Exploring Digital Health Literacy among the Elderly Population in North Karnataka, India: Influencing Factors and Barriers

Binu K M, H. Doddayya, Akshay J, Nuzhat Fatima, Pranotosh Mondal, Shifa Anjum, Toufeeq Rasheed,

doi:10.5281/zenodo.18016058

Research Paper | Open Access
Volume 03 | Issue 12 | Article Id IJPS/250312297

Exploring Digital Health Literacy among the Elderly Population in North Karnataka, India: Influencing Factors and Barriers
Binu K M* H. Doddayya Akshay J Nuzhat Fatima Pranotosh Mondal Shifa Anjum Toufeeq Rasheed
N.E.T Pharmacy College, Raichur, Karnataka

Abstract

Background: Digital health literacy (DHL) is increasingly essential for older adults as healthcare services shift toward digital platforms for accessing information, communication, and service delivery. However, elderly populations in developing regions often face barriers such as limited digital exposure, low education, and restricted access to technology. Objectives: To assess DHL among elderly individuals in North Karnataka and identify key demographic, technological, and social factors, along with barriers affecting the use of digital health services.. Methods: A questionnaire-based observational study was conducted among 150 elderly individuals (?60 years) in North Karnataka over six months. Data were collected face-to-face in Kannada using a validated tool assessing demographics, device access, digital use, support, and barriers. Descriptive statistics were analyzed using SPSS v26. Participants above 60 years were included, while those with severe mental impairment, communication difficulties, or unwillingness to consent were excluded. Results: Among 150 elderly participants, DHL was moderate (2.68–3.17). Scores varied slightly by age (2.83 ± 0.61 to 2.88 ± 0.68) and increased with education (2.76 ± 0.68 to 2.91 ± 0.57) and higher social status (2.93 ± 0.64). Daily digital health use showed the highest DHL (3.17 ± 0.57). IT support improved scores (up to 2.99 ± 0.65), while poor internet, limited devices, and low confidence reduced DHL (2.70– 2.81).Conclusion: Digital health literacy was moderate (2.68–3.17) and improved with higher education (2.76–2.91) and socioeconomic status (2.93). Daily digital health use showed the highest scores (3.17), and IT support increased literacy (2.99). Barriers like poor internet, limited devices, and low confidence lowered DHL (2.70–2.81). Training and better access can enhance DHL.

Keywords

Barriers, Digital health literacy, Digital transformation, Geriatrics, Health technology.

Introduction

The rapid development of information and communication technology (ICT) has resulted in an exponential increase in the availability of digital health tools, such as online health information systems and telehealth that provide people with opportunities to participate in their own health care and allow easier access to health care resources ¹. Digital health literacy (DHL) is defined as the capability of individuals to search, understand, evaluate and use health information obtained through online sources to make informed health decisions. DHL is important for health behavior, disease prevention and self-care behaviors, especially among those with high levels of chronic disease ^2,3.

The global population is rapidly aging; hence, the elderly are increasingly needing digital health capabilities. According to the United Nations, the number of people aged 60 years and older is projected to reach 2.1 billion by 2050 ⁴. Access to digital technologies has rapidly increased, however, older adults remain disadvantaged on the wrong side of the digital divide ⁵. Studies show older adults have problems using smartphones, personal computers, and online portals due to the limited history of exposure, decline in cognition and physical functioning, and lack of support during technology anxiety ⁶. This population group may therefore be disadvantaged in accessing key health information and services that are provided online ⁷.

A number of research studies have noted how there are multiple factors affecting DHL among older people. These factors range from demographic variables (age, education, income, environment) to psychosocial factors (motivation, self- efficacy, perceived usefulness) to external factors (technology access, family assistance, and social engagement) ^8,9. In opposition, barriers, such as poor digitized infrastructure, low literacy levels, privacy concerns, and lack of formal training, have continued to hold them back from being engaged in digital health environments ^10,11. In developing countries, these barriers are compounded by social, economic disparities, and lack of integration in the healthcare system ¹².

This study focused on assessing digital health literacy among the elderly population in selected districts of North Karnataka, India, specifically individuals aged 60 years and above. With increasing digitization of healthcare services, it is essential to understand how older adults access, interpret, and utilize digital health information.

The research explores various influencing factors such as education level, exposure to technology, socio-economic background, cognitive ability, and support from family or guardian. These elements play a crucial role in shaping the digital competence of elderly individuals.

In addition to identifying positive factors, the study also examines key barriers faced by the elderly. These include poor internet access, lack of digital devices, limited digital skills, mistrust in online information, and concerns about privacy and cost.

