Digital Health Communication Engagement Experiences of Older Adults in Community Contexