my goodness. It was an unpleasant memory. The system (smartphone) installed lots of junk software by itself. It pushed tons of ads, and I could not delete at all …, my blood pressure rose at that moment. (Participant 16)

Poor digital inclusion environment

Participants mentioned that smartphone usage was limited due to the poor digital inclusion environment in nursing homes. After entering into the nursing homes, they could not utilize previous interpersonal resources to learn smartphone use.

Participant 18, a resident who has just moved in for two months and often acts alone, told us: “Nursing home is an unfamiliar environment for me. No families or friends are by my side. It is not easy to find others to show me how to use a smartphone.”

For nursing home residents, it was difficult to establish the close relationship with new neighbors. Due to “not wanting to trouble others,” they were reluctant to seek digital assistance.

Furthermore, nursing home staff were often overwhelmed with daily care and physical health. The usual services rarely involved in digital support for the residents.

I ever asked the caregivers how to use a smartphone. They don’t have enough time to teach me well … There are no smartphone tutoring classes here. (Participant 21)

Practical strategies for digital inclusion

It is undeniably difficult for older adults to learn about smartphones. But most participants still shared valuable experiences in learning about smartphones and offered specific and actionable recommendations.

Visual smartphone use guidelines

The decline in memory and cognitive abilities negatively impact the learning of smartphones among older adults. One participant demonstrated his notes from the process of learning to use a smartphone and shared, “I am getting older and memory is not as good. When others teach me how to use a smartphone, I write it down so I can review it later” (Participant 13).

“Self-help manual,” “smartphone usage videos,” and “smartphone use flow” were commonly suggested by the nursing home residents. Another participant shared that “Teaching videos might be a better choice. Videos can simulate real-world scenarios, helping us better understand and apply the knowledge we have learned” (Participant 3).

Supportive digital environment

A digital setting was suggested to facilitate, enhance, and promote learning and interaction among nursing home residents. Some participants proposed small digital learning groups to capitalize on the strengths of the “big family.” This would encourage residents to help each other and foster a collaborative learning atmosphere.

Actually, we peers can understand our own needs of smartphone use. Nursing homes can organize us to learn together or share experiences. We can support each other. (Participant 6)

In addition to peer support, intergenerational support from youth volunteers and senior university volunteers was also recommended by the Participant 8. “I like to talk to and learn from young men. Seeing young men makes me happy.”

Furthermore, some participants indicated that providing digital assistance to older adults is a long-term project. They suggested nursing homes set up digital assistance stations for digital consultation services.

Digital poverty alleviation in older adults is a long-term project. Lectures are far from enough. A real service station should be set up in nursing homes to address their questions and concerns about the Internet and smartphones. (Participant 10)

Digital life scenario

Digital living scenario refers to the various contexts and situations in which digital technologies are integrated into everyday life. Some participants suggested that digital living scenarios could be developed to actively engage residents in daily life, such as through smartphone photography contests, new search contests, and connecting with friends, among other activities.

A smartphone photography contest could be held, inviting residents to record short videos of life in the nursing home. The contest will facilitate residents to learn and use smartphones. Surely, it will enrich our lives here. (Participant 6)

Besides, the participants suggested that digital devices could be integrated into the rehabilitation training in nursing homes, enabling more residents to participate in digital life.

Try having the residents wear smart bracelets. They can count steps and monitor heart rates when they exercise. This way, the residents can have more digital engagement and enjoy technological progress right here in the nursing home. (Participant 9)

Discussion

This qualitative study explored a deep understanding of the perspectives and concerns of nursing home residents about smartphone use in the context of the development of “Digital China.” The participants described current challenges that nursing home residents may face when using smartphones, including internal cognitive biases and objective constraints. Meanwhile, they offered valuable suggestions on how to improve smartphone use among nursing home residents from digital support perspective. This study enriches the understanding of smartphone use among nursing home residents and provides a reference for developing environment-sensitive digital inclusion strategies.