The findings of this study will provide valuable insights for policymakers, healthcare providers, and digital platform developers. The goal is to design effective strategies and support systems to improve digital health access and literacy among the aging population.

MATERIALS AND METHODS

A questionnaire-based observational study was conducted among elderly individuals aged 60 years and above in selected districts of North Karnataka, India, over a period of six months. The study aimed to assess the level of digital health literacy and to identify influencing factors and barriers among older adults. Participants aged above 60 years were selected from community centers, households, and outpatient clinics. Elderly individuals who were permanent residents of the study area and willing to participate were included, while those with severe mental impairment, communication difficulties, or who declined consent were excluded. Data were collected using a structured questionnaire adapted from previously validated studies on digital health literacy by Tran et al.¹³, titled Digital health literacy and its determinants among community-dwelling elderly people in Taiwan. The tool consisted of questions on socio-demographic details, access to digital devices, frequency of internet use, and self-assessed ability to search, understand, and use online health information, along with perceived barriers and support factors. The questionnaire was administered through face-to-face interviews in the local language (Kannada) by trained investigators to ensure comprehension. Data were coded and entered into Microsoft Excel and analyzed using SPSS version 26. Descriptive statistics such as mean, standard deviation, frequency, and percentage were used. The study was approved Institutional Ethical Committee of study hospital by using ethical clearance certificate.

Sample Size Calculation:

P= 0.50, Z= 1.96 at 95% CI, d= 0.08

n = Z² x p(1-p)

n = (1.96)² x 0.5 (1-0.5)

(0.08)²

n = 150

where Z = 1.96 for a 95% confidence interval, p = 0.50 (assumed prevalence of adequate digital health literacy from similar studies), and d = 0.08 (allowable error). Based on the calculation, n = 150 participants.

Statistical analysis:

The data collected was consolidated in an MS Excel spread sheet (2007 version). The data was meticulously checked for completeness and accuracy. Descriptive statistics, including frequencies and percentages were used to analyze data.

RESULTS

Table 1. Distribution of digital health literacy by participants’ characteristics (n = 150)

Variables	Total (n = 150)	DHL (M ± SD)
Age (years)
60–74	68 (45.3%)	2.83 ± 0.61
75–85	60 (40.0%)	2.86 ± 0.65
> 85	22 (14.7%)	2.88 ± 0.68
Gender
Male	82 (54.7%)	2.84 ± 0.55
Female	68 (45.3%)	2.83 ± 0.63
Formal education
Primary or below	52 (34.7%)	2.76 ± 0.68
Upper secondary	46 (30.7%)	2.85 ± 0.58
Senior high school or above	52 (34.7%)	2.91 ± 0.57
Marital status
Single	2 (1.3%)	2.69 ± 0.63
Married	110 (73.3%)	2.81 ± 0.65
Separated/Divorced/Widowed	38 (25.3%)	2.97 ± 0.48
Social status
Low	30 (20.0%)	2.68 ± 0.67
Medium	86 (57.3%)	2.85 ± 0.59
High	34 (22.7%)	2.93 ± 0.64
Medication payment ability
Very or fairlydifficult	54 (36.0%)	2.82 ± 0.64
Very or fairly easy	96 (64.0%)	2.84 ± 0.61
Reside
Urban	84 (56.0%)	2.85 ± 0.61
Suburban / Rural	66 (44.0%)	2.76 ± 0.65
Residence
Urban	106 (70.3%)	2.81 ± 0.64
Suburban / Rural	44 (29.7%)	2.85 ± 0.59
Number of people living in the same household
≤ 3	75 (50.1%)	2.81 ± 0.60
> 3	75 (49.9%)	2.88 ± 0.65

