Age-friendly eHealth strategies: Qualitative insights from older persons in Sri Lanka on digital health information access

Age-friendly eHealth strategies: Qualitative insights from older persons in Sri Lanka on digital health information access | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Age-friendly eHealth strategies: Qualitative insights from older persons in Sri Lanka on digital health information access Bhumini Janani Karunarathna, Shiromi Maduwage, Millawage Supun Dilara Wijesinghe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7396557/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Rapid population aging in Sri Lanka is paralleled by the rising burden of chronic diseases, prompting older adults to seek web-based health information. However, the factors that enable or hinder this behavior in low-resource, urbanizing settings remain poorly understood. In this study, we explored the individual, technological, and sociocultural determinants of online health information retrieval among community-dwelling older persons in the Colombo district, Sri Lanka. Methods A qualitative descriptive study employed five focus group discussions with 40 adults (60–83 years; 62% women) purposively sampled for variation in gender, education, and digital literacy. Semi-structured guides, developed in Sinhala, Tamil, and English, and pilot-tested for clarity, elicited experiences of searching for health information online. The sessions were audio-recorded, transcribed verbatim, translated, and thematically analyzed in NVivo 14 by two independent coders using an inductive approach. Methodological rigor was supported through member checking, reflexive journaling, an audit trail, and saturation monitoring. Results Three overarching themes emerged from the data. Individual influences included: (i) belief in the usefulness of online health information, (ii) desire to learn, and (iii) prior positive eHealth experiences as facilitators; countered by (iv) age-related functional decline, (v) technophobia, (vi) mistrust of online accuracy, and (vii) English-language dominance as barriers. Technological influences featured audio-visual formats as the sole facilitator, while barriers comprised limited device ownership, complex interfaces, poor connectivity, dense content, and lack of formal training. Socio-cultural influences revealed family encouragement, peer learning and perceived cost-savings as motivators, contrasted with reduced interpersonal contact and a cultural perception that “the Internet is for the young.” Conclusions Older adults’ engagement with digital health content is shaped by a dynamic interplay of personal motivation, age-friendly technology, and supportive social networks. Interventions should pair intergenerational digital-literacy training with intuitive multimedia platforms and culturally sensitive messaging to narrow the digital health divide. Aged Health Information Seeking Behavior Internet Health Literacy Qualitative Research Introduction The global population is rapidly aging, with significant implications for healthcare systems worldwide ( 1 ). By 2030, one in six people globally will be aged 60 years or older, a trend mirrored in Sri Lanka, where 20% of the population is projected to fall into this age group ( 2 ). The Colombo district, the nation’s most urbanized region, already reflects this demographic shift, with 12.5% of its population aged 60 years or older ( 2 ). This aging trajectory emphasizes the urgent need to address health challenges prevalent among older adults, including chronic conditions such as hypertension (54.7%), hypercholesterolemia (48.7%), and diabetes mellitus (46.5%) ( 3 ). Managing these conditions often necessitates frequent medical consultations and access to reliable health information ( 4 ). In response, older adults increasingly turn to digital platforms for health-related information, particularly in resource-limited or remote settings where healthcare access is constrained ( 5 , 6 ). eHealth interventions, such as online health messages, have emerged as promising tools in Sri Lanka to bridge gaps in preventive care, including cardiovascular disease management ( 7 ). Studies have highlighted their potential to improve health literacy and empower older adults to engage in self-care ( 8 ). However, the effectiveness of these interventions hinges on equitable digital access and the ability of older populations to navigate online resources, a challenge compounded by infrastructural, sociocultural, and cognitive barriers ( 9 , 10 ). Despite the growing emphasis on eHealth, research in Sri Lanka remains nascent, particularly regarding older adults’ experiences. Existing studies have predominantly focused on the quantitative assessment of technology adoption ( 11 ) or clinical outcomes ( 7 ), neglecting the lived experiences of older adults navigating digital health tools. For instance, while infrastructural barriers such as internet connectivity have been documented ( 6 ), deeper sociocultural factors such as digital literacy, trust in online information, and intergenerational support remain underexplored ( 12 ). This gap is critical, as qualitative insights are essential for designing age-friendly eHealth strategies that align with the needs and capabilities of older adults ( 13 ). Without such insights, eHealth interventions risk perpetuating disparities, particularly among older persons in urban settings such as the Colombo district, where digital infrastructure is available but underutilized by this demographic ( 2 , 6 ). This qualitative study addresses this gap by exploring the facilitators and barriers influencing online health information retrieval among adults aged ≥ 60 years in the Colombo district of Sri Lanka. The findings will inform targeted strategies to enhance the accessibility and relevance of eHealth interventions for older populations. Methods This qualitative study employed Focus Group Discussions (FGDs) to explore the facilitators and barriers to retrieving online health information among older adults (≥ 60 years) in Colombo district, Sri Lanka. The FGD methodology was chosen to capture dynamic, socially