The present study has indicated the current divergent views on smartphone use among nursing home residents. Some participants viewed a smartphone as “best buddy” or “mobile treasure box,” while others considered it as a “landline.” The reasonable explanation is that the perceived usefulness plays a driving role in the process of technology adaptation.²⁶ Yang et al.²⁷ proposed that the desired effect produced by using a smartphone and the degree to which it helps in daily life directly affects older adults’ intention to use it. Some participants even mentioned that a smartphone is more helpful than expected, particularly because it can serve as a spiritual companion. Interestingly, while younger demographics may perceive increased work efficiency as a key advantage of smartphones,²⁸ nursing home residents might find the devices more valuable for the contribution to spiritual fulfillment and well-being. This not only indicated that digital life served as a bond for older adults to maintain emotional connections and enriched their spiritual and cultural life, but also required researchers to pay greater attention to meeting older adults’ spiritual needs through their interaction with the Internet when developing digital inclusion interventions in the future.

We also found that nursing home residents are prone to internal cognitive biases toward smartphones, which was mainly reflected in cognitive limitations and technology anxiety. Niehaves et al.²⁹ supported that individuals’ cognitive bias towards smartphones comes from fear of technological advancement, high self-learning costs, and lack of necessary knowledge. Moreover, participants in this study indicated that a lack of essential Internet knowledge can leave older users feeling at a loss when using smartphones. Similarly, Ma et al.¹⁵ reported that not understanding the meaning of symbols in smartphones often results in a poor experience for older users. Therefore, developing the digital knowledge and improving the digital skills of nursing home residents are key elements in promoting the process of digital inclusion. Towards this end, the suggestion from participants to provide smartphone video operation manuals for nursing home residents is a novel perspective not commonly reported in existing literature. This suggestion may take into account that video teaching is easy to imitate and convenient to store, making it more friendly for residents with limited cognitive abilities or declining memory. Pichayapinyo et al.³⁰ also suggested that creating instructional videos with simple language, clear sound, concise content, and easy comprehensibility and recall can effectively enhance patients’ motivation to learn. Furthermore, the changes in digital competency requirements and rapid technological advances have challenged the memory and cognitive abilities of older adults. We can foresee that continuous training and assistance will become essential digital support services for nursing home residents in the future. In this study, some participants advocated for the establishment of positive relationships between intergenerational volunteers and nursing home residents to help older adults overcome digital barriers. This is similar to the Engaging Generations: Cyber-Seniors Program initiative advocated and implemented by Leedahl et al.³¹ They argued that intergenerational digital support programs can provide technical assistance to older adults on the one hand, and help students develop communication and teaching skills on the other. Both students and older adults are mutually beneficial groups in such programs.³¹ Therefore, nursing home administrators could consider recruiting intergenerational volunteers to help older adults keep their digital knowledge up to date and consolidate their digital skills.

Additionally, this study has offered a holistic understanding of challenges to smartphone use among nursing home residents. One key challenge is the poor digital inclusion environment in nursing homes, which can affect individual's Internet acceptance. This is confirmed by Venkatesh et al.,³² who explained the positive correlation between social environment and the behavioral intentions to use the Internet based on the Technology Acceptance Model. Nursing home residents often have difficulties in accessing digital assistance due to the decreased levels of social support. Our participants presented that after moving into a nursing home, it is difficult to receive timely help from family and friends. Cheng et al.³³ also supported that changes in living environments can result in reduced social support in nursing home residents. Worse still, they felt embarrassed to ask for help from an unfamiliar roommate or a busy staff member. This phenomenon may be constrained by the concept of “self-sufficiency” in traditional Chinese culture.^34,35 It has made the Chinese people repel acts of “dependence” and tend to “avoid seeking help unless necessary” to prevent personal needs from disrupting collective harmony. Some participants in this study suggested that fostering a positive peer support atmosphere can enhance their digital support. The World Health Organization has advocated that peer support may be more catered to peer care demands.³⁶ As experienced experts, peers possess first-hand knowledge and experience. Therefore, they are able to uniquely connect with, and relate to individuals going through the challenge of “digital isolation.”^36,37 It implies that peer mentors or peer support groups could be an acceptable and feasible intervention strategy for digital inclusion activities.