Among the 150 participants aged 60 years and above, digital health literacy (DHL) levels were moderate overall, with slight variations across demographic characteristics. Participants aged 60–74 years (45.3%) and 75–85 years (40.0%) showed similar DHL means (2.83 ± 0.61 and 2.86 ± 0.65), while those above 85 years (14.7%) had a slightly higher score (2.88 ± 0.68). Males (54.7%) and females (45.3%) demonstrated nearly identical literacy levels (2.84 ± 0.55 and 2.83 ± 0.63). Education had a noticeable influence, with those holding senior high school or higher education (34.7%) achieving the highest DHL mean (2.91 ± 0.57), followed by upper secondary (30.7%, 2.85 ± 0.58) and primary or below (34.7%, 2.76 ± 0.68). Marital status also showed some variation, as separated, divorced, or widowed participants (25.3%) had the highest DHL mean (2.97 ± 0.48), compared to married (73.3%, 2.81 ± 0.65) and single participants (1.3%, 2.69 ± 0.63). Participants with high social status (22.7%) reported greater DHL (2.93 ± 0.64) than those with medium (57.3%, 2.85 ± 0.59) or low (20.0%, 2.68 ± 0.67) status. Those who found it easy to pay for medications (64%) scored slightly higher (2.84 ± 0.61) than those who found it difficult (36%, 2.82 ± 0.64). Urban residents (56%) had higher DHL (2.85 ± 0.61) compared to suburban or rural participants (44%, 2.76 ± 0.65). Finally, participants living in households with more than three members (49.9%) had slightly higher DHL (2.88 ± 0.65) than those with three or fewer members (50.1%, 2.81 ± 0.60). Overall, education, social class, and marital status appeared to be key determinants of higher digital health literacy, whereas gender, residence, and household size showed minimal influence. Details were shown in table no 1.

Table 2: Use of Digital Health Information and Resources (n = 150)

Variables	Total (n = 150)	DHL (M ± SD)
Website for health information
< 1×/week	78 (52%)	2.82 ± 0.57
1–6×/week	48 (32%)	2.85 ± 0.50
≥ 1×/day	24 (16%)	3.01 ± 0.66
Social media / forums
< 1×/week	76 (50.7%)	2.89 ± 0.61
1–6×/week	48 (32%)	2.80 ± 0.47
≥ 1×/day	26 (17.3%)	3.02 ± 0.66
Digital device related to health care
< 1×/week	76 (50.7%)	2.93 ± 0.67
1–6×/week	48 (32%)	2.73 ± 0.49
≥ 1×/day	26 (17.3%)	2.99 ± 0.60
Health app on phone
< 1×/week	76 (50.7%)	2.85 ± 0.61
1–6×/week	48 (32%)	2.84 ± 0.51
≥ 1×/day	26 (17.3%)	3.01 ± 0.63
Digital interaction with health system
< 1×/week	76 (50.7%)	2.87 ± 0.56
1–6×/week	48 (32%)	2.79 ± 0.55
≥ 1×/day	26 (17.3%)	3.17 ± 0.57
Other digital resources
< 1×/week	74 (49.3%)	2.84 ± 0.54
1–6×/week	50 (33.3%)	2.83 ± 0.49
≥ 1×/day	26 (17.3%)	3.12 ± 0.60

Use of digital health information and resources showed clear associations with digital health literacy (DHL) levels. Participants who accessed websites for health-related information less than once per week (52%) had a moderate DHL mean of 2.82 ± 0.57, while those who used them daily or more often (16%) exhibited a higher mean of 3.01 ± 0.66. Similarly, participants who used social media or online forums for health information less frequently (50.7%) had a mean DHL of 2.89 ± 0.61, compared to 3.02 ± 0.66 among those engaging daily. The pattern was consistent for digital devices related to health care, where daily users showed the highest literacy (2.99 ± 0.60) compared to infrequent users (2.93 ± 0.67). Participants who used health apps on their phones and interacted digitally with health systems more regularly demonstrated higher DHL scores, with daily users reaching around 3.0 or above, particularly those engaging daily with their health system (3.17 ± 0.57). Likewise, those who used other digital resources for health information once a day or more (17.3%) achieved a higher DHL mean (3.12 ± 0.60) than those who used them rarely (2.84 ± 0.54). Overall, the findings indicate that more frequent engagement with digital health platforms—websites, social media, health apps, and other online resources—is associated with higher digital health literacy, suggesting that regular use and familiarity with digital tools enhance individuals’ ability to access and utilize health-related information effectively. Data were depicted in table no2.

Table 3: IT-Related Social Support (n=150)

Variables	Total (n = 150)	DHL (M ± SD)
Find someone to help you find a site/service
Difficult	38 (25.3%)	2.68 ± 0.76
Neutral	52 (34.7%)	2.74 ± 0.53
Easy	60 (40%)	2.90 ± 0.60
Frequency of internet use to find others
Rarely	44 (29.3%)	2.80 ± 0.77
Sometimes	58 (38.7%)	2.76 ± 0.46
Often	48 (32%)	2.99 ± 0.65