constructed perspectives through group interactions, enabling a deeper exploration of shared cultural and contextual experiences ( 14 ). Data collection occurred between June and July 2024. Participants were recruited via purposive sampling to ensure representation across gender, education level, and digital literacy. The inclusion criteria required individuals to be aged ≥ 60 years, reside in Colombo district for at least six months, and have attempted to access online health information within the past year. The exclusion criteria included terminal illness, blindness, or severe cognitive impairment. Five FGDs, each consisting of six to eight participants, were conducted until thematic saturation ( 15 ) was achieved, defined as the point at which no new themes emerged in the final two discussions. Recruitment was conducted through community centers, senior clubs, and referrals from public health workers to ensure participant diversity. A semi-structured interview guide (Appendix) was developed in Sinhala, Tamil, and English, Sri Lanka’s official languages, and pilot-tested with five older adults, and subsequently revised for clarity. The guide comprised demographic questions related to age, education, and frequency of internet use; open-ended prompts such as, “Describe a time you sought health information online, what helped or hindered you?” and probes aimed at clarifying nonverbal cues, such as hesitation or enthusiasm. The Principal Investigator (PI), a public health researcher with five years of qualitative research experience, along with two bilingual data collectors trained over three sessions, conducted the FGDs. Their training included instructions on neutral probing techniques, managing dominant participants, and recording detailed field notes on group dynamics. FGDs were conducted in quiet community halls familiar to the participants to minimize power imbalances. Written informed consent, emphasizing voluntary participation and anonymity through assigned random identification numbers, was obtained, along with verbal consent for audio recording. Sessions lasted between 60 and 90 minutes and included breaks to accommodate participant fatigue. Audio recordings were transcribed verbatim in their original languages and translated into English by bilingual experts, with cross-checks performed for accuracy. Using an inductive approach, the PI and an independent qualitative researcher familiarized themselves with transcripts, generated initial codes such as “distrust of online sources” and “family support,” and iteratively grouped these codes into themes like “Sociocultural influences” utilizing NVivo 14 software. Discrepancies were resolved through consensus. Rigor and trustworthiness were ensured through several strategies: credibility was supported by member checking, summarizing key points immediately after FGDs for participant validation; dependability was maintained via an audit trail documenting coding decisions and the evolution of themes; transferability was enhanced through thick descriptions of participant quotes and contexts; and confirmability was assured by maintaining reflexivity journals that documented researchers’ assumptions, such as the PI’s potential bias toward digital literacy as a primary barrier. Saturation was confirmed when the fifth FGD replicated themes from prior discussions without introducing new concepts. Results Five focus group discussions were conducted with 40 older persons representing diverse age groups and socioeconomic backgrounds (Table 1 ). Mean age of the participants was 69.88 years. Table 1 Sociodemographic characteristics of the participants of FGDs Socio-demographic characteristic Frequency Percentage (%) Age (in completed years) 60–69 20 50.0 70–79 15 37.5 80 and above 5 12.5 Sex Male 21 52.5 Female 19 47.5 Education level Grade 1 to 5 02 5.0 Grade 6 to 10 04 10.0 GCE O/L* completed 11 27.5 GCE A/L** completed 18 45.0 Diploma/ vocational training 02 5.0 Degree and above 03 7.5 Monthly family income (in Sri Lankan rupees) 100000 03 7.5 Thematic analysis revealed three primary themes, each encompassing interconnected facilitators and barriers that influence online health information retrieval. The themes are presented below, integrating sub-themes and retaining original participant quotes to contextualize findings (Table 2 ). Theme 1: Individual influences Participants acknowledged the benefits of online health information , particularly its ability to provide specialized knowledge from experts, which motivated its use. Many expressed a desire to learn , driven by their curiosity about health and technology. A 73-year-old unemployed man emphasized this, stating, “I like to learn new things even at this age. Now I’m 73. However, I like to learn new things, even from computers. When the lab sends my blood report to my phone, I like to see it myself. So, I would like to learn how to see it. I have high blood cholesterol. I like to watch YouTube videos about food items that reduce my cholesterol.” Positive prior experiences with eHealth services, such as telemedicine during the COVID-19 pandemic, further reinforced engagement. A 68-year-old retired teacher noted, “I got down my clinic medicine from the pharmacy ordering through WhatsApp during the COVID time. We used the Facebook page of our MOH office to determine vaccination dates. With that practice, still I look at that to get any new health information.” However, aging-related limitations , including physical decline (e.g., tremors and poor vision) and cognitive challenges (e.g., memory loss), hindered access. An 80-year-old man described, “I cannot keep on holding the phone to press any button to see anything. My hands are shaking. I do not have any energy now. Phone falls.” Additionally, fear of technology and distrust of online accuracy deterred its use. A 64-year-old pensioner admitted, “I am scared to press buttons - too many things pop up. I might misunderstand and harm myself.” Language barriers compounded these issues, as most content was in English, which is a secondary language for many. Theme 2: Technological influences Participants valued audio-visual content for its