This study has important implications for promoting digital inclusion among nursing home residents. Nursing homes could develop digital inclusion programs to improve the perceived usefulness of Internet use, digital operating skills, and the digital inclusion environment in nursing home residents. Priority could be given to building good senior peer support relationships. Regular digital skills sharing sessions can be organized, where residents with digital skills act as “peer mentors” to foster a mutual-aid atmosphere. Based on the provision of age-appropriate digital teaching resources that match their cognitive characteristics, nursing home residents should be encouraged to actively engage in digital life. Additionally, policymakers are suggested to advocate ageing-friendly reforms in terms of the supply of digital products and the software system upgrade, particularly for users with sensory or cognitive impairments. On the one hand, physical optimizations can be made to the display screens and speakers of smartphones through hardware upgrades, ensuring that users with sensory impairments can use them normally. On the other hand, remote collaboration functions could be added to smartphone systems. This would allow family members or nursing home staff to help senior users resolve difficulties encountered when using smartphones, within the scope of privacy agreements. Through the collaborative co-creation between care providers and biomedical engineers to design smartphones that are more tailored to the needs of senior users, it is expected that the digital inclusion process of nursing home residents in China will be better advanced.

Limitations

This study had some limitations. First, the study exclusively recruited nursing home residents, excluding the perspectives of the nursing home staff. Future research could incorporate the perspectives of more stakeholders to explore digital inclusion. Second, although we achieved data saturation and tried to cover nursing homes of different operating types, our sample was relatively small and homogenous in terms of race and geographic location. Future research is warranted to address these considerations. The study deserves to be replicated in nursing homes in other regions within worldwide.

Conclusion

Smartphones remain a subject of divergent views among Chinese nursing home residents in the context of the development of “Digital China.” Residents are adversely affected by subjective cognitive bias and objectively poor digital support environment regarding using smartphones. Nevertheless, insights from nursing home residents emphasize the importance of the perceived usefulness of Internet usage and the digital support environment. Moving forward, it is imperative for future research to develop suitable digital inclusion strategies for nursing home residents.

Supplemental Material

sj-pdf-1-dhj-10.1177_20552076251386671 - Supplemental material for Wandering at the crossroads of using a smartphone among nursing home residents: A qualitative descriptive study

Supplemental material, sj-pdf-1-dhj-10.1177_20552076251386671 for Wandering at the crossroads of using a smartphone among nursing home residents: A qualitative descriptive study by Qiyuan Huang, Yuanfeng Lu, Sheng Wu, Wan Cheng, Huangqin Liu and Huimin Xiao in DIGITAL HEALTH

Supplemental Material

sj-docx-2-dhj-10.1177_20552076251386671 - Supplemental material for Wandering at the crossroads of using a smartphone among nursing home residents: A qualitative descriptive study

Supplemental material, sj-docx-2-dhj-10.1177_20552076251386671 for Wandering at the crossroads of using a smartphone among nursing home residents: A qualitative descriptive study by Qiyuan Huang, Yuanfeng Lu, Sheng Wu, Wan Cheng, Huangqin Liu and Huimin Xiao in DIGITAL HEALTH

Footnotes

Acknowledgements

We would like to thank the nursing home residents for their participation.

ORCID iD

Qiyuan Huang

Ethical approval

This study was conducted with the approval of Fujian Medical University Biomedical Ethical Committee ([2024] BECFJMU(194)). All methods were performed in accordance with the Declarations of Helsinki. All participants were provided written informed consent.

Contributorship

QH drafted the manuscript, conducted data analysis and collected data, YL conducted data analysis and translated text, WC and SW were involved in discussing earlier versions of the text. HL translated text, HX conceived the study and drafted the manuscript. All authors participated in its design, read and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Guarantor

Huimin Xiao.

Supplemental material

Supplemental material for this article is available online.

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