When Healthcare goes digital, who gets left behind?

Healthcare is changing rapidly. Increasingly, we book appointments online, receive test results through digital portals, manage prescriptions using apps, communicate with health professionals electronically and turn to the internet when we want answers about our health. Digital technology has enormous potential to make healthcare more accessible, connected and personalised. But, as healthcare becomes increasingly digital, there is an important question we need to ask. “Who might be left behind?”

This is not simply a question about whether someone knows how to use a smartphone, computer or tablet. It is a question about equity, participation, and our ability to access and understand the healthcare we need. If essential parts of healthcare are increasingly delivered through digital systems, then being able to navigate those systems becomes increasingly important to our health. 

What the Research Tells Us

Recent research examining digital health literacy interventions for adults aged 45 years and over highlights why this matters. A scoping review of 24 studies found that interventions can improve peoples’ digital skills, confidence and self-efficacy, particularly when learning is delivered face to face, in small groups or through blended approaches. These are encouraging findings. However, the review also identified an important gap. Most interventions concentrated on psychological factors, while biological and social factors were considered much less consistently. There was also limited evidence that interventions improved critical thinking, sustained engagement or longer-term health outcomes. 

In other words; the answer to digital exclusion cannot simply be that we need to teach people more technology.

When the System Becomes a Barrier

Imagine receiving a message, telling you that important information about your health is available through an online portal. You need to create an account, remember a password, navigate several screens, find the information you need and understand what it means. For someone who is comfortable with technology, this might take a few minutes. For someone experiencing vision difficulties, reduced dexterity, anxiety about technology, limited internet access or simply a lack of confidence, the same process can become a significant barrier.

And that barrier can have consequences. 

More Than a Skills Gap

The problem is that we often talk about the ‘digital divide’ as though it is primarily an individual’s skills gap. Someone cannot use a particular technology, so we assume the solution is to teach them. But people’s experiences with technology are shaped by much more than technical ability. Engagement with digital technologies is influenced by interacting biological, psychological, social and digital factors, including health and functional capacity, confidence and previous experiences, social networks and support, education and financial circumstances, and access to devices and reliable internet connectivity.

This is why digital health literacy needs to be considered through an equity lens. None of these circumstances make someone less capable of making decisions about their health. They may simply mean the system has not been designed with them in mind. Rather than asking “Why can’t this person use the technology”, we should also ask “what could we change to make it easier for them to participate”.

What Digital Health Literacy Really Means

Digital health literacy is about far more than operating a device. It involves the ability to find, understand, evaluate and appropriately apply health information obtained through digital technologies. In an environment increasingly shaped by misinformation, artificial intelligence and algorithmically generated content, the ability to critically evaluate information may be one of the most important digital health capabilities we can develop. 

Beyond ‘Keeping Up’

Digital transformation therefore presents both an opportunity and a responsibility. Technology can improve access to healthcare, support self-management and reduce practical barriers. But if it makes healthcare easier for those who are already confident and connected, while creating new barriers for others, we risk increasing health inequality.

This means we need to move beyond the idea that people simply need to ‘keep up’ with technology. Sometimes equity means better digital education, sometimes it means simpler design, accessible information or additional support. It might also mean sometimes ensuring a non-digital option remains available. 

The goal is not to make everyone digitally independent at all costs. It is to ensure that people can participate meaningfully in their healthcare, regardless of their age, circumstances, abilities or level of digital confidence. Adults over 45 are not a single group, and digital health systems should recognise this diversity, rather than make assumptions based on age. 

Ultimately, digital healthcare is still healthcare. People deserve the same dignity, accessibility and choice whether care is delivered in person or through a screen. 

Technology should help close gaps in healthcare, not create new ones.