clarity and engagement, such as videos demonstrating healthy practices. However, device accessibility was a critical barrier, as many relied on borrowed devices. The technical complexity of navigating browsers, connecting to networks, or using apps frustrated older users. Rural participants highlighted poor Internet connectivity , with frequent disruptions discouraging use. Content overload also reduced utility, as technical jargon or excessive information overwhelmed users. A 70-year-old housewife remarked, “What I dislike the most is that, on the Internet, they tell us a lot of information at once within a short time. We, old people need some time and space to understand those one by one.” A lack of formal training on device/internet usage left many participants dependent on informal support systems. Theme 3: Socio-cultural influences Family and peer support played pivotal roles in facilitating access to care. A 66-year-old housewife shared, “My granddaughter has a lot of patience. She is the one who teaches everything on this phone and how to use the internet. She motivates me to look at important health messages and videos on the internet too.” Peer networks in social groups provide opportunities for collaborative learning. Cost-effectiveness also encouraged use, as online resources were perceived as cheaper than consultations or printed materials. A 62-year-old pensioner explained, “These days you need lot of money to channel a doctor. Books and magazines with health information are also very costly. Therefore, I like to get health information from the internet. For that, I don’t have to pay.” Conversely, some lamented the impersonal nature of digital platforms. A 60-year-old retired teacher noted, “I like when my doctor or nurse tells me something with a beautiful smile and kind words. Sometimes they touch my hand also. My doctor calls me “Amma” (referring to mother). These phones and computers can’t do that. They only show us some facts.” Cultural perceptions further deterred engagement, as technology was viewed as inappropriate for older persons . Many felt that this aligned with youth, creating reluctance to explore online tools. Table 2 Barriers and facilitators for digital health information access Theme (level of influence) Facilitators Barriers Theme 1: Individual-level influences 1. Belief that online health information is beneficial 2. Desire to learn 3. Previous positive experience with eHealth 1. Limitations due to aging (e.g., vision, tremor, cognition) 2. Fear and dislike of new technology 3. Concerns about trustworthiness/accuracy of online information 4. Language barriers Theme 2: Technological influences 1. Use of audio-visuals 1. Unavailability of a suitable device 2. Complex functionality of devices 3. Poor Internet connection 4. Complexity of online content 5. Lack of user training Theme 3: Socio-cultural influences 1. Support from the family 2. Peer learning 3. Cost-effectiveness 1. Poor social interaction (loss of human touch) 2. Sense of cultural inappropriateness Discussion This study explored the facilitators and barriers influencing online health information retrieval among older persons through five FGDs involving 40 participants. Participant diversity across age and socioeconomic backgrounds minimized selection bias, while homogeneous FGD groupings ensured psychological safety and data credibility. A semi-structured guide with open-ended questions reduced response bias ( 11 ), and independent coding enhanced analytic robustness. Conducting multiple FGDs balanced the potential group-specific biases. However, reliance on self-reported data and the absence of key informant perspectives (e.g., healthcare providers) limit the contextual depth of the gap addressed in the recommendations. Individual influences Participants’ belief in the benefits of online health information aligns with studies highlighting its role in empowering older adults to manage their health proactively ( 16 ). The desire to learn mirrors findings among patients with heart failure motivated by technological curiosity ( 17 ), while positive eHealth experiences reinforce self-confidence and sustained engagement ( 18 ). Conversely, aging-related physical and cognitive decline echo global evidence of sensory and motor challenges restricting technology use ( 19 , 20 ). Fear of technology and distrust of online accuracy, consistent with previous studies ( 21 – 23 ), underscore the need for intuitive designs and credibility markers. Language barriers, particularly in non-English contexts ( 20 ), further highlight the systemic inequities in digital health access. Technological influences Audio-visuals have emerged as critical facilitators, paralleling their efficacy in health education ( 24 ). However, device inaccessibility and technical complexity, mirroring barriers in German and Colombian studies ( 20 , 23 ), reflect socioeconomic and usability gaps. Poor connectivity in rural areas, consistent with prior findings ( 25 ), exacerbates this exclusion. Content complexity and information overload, noted in older populations ( 26 ), require simplified and layered content delivery. The lack of training observed in African American cohorts ( 27 ) underscores the urgency of implementing structured digital literacy programs. Socio-cultural influences Family and peer support proved pivotal, aligning with global evidence of intergenerational learning ( 20 , 28 ). Cost-effectiveness resonates with studies emphasizing the economic advantages of eHealth ( 29 ). However, reduced social interaction and perceived cultural inappropriateness echo preferences for humanized care ( 22 , 25 ) and generational stereotypes ( 30 ), highlighting tensions between efficiency and empathy in digital transitions. In Sri Lanka’s aging society, enhancing digital literacy and infrastructure is critical to ensuring equitable access to healthcare. National programs should combine training initiatives with affordable Internet access, particularly in rural areas. Tailored eHealth tools that balance efficiency with human-centered design can foster autonomy in chronic disease management and strengthen preventive care