"It's coming whether we want it to or not": A qualitative exploration of older adults' comfort with and perceptions of technology and digital health.

Background: Older adults bear a disproportionate cancer burden but remain underrepresented in digital health intervention trials compared to younger counterparts. Since the COVID-19 pandemic, engagement with telemedicine and patient portals through the electronic health record (EHR) has grown for all age groups, suggesting readiness to adopt digital health tools. This qualitative study primarily sought to understand how adults eligible for lung cancer screening (LCS) engage with technology and digital health in their daily lives. The secondary objective was to assess acceptability and compatibility of a video-based LCS health communication as a digital health tool. Methods: Semi-structured interviews were conducted with 15 participants aged 51-80 through videoconferencing or telephone. Transcripts were analyzed using a rapid team-based analysis approach. The Consolidated Framework for Implementation Research (CFIR) was used as a guiding framework from throughout the study, with constructs of interest informing interview guide questions in data collection, and CFIR-mapping to generate a code list in the analysis. Results: Our findings generated four CFIR-informed themes, with 8 subthemes: 1) Internal facilitators: comfort with technology, self-efficacy in troubleshooting; 2) External facilitators: leveraging internet for health information, use of wearable devices, patient portal functionalities; 3) Internal barriers: emotional response, social isolation; 4) External barriers: scamming and data privacy. When shown the LCS video-based health communication, participants described general approval of the content and delivery but expressed concerns about safety related to accessing the video due to its delivery via weblink. Conclusions: Broadly, we found that older adults had high levels of technology use and leveraged various digital tools (such as wearable devices, mobile applications, and EHR patient portals) to manage their health care needs. Our findings underscore that older adults are active users of digital tools, yet persistent concerns about privacy, social isolation, and emotional burden must be addressed for digital health interventions to be acceptable and sustainable in this population. Trial registration: ClinicalTrials.gov: NCT05747443; 2023-02-17.