Among 150 participants, levels of digital health literacy (DHL) were influenced by the degree of IT-related social support available to them. Participants who found it easy or very easy to get help from someone in finding a particular health-related site or service (40%) demonstrated a higher DHL mean of 2.90 ± 0.60, compared to those who found it difficult or very difficult (25.3%), whose mean was 2.68 ± 0.76. Those who felt neutral about the availability of such help (34.7%) had a moderate DHL level (2.74 ± 0.53). Similarly, when examining how often participants used the internet to connect with others facing similar health issues, those who did so often or very often (32%) recorded the highest DHL mean (2.99 ± 0.65), followed by those who did so sometimes (38.7%) with 2.76 ± 0.46, and rarely or very rarely (29.3%) with 2.80 ± 0.77. Overall, the findings indicate that having social and technical support when navigating online health information and frequently using the internet for peer interaction are associated with higher digital health literacy, emphasizing the importance of both interpersonal assistance and active online engagement in enhancing digital competence among older adults. Data were shown table no 3.

Table 4: Barriers and Enhancers of Digital Health Service Use (n=150)

Variables	Total (n = 150)	DHL (M ± SD)
Bad/unstable internet connection
Untrue	76 (50.7%)	2.84 ± 0.72
Neutral	48 (32%)	2.77 ± 0.54
True	26 (17.3%)	2.95 ± 0.65
No device available at all times
Untrue	70 (46.7%)	2.92 ± 0.59
Neutral	34 (22.7%)	2.70 ± 0.54
True	46 (30.7%)	2.81 ± 0.74
Not good at using devices
Untrue	58 (38.7%)	2.91 ± 0.62
Neutral	44 (29.3%)	2.79 ± 0.53
True	48 (32%)	2.78 ± 0.75
Difficult to understand internet content
Untrue	60 (40%)	2.94 ± 0.61
Neutral	44 (29.3%)	2.72 ± 0.53
True	46 (30.7%)	2.81 ± 0.72
Too old to use online services
Untrue	66 (44%)	2.93 ± 0.62
Neutral	34 (22.7%)	2.74 ± 0.51
True	50 (33.3%)	2.79 ± 0.70
No time
Untrue	38 (25.3%)	2.91 ± 0.63
Neutral	74 (49.3%)	2.72 ± 0.52
True	38 (25.3%)	2.82 ± 0.69
Can’t afford devices/services
Untrue	90 (60%)	2.89 ± 0.60
Neutral	24 (16%)	2.78 ± 0.57
True	36 (24%)	2.79 ± 0.70
Worry about cost of devices/services
Untrue	80 (53.3%)	2.86 ± 0.63
Neutral	38 (25.3%)	2.76 ± 0.54
True	32 (21.3%)	2.86 ± 0.65
Don’t trust online information
Untrue	32 (21.3%)	2.90 ± 0.65
Neutral	48 (32%)	2.76 ± 0.57
True	70 (46.7%)	2.87 ± 0.65
No one to help navigate digital system
Untrue	66 (44%)	2.90 ± 0.63
Neutral	42 (28%)	2.72 ± 0.51
True	42 (28%)	2.85 ± 0.69
Good at surfing internet
Untrue	58 (38.7%)	2.70 ± 0.70
Neutral	34 (22.7%)	2.78 ± 0.46
True	58 (38.7%)	3.06 ± 0.64
Relatives/others help surf internet
Untrue	38 (25.3%)	2.69 ± 0.72
Neutral	56 (37.3%)	2.80 ± 0.56
True	56 (37.3%)	2.92 ± 0.60
Have computer/tablet/Smartphone
Untrue	40 (26.7%)	2.70 ± 0.72
Neutral	46 (30.7%)	2.73 ± 0.52
True	64 (42.7%)	3.00 ± 0.61

As show in table no 4, among the 150 participants, several barriers and enhancers were identified that influenced digital health literacy (DHL) levels. Participants who reported having a stable internet connection showed higher DHL scores (2.84 ± 0.72) than those with unstable connections (2.95 ± 0.65), indicating that internet quality impacts literacy. Access to digital devices also played an important role—those who had a computer, tablet, or smartphone available at all times demonstrated higher DHL (3.00 ± 0.61) compared to those without regular access (2.70 ± 0.72). Participants who felt confident in using digital devices and comfortable understanding online information had better literacy levels (around 2.9– 3.0), while those who found it difficult to manipulate devices or understand online content showed lower scores (around 2.7–2.8). Similarly, those who disagreed with statements such as “I am too old to use online services” or “I have no time” reported higher DHL means (about 2.9 ± 0.6) than those who agreed (around 2.7–2.8). Financial concerns had minimal impact, as most participants who could not afford devices or worried about costs still maintained moderate DHL levels (2.78–2.86). Participants who trusted online information and had someone to help navigate digital systems tended to score higher (2.85–2.90) than those who lacked support. Confidence in digital skills strongly enhanced literacy—participants who stated “I am good at surfing the internet” recorded the highest DHL mean (3.06 ± 0.64). Similarly, those whose relatives or others helped them surf the internet showed improved literacy (2.92 ± 0.60). Overall, the findings highlight that access to devices, confidence in digital skills, availability of support, and a positive attitude toward technology act as enhancers, while limited access, low confidence, and perceived barriers such as lack of time or technical difficulty serve as constraints to achieving higher digital health literacy among older adults.