engagement. Strengths and limitations Strengths include rigorous methodology (diverse sampling, independent coding) and thematic saturation across the FGDs. Limitations include reliance on participant recall, exclusion of caregiver/provider perspectives, and contextual specificity to Sri Lanka, which may limit generalizability. Conclusions and recommendations Age-related barriers, content complexity, and language inequities restrict older adults’ access to digital health. To address this, eHealth platforms must prioritize age-friendly designs, such as larger fonts, intuitive interfaces, multilingual options, and audio-visual aids. Future research should integrate key informant interviews with providers and caregivers to holistically map the determinants of digital inclusion. Abbreviations FGDs Focused Group Discussions PI Principal Investigator Declarations Author declarations Ethics approval and consent to participate All methods used in this study were performed in accordance with the ethical principles of the Declaration of Helsinki for medical research involving human subjects. Ethical clearance was obtained from the Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka. We obtained verbal informed consent from all the participants (reference number: EC-23-029). Clinical trial number not applicable Consent for publication Not applicable. Funding This study did not receive any specific grants from funding agencies. Author Contribution Conceptualization, BJK,SM; Methodology; BJK, MSDW, SM; Formal analysis, BJK, MSDW; Investigation; BJK; Resources, BJK, SM, MSDW; Data curation; BJK,SM; Writing – original draft; BJK; Writing - review & editing, BJK, SM, MSDW; Supervision, SM, MSDW; Project administration, BJK,SM All authors have read and agreed to the published version of the manuscript. Acknowledgements We acknowledge all individuals who contributed to this research Data Availability The datasets used in this study are available from the corresponding author upon reasonable request. The authors declare no conflicts of interest References Older persons| United Nations. Available from: https://emergency.unhcr.org Perera S, Fund SLUNP. 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Supplementary Files SemistructuredInterviewguidefortheFGDEnglish.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 30 Sep, 2025 Editor assigned by journal 23 Sep, 2025 Editor invited by journal 05 Sep, 2025 Submission checks completed at journal 05 Sep, 2025 First submitted to journal 05 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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04:22:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":653841,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7396557/v1/3d200037-711c-47ab-ae2c-73a996e66a4e.pdf"},{"id":93363582,"identity":"c6b07c1b-5e3b-474b-ba95-27faf9f66e02","added_by":"auto","created_at":"2025-10-13 04:06:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":100232,"visible":true,"origin":"","legend":"","description":"","filename":"SemistructuredInterviewguidefortheFGDEnglish.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7396557/v1/70cd4e55e45c022a3b98b9f3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Age-friendly eHealth strategies: Qualitative insights from older persons in Sri Lanka on digital health information access","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global population is rapidly aging, with significant implications for healthcare systems worldwide (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). By 2030, one in six people globally will be aged 60 years or older, a trend mirrored in Sri Lanka, where 20% of the population is projected to fall into this age group (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The Colombo district, the nation\u0026rsquo;s most urbanized region, already reflects this demographic shift, with 12.5% of its population aged 60 years or older (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This aging trajectory emphasizes the urgent need to address health challenges prevalent among older adults, including chronic conditions such as hypertension (54.7%), hypercholesterolemia (48.7%), and diabetes mellitus (46.5%) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Managing these conditions often necessitates frequent medical consultations and access to reliable health information (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn response, older adults increasingly turn to digital platforms for health-related information, particularly in resource-limited or remote settings where healthcare access is constrained (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). eHealth interventions, such as online health messages, have emerged as promising tools in Sri Lanka to bridge gaps in preventive care, including cardiovascular disease management (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Studies have highlighted their potential to improve health literacy and empower older adults to engage in self-care (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). However, the effectiveness of these interventions hinges on equitable digital access and the ability of older populations to navigate online resources, a challenge compounded by infrastructural, sociocultural, and cognitive barriers (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the growing emphasis on eHealth, research in Sri Lanka remains nascent, particularly regarding older adults\u0026rsquo; experiences. Existing studies have predominantly focused on the quantitative assessment of technology adoption (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) or clinical outcomes (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), neglecting the lived experiences of older adults navigating digital health tools. For instance, while infrastructural barriers such as internet connectivity have been documented (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), deeper sociocultural factors such as digital literacy, trust in online information, and intergenerational support remain underexplored (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). This gap is critical, as qualitative insights are essential for designing age-friendly eHealth strategies that align with the needs and capabilities of older adults (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Without such insights, eHealth interventions risk perpetuating disparities, particularly among older persons in urban settings such as the Colombo district, where digital infrastructure is available but underutilized by this demographic (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). This qualitative study addresses this gap by exploring the facilitators and barriers influencing online health information retrieval among adults aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years in the Colombo district of Sri Lanka. The findings will inform targeted strategies to enhance the accessibility and relevance of eHealth interventions for older populations.