Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study.

backgroundThe emergence of eHealth services could contribute to improving individuals' quality of life by optimizing effective and efficient care. However, various challenges might limit some older adults' use of eHealth services.

objectiveThis study aimed to understand the perspectives of older adults (aged ≥65 years) of different backgrounds regarding eHealth services. We explored the experiences of Iranian immigrant and nonimmigrant older adults with eHealth services to identify their perceived challenges, emotions, and wishes. Immigrants face more challenges, and there is a need to understand their perspectives in addition to those of nonimmigrants. Iranians are one important immigrant group, as their number is limited and their specific needs are less well understood compared to those of the bigger immigrant groups.

methodsThis study used a qualitative explorative research design. Semistructured interviews were conducted between February 2023 and May 2023. The participants were 25 older adults: nonimmigrants residing in cities (n=8, 32%), nonimmigrants residing in rural areas (n=9, 36%), and Iranian immigrants residing in cities (n=8, 32%). Data were analyzed through inductive and deductive content analysis and interpreted through self-determination theory.

resultsInteracting with eHealth services was challenging for some older adults. They perceived several difficulties, with the most obvious ones being related to values and preferences, as some older adults did not value eHealth services (16/25, 64%), had insufficient digital skills (15/25, 60%), and experienced usability issues (15/25, 60%). The first two challenges were more pronounced among immigrants. In contrast, nonimmigrants from cities, being more familiar with the services, shared more usability issues. These identified challenges prevented older adults from satisfying their basic psychological needs of being competent and autonomous users and having a sense of belonging (aspects of self-determination theory), which were the main source of negative emotions. A common negative feeling was confusion (16/25, 64%) among those with limited experience using smart devices and those with poor self-reported digital skills. Conversely, older adults' interaction with eHealth services generated positive emotions that were connected to the satisfaction of their basic psychological needs. Being interested in using eHealth services was a common feeling among most participants regardless of their background and was connected to satisfying their need for being competent and autonomous. The positive emotions could be supported by applying older adults' needs to the design of eHealth services (10/25, 40%) and by supporting their digital skills (19/25, 76%).

conclusionsSome older adults value eHealth services and see their added benefits. However, various challenges limit their use of these services. The analysis of older adults' needs yielded several practical ideas that could improve the user-friendliness of the services and highlighted the importance of sufficient support services tailored to the cultural needs of specific groups of older adults.