DISCUSSION

The present study explored the level of digital health literacy (DHL) among 150 older adults and examined various demographic, behavioral, and social factors influencing it. Overall, participants demonstrated a moderate level of DHL, which aligns with previous findings among elderly populations across different settings. Similar to the results of Kong and Wang, the present study revealed that education level, social class, and frequency of digital engagement were among the most influential factors. Participants with higher education and better socioeconomic status reported greater confidence and capability in accessing and interpreting online health information, suggesting that lifelong learning and prior exposure to technology play crucial roles in improving digital literacy among the elderly.

Although DHL levels varied slightly across age groups, the results indicated that age alone was not a major determinant of digital competence. This finding is consistent with Jung et al, who noted that e-health literacy evolves with experience and motivation rather than chronological age. Participants aged 60–74 years and 75–85 years displayed similar DHL scores, whereas those above 85 years showed only a marginal decline, reflecting that older adults can retain or enhance digital skills when supported by exposure and guidance. This pattern aligns with the cross-sectional study by Zhang et al, which found that attitude toward technology and educational background were stronger predictors of DHL than age in Chinese elderly populations.

Frequent engagement with digital platforms was strongly associated with higher DHL levels. Participants who regularly used websites, social media, health apps, or digital devices to obtain health information exhibited significantly higher literacy compared to those with limited or no digital exposure. These findings are consistent with the reviews by Leung et al and Shi et al, which emphasized that repetitive use and familiarity with digital resources contribute to confidence and independence in navigating online health systems. Similarly, those who interacted with health systems digitally on a daily basis recorded the highest DHL means, demonstrating that continued digital participation enhances health-related knowledge and self-efficacy.

Social and technical support were also found to be major enhancers of DHL. Participants who found it easy to get assistance when searching for health- related information online or who frequently connected with others experiencing similar health concerns showed significantly higher literacy levels. This finding corroborates the qualitative study by Shao et al, which identified interpersonal encouragement and family involvement as critical factors in motivating older adults to use digital health resources. Moreover, peer support and intergenerational help—such as guidance from children or relatives—were shown to improve self-confidence and willingness to adopt technology, a trend also reported by Wilson et al.

Conversely, several barriers were identified that hindered the effective use of digital health services. Participants who reported unstable internet connections, limited device access, or difficulty understanding online content exhibited lower DHL scores, mirroring barriers identified in global studies. In particular, Almulhem found that cost, lack of technical training, and fear of privacy breaches were key deterrents to mobile health adoption among the elderly in Saudi Arabia. In this study, participants who lacked confidence in handling digital devices or believed they were “too old” to use online services scored lower, further supporting the conclusions of Shi et al, who emphasized the influence of self-perception and psychological readiness on digital engagement.

Importantly, participants who described themselves as good at surfing the internet or had access to digital devices such as smartphones, tablets, or computers demonstrated the highest DHL means. This is in line with the work of Kong and Wang, who highlighted that self-efficacy, device accessibility, and continuous digital practice are among the strongest predictors of information literacy in older adults. Furthermore, the results underscore that training programs focusing on practical digital skills, supported by community-based interventions, can enhance digital confidence and sustainability in technology use. These findings echo recommendations from Jung et al and Zhang et al, who proposed structured digital education programs and user-friendly technologies tailored to older users.

CONCLUSION

Overall, this study supports a multidimensional understanding of digital health literacy as shaped by personal, social, and environmental factors. Educational attainment, socioeconomic background, access to technology, and family or peer support emerged as facilitators, while poor internet infrastructure, low confidence, and limited experience acted as barriers. The results suggest that improving digital literacy among older adults requires a combination of technical training, emotional support, and inclusive digital design. Efforts to create accessible learning environments, strengthen intergenerational mentoring, and provide affordable technology are crucial strategies to reduce the digital divide and empower older adults to engage effectively in digital health management.

ACKNOWLEDGEMENT:

The authors would like to thank hospital staff members for their cooperation and support in the completion of the project.

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