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis qualitative study employed Focus Group Discussions (FGDs) to explore the facilitators and barriers to retrieving online health information among older adults (\u0026ge;\u0026thinsp;60 years) in Colombo district, Sri Lanka. The FGD methodology was chosen to capture dynamic, socially constructed perspectives through group interactions, enabling a deeper exploration of shared cultural and contextual experiences (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Data collection occurred between June and July 2024.\u003c/p\u003e\u003cp\u003e Participants were recruited via purposive sampling to ensure representation across gender, education level, and digital literacy. The inclusion criteria required individuals to be aged\u0026thinsp;\u0026ge;\u0026thinsp;60 years, reside in Colombo district for at least six months, and have attempted to access online health information within the past year. The exclusion criteria included terminal illness, blindness, or severe cognitive impairment. Five FGDs, each consisting of six to eight participants, were conducted until thematic saturation (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) was achieved, defined as the point at which no new themes emerged in the final two discussions. Recruitment was conducted through community centers, senior clubs, and referrals from public health workers to ensure participant diversity.\u003c/p\u003e\u003cp\u003eA semi-structured interview guide (Appendix) was developed in Sinhala, Tamil, and English, Sri Lanka\u0026rsquo;s official languages, and pilot-tested with five older adults, and subsequently revised for clarity. The guide comprised demographic questions related to age, education, and frequency of internet use; open-ended prompts such as, \u0026ldquo;Describe a time you sought health information online, what helped or hindered you?\u0026rdquo; and probes aimed at clarifying nonverbal cues, such as hesitation or enthusiasm. The Principal Investigator (PI), a public health researcher with five years of qualitative research experience, along with two bilingual data collectors trained over three sessions, conducted the FGDs. Their training included instructions on neutral probing techniques, managing dominant participants, and recording detailed field notes on group dynamics. FGDs were conducted in quiet community halls familiar to the participants to minimize power imbalances. Written informed consent, emphasizing voluntary participation and anonymity through assigned random identification numbers, was obtained, along with verbal consent for audio recording. Sessions lasted between 60 and 90 minutes and included breaks to accommodate participant fatigue.\u003c/p\u003e\u003cp\u003eAudio recordings were transcribed verbatim in their original languages and translated into English by bilingual experts, with cross-checks performed for accuracy. Using an inductive approach, the PI and an independent qualitative researcher familiarized themselves with transcripts, generated initial codes such as \u0026ldquo;distrust of online sources\u0026rdquo; and \u0026ldquo;family support,\u0026rdquo; and iteratively grouped these codes into themes like \u0026ldquo;Sociocultural influences\u0026rdquo; utilizing NVivo 14 software. Discrepancies were resolved through consensus. Rigor and trustworthiness were ensured through several strategies: credibility was supported by member checking, summarizing key points immediately after FGDs for participant validation; dependability was maintained via an audit trail documenting coding decisions and the evolution of themes; transferability was enhanced through thick descriptions of participant quotes and contexts; and confirmability was assured by maintaining reflexivity journals that documented researchers\u0026rsquo; assumptions, such as the PI\u0026rsquo;s potential bias toward digital literacy as a primary barrier. Saturation was confirmed when the fifth FGD replicated themes from prior discussions without introducing new concepts.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFive focus group discussions were conducted with 40 older persons representing diverse age groups and socioeconomic backgrounds (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Mean age of the participants was 69.88 years.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of the participants of FGDs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocio-demographic characteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (in completed years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e60\u0026ndash;69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e70\u0026ndash;79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e80 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 1 to 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGrade 6 to 10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGCE O/L* completed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGCE A/L** completed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiploma/ vocational training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDegree and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonthly family income (in Sri Lankan