# The usage divide of digital health technology in age-friendly home modifications: an ethnographic study among older adults in rural China

## TL;DR

This study explores why older adults in rural China struggle to use digital health technologies in their homes, identifying barriers like skills, motivation, and support.

## Contribution

The study introduces a multidimensional framework to understand the usage divide of digital health technologies among older adults in rural China.

## Key findings

- The usage divide spans four dimensions: skills, motivation, support, and persistence.
- Older adults face barriers including cognitive misunderstandings, low self-efficacy, and inadequate community support.
- Effective use of digital health technologies requires more than access; it demands sustained support and motivation.

## Abstract

Digital health technologies, as an integral component of age-friendly home modifications in rural China, provide a promising pathway to address the challenges of population aging. However, a usage divide has emerged as a critical barrier, preventing older adults in these areas from fully benefiting from these technologies. This study aims to systematically examine this divide in the adoption of digital health technologies for age-friendly home modifications among older adults in rural China and to generate empirical evidence to inform policy and practice improvements.

This study employed a focused ethnographic approach, informed by the constant comparative method of grounded theory. Intensive fieldwork was undertaken from June to December 2024. Data were generated through participant observation and semi-structured interviews and subsequently analyzed using thematic analysis.

Within the context of age-friendly home modifications among older adults in rural China, the usage divide in digital health technology emerged across four interrelated dimensions. The skills divide was manifested in cognitive misunderstandings of functional purposes, procedural barriers to execution, and inadequate problem-solving strategies. The motivation divide stemmed from intergenerational gaps in value perception, multiple manifestations of psychological resistance, and persistently low self-efficacy. The support divide was reflected in the formalization dilemma of formal training, systemic gaps in family support, and resource bottlenecks in community-based support. Finally, the persistence divide encompassed barriers to forming stable technology habits, difficulties in adapting to system updates, and the cumulative effects of repeated setbacks.

Within the framework of age-friendly home modifications for older adults in rural China, the application of digital health technologies must transcend the narrow assumption that access alone guarantees use, shifting instead toward a comprehensive perspective that spans the continuum from access to effective utilization. The skills divide represents a fundamental barrier that undermines operational competence, while the motivation divide shapes willingness and readiness to engage with technology. The support divide provides the external conditions necessary to sustain both skills and motivation, and the persistence divide captures the temporal dynamics through which these dimensions evolve. Collectively, this multidimensional and dynamic usage divide explains why older adults in rural areas often fail to achieve effective use even after gaining access. It also reveals the mechanisms that determine whether technological availability is ultimately transformed into genuine empowerment. These findings contribute empirical evidence to refine rural age-friendly modification policies, narrow disparities in digital health technology use, and advance the dual goals of healthy aging and digital inclusion.