rupees)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;25000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25001\u0026ndash;50000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50001\u0026ndash;75000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e75001\u0026ndash;100000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;100000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThematic analysis revealed three primary themes, each encompassing interconnected facilitators and barriers that influence online health information retrieval. The themes are presented below, integrating sub-themes and retaining original participant quotes to contextualize findings (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eTheme 1: Individual influences\u003c/h3\u003e\n\u003cp\u003eParticipants acknowledged the \u003cem\u003ebenefits of online health information\u003c/em\u003e, particularly its ability to provide specialized knowledge from experts, which motivated its use. Many expressed a \u003cem\u003edesire to learn\u003c/em\u003e, driven by their curiosity about health and technology. A 73-year-old unemployed man emphasized this, stating, \u003cem\u003e\u0026ldquo;I like to learn new things even at this age. Now I\u0026rsquo;m 73. However, I like to learn new things, even from computers. When the lab sends my blood report to my phone, I like to see it myself. So, I would like to learn how to see it. I have high blood cholesterol. I like to watch YouTube videos about food items that reduce my cholesterol.\u0026rdquo;\u003c/em\u003e Positive prior experiences with eHealth services, such as telemedicine during the COVID-19 pandemic, further reinforced engagement. A 68-year-old retired teacher noted, \u003cem\u003e\u0026ldquo;I got down my clinic medicine from the pharmacy ordering through WhatsApp during the COVID time. We used the Facebook page of our MOH office to determine vaccination dates. With that practice, still I look at that to get any new health information.\u0026rdquo;\u003c/em\u003e However, \u003cem\u003eaging-related limitations\u003c/em\u003e, including physical decline (e.g., tremors and poor vision) and cognitive challenges (e.g., memory loss), hindered access. An 80-year-old man described, \u003cem\u003e\u0026ldquo;I cannot keep on holding the phone to press any button to see anything. My hands are shaking. I do not have any energy now. Phone falls.\u0026rdquo;\u003c/em\u003e Additionally, \u003cem\u003efear of technology\u003c/em\u003e and distrust of online accuracy deterred its use. A 64-year-old pensioner admitted, \u003cem\u003e\u0026ldquo;I am scared to press buttons - too many things pop up. I might misunderstand and harm myself.\u0026rdquo;\u003c/em\u003e Language barriers compounded these issues, as most content was in English, which is a secondary language for many.\u003c/p\u003e\n\u003ch3\u003eTheme 2: Technological influences\u003c/h3\u003e\n\u003cp\u003eParticipants valued \u003cem\u003eaudio-visual content\u003c/em\u003e for its clarity and engagement, such as videos demonstrating healthy practices. However, \u003cem\u003edevice accessibility\u003c/em\u003e was a critical barrier, as many relied on borrowed devices. \u003cem\u003eThe technical complexity\u003c/em\u003e of navigating browsers, connecting to networks, or using apps frustrated older users. Rural participants highlighted \u003cem\u003epoor Internet connectivity\u003c/em\u003e, with frequent disruptions discouraging use. \u003cem\u003eContent overload\u003c/em\u003e also reduced utility, as technical jargon or excessive information overwhelmed users. A 70-year-old housewife remarked, \u003cem\u003e\u0026ldquo;What I dislike the most is that, on the Internet, they tell us a lot of information at once within a short time. We, old people need some time and space to understand those one by one.\u0026rdquo;\u003c/em\u003e A lack of formal \u003cem\u003etraining on device/internet usage\u003c/em\u003e left many participants dependent on informal support systems.\u003c/p\u003e\n\u003ch3\u003eTheme 3: Socio-cultural influences\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eFamily and peer support\u003c/em\u003e played pivotal roles in facilitating access to care. A 66-year-old housewife shared, \u003cem\u003e\u0026ldquo;My granddaughter has a lot of patience. She is the one who teaches everything on this phone and how to use the internet. She motivates me to look at important health messages and videos on the internet too.\u0026rdquo;\u003c/em\u003e Peer networks in social groups provide opportunities for collaborative learning. \u003cem\u003eCost-effectiveness\u003c/em\u003e also encouraged use, as online resources were perceived as cheaper than consultations or printed materials. A 62-year-old pensioner explained, \u003cem\u003e\u0026ldquo;These days you need lot of money to channel a doctor. Books and magazines with health information are also very costly. Therefore, I like to get health information from the internet. For that, I don\u0026rsquo;t have to pay.\u0026rdquo;\u003c/em\u003e Conversely, some lamented the \u003cem\u003eimpersonal nature\u003c/em\u003e of digital platforms. A 60-year-old retired teacher noted, \u003cem\u003e\u0026ldquo;I like when my doctor or nurse tells me something with a beautiful smile and kind words. Sometimes they touch my hand also. My doctor calls me \u0026ldquo;Amma\u0026rdquo;\u003c/em\u003e (referring to mother). \u003cem\u003eThese phones and computers can\u0026rsquo;t do that. They only show us some facts.\u0026rdquo;\u003c/em\u003e Cultural perceptions further deterred engagement, as technology was viewed as \u003cem\u003einappropriate for older persons\u003c/em\u003e. Many felt that this aligned with youth, creating reluctance to explore online tools.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBarriers and facilitators for digital health information access\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme (level of influence)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFacilitators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBarriers\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme 1: Individual-level influences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Belief that online health information is beneficial\u003c/p\u003e\u003cp\u003e2. Desire to learn\u003c/p\u003e\u003cp\u003e3. Previous positive experience with eHealth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Limitations due to aging (e.g., vision, tremor, cognition)\u003c/p\u003e\u003cp\u003e2. Fear and dislike of new technology\u003c/p\u003e\u003cp\u003e3. Concerns about trustworthiness/accuracy of online information\u003c/p\u003e\u003cp\u003e4. Language barriers\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme 2: Technological influences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Use of audio-visuals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Unavailability of a suitable device\u003c/p\u003e\u003cp\u003e2. Complex functionality of devices\u003c/p\u003e\u003cp\u003e3. Poor Internet connection\u003c/p\u003e\u003cp\u003e4. Complexity of online content\u003c/p\u003e\u003cp\u003e5. Lack of user training\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme 3: Socio-cultural influences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1. Support from the family\u003c/p\u003e\u003cp\u003e2. Peer learning\u003c/p\u003e\u003cp\u003e3. Cost-effectiveness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1. Poor social interaction (loss of human touch)\u003c/p\u003e\u003cp\u003e2. Sense of cultural inappropriateness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the facilitators and barriers influencing online health information retrieval among older persons through five FGDs involving 40 participants. Participant diversity across age and socioeconomic backgrounds minimized selection bias, while homogeneous FGD groupings ensured psychological safety and data credibility. A semi-structured guide with open-ended questions reduced response bias (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and independent coding enhanced analytic robustness. Conducting multiple FGDs balanced the potential group-specific biases. However, reliance on self-reported data and the absence of key informant perspectives (e.g., healthcare providers) limit the contextual depth of the gap addressed in the recommendations.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eIndividual influences\u003c/h2\u003e\u003cp\u003eParticipants’ belief in the benefits of online health information aligns with studies highlighting its role in empowering older adults to manage their health proactively (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The desire to learn mirrors findings among patients with heart failure motivated by technological curiosity (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), while positive eHealth experiences reinforce self-confidence and sustained engagement (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Conversely, aging-related physical and cognitive decline echo global evidence of sensory and motor challenges restricting technology use (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Fear of technology and distrust of online accuracy, consistent with previous studies (\u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e–\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), underscore the need for intuitive designs and credibility markers. Language barriers, particularly in non-English contexts (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), further highlight the systemic inequities in digital health access.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eTechnological influences\u003c/h3\u003e\n\u003cp\u003eAudio-visuals have emerged as critical facilitators, paralleling their efficacy in health education (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). However, device inaccessibility and technical complexity, mirroring barriers in German and Colombian studies (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), reflect socioeconomic and usability gaps. Poor connectivity in rural areas, consistent with prior findings (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), exacerbates this exclusion. Content complexity and information overload, noted in older populations (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), require simplified and layered content delivery. The lack of training observed in African American cohorts (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) underscores the urgency of implementing structured digital literacy programs.\u003c/p\u003e\n\u003ch3\u003eSocio-cultural influences\u003c/h3\u003e\n\u003cp\u003eFamily and peer support proved pivotal, aligning with global evidence of intergenerational learning (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Cost-effectiveness resonates with studies emphasizing the economic advantages of eHealth (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). However, reduced social interaction and perceived cultural inappropriateness echo preferences for humanized care (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and generational stereotypes (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), highlighting tensions between efficiency and empathy in digital transitions.\u003c/p\u003e\u003cp\u003eIn Sri Lanka’s aging society, enhancing digital literacy and infrastructure is critical to ensuring equitable access to healthcare. National programs should combine training initiatives with affordable Internet access, particularly in rural areas. Tailored eHealth tools that balance efficiency with human-centered design can foster autonomy in chronic disease management and strengthen preventive care engagement.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eStrengths include rigorous methodology (diverse sampling, independent coding) and thematic saturation across the FGDs. Limitations include reliance on participant recall, exclusion of caregiver/provider perspectives, and contextual specificity to Sri Lanka, which may limit generalizability.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions and recommendations","content":"\u003cp\u003eAge-related barriers, content complexity, and language inequities restrict older adults’ access to digital health. To address this, eHealth platforms must prioritize age-friendly designs, such as larger fonts, intuitive interfaces, multilingual options, and audio-visual aids. Future research should integrate key informant interviews with providers and caregivers to holistically map the determinants of digital inclusion.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eFGDs Focused Group Discussions\u003c/p\u003e\u003cp\u003ePI Principal Investigator\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cb\u003eAuthor declarations\u003c/b\u003e\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003e All methods used in this study were performed in accordance with the ethical principles of the Declaration of Helsinki for medical research involving human subjects. Ethical clearance was obtained from the Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo 08, Sri Lanka. We obtained verbal informed consent from all the participants (reference number: EC-23-029).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003cp\u003enot applicable\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study did not receive any specific grants from funding agencies.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization, BJK,SM; Methodology; BJK, MSDW, SM; Formal analysis, BJK, MSDW; Investigation; BJK; Resources, BJK, SM, MSDW; Data curation; BJK,SM; Writing \u0026ndash; original draft; BJK; Writing - review \u0026amp; editing, BJK, SM, MSDW; Supervision, SM, MSDW; Project administration, BJK,SM All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eWe acknowledge all individuals who contributed to this research\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used in this study are available from the corresponding author upon reasonable request. 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Barriers to patient portal access among veterans receiving home-based primary care: A qualitative study. Health Expect. 2015;18(6):2296\u0026ndash;305.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAyalew M, Gonzalez VR, Saha S, Gentili A, Failla G, Melnyk A et al. The cost-effectiveness of digital health interventions: A systematic review of the literature.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePywell J, Vijaykumar S, Dodd A, Coventry L. Barriers to older adults\u0026rsquo; uptake of mobile-based mental health interventions. Digit Health. 2020;6.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aged, Health Information Seeking Behavior, Internet, Health Literacy, Qualitative Research","lastPublishedDoi":"10.21203/rs.3.rs-7396557/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7396557/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eRapid population aging in Sri Lanka is paralleled by the rising burden of chronic diseases, prompting older adults to seek web-based health information. However, the factors that enable or hinder this behavior in low-resource, urbanizing settings remain poorly understood. In this study, we explored the individual, technological, and sociocultural determinants of online health information retrieval among community-dwelling older persons in the Colombo district, Sri Lanka.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA qualitative descriptive study employed five focus group discussions with 40 adults (60\u0026ndash;83 years; 62% women) purposively sampled for variation in gender, education, and digital literacy. Semi-structured guides, developed in Sinhala, Tamil, and English, and pilot-tested for clarity, elicited experiences of searching for health information online. The sessions were audio-recorded, transcribed verbatim, translated, and thematically analyzed in NVivo 14 by two independent coders using an inductive approach. Methodological rigor was supported through member checking, reflexive journaling, an audit trail, and saturation monitoring.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThree overarching themes emerged from the data. Individual influences included: (i) belief in the usefulness of online health information, (ii) desire to learn, and (iii) prior positive eHealth experiences as facilitators; countered by (iv) age-related functional decline, (v) technophobia, (vi) mistrust of online accuracy, and (vii) English-language dominance as barriers. Technological influences featured audio-visual formats as the sole facilitator, while barriers comprised limited device ownership, complex interfaces, poor connectivity, dense content, and lack of formal training. Socio-cultural influences revealed family encouragement, peer learning and perceived cost-savings as motivators, contrasted with reduced interpersonal contact and a cultural perception that \u0026ldquo;the Internet is for the young.\u0026rdquo;\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eOlder adults\u0026rsquo; engagement with digital health content is shaped by a dynamic interplay of personal motivation, age-friendly technology, and supportive social networks. Interventions should pair intergenerational digital-literacy training with intuitive multimedia platforms and culturally sensitive messaging to narrow the digital health divide.\u003c/p\u003e","manuscriptTitle":"Age-friendly eHealth strategies: Qualitative insights from older persons in Sri Lanka on digital health information access","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-13 04:06:22","doi":"10.21203/rs.3.rs-7396557/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-09-30T10:14:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-23T10:21:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-05T12:07:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-05T11:25:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-09-05T11:18:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba544327-8b20-4a9a-986c-de3b8b9a047b","owner":[],"postedDate":"October 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-13T04:06:22+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-13 04:06:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7396557","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7396557","identity":"rs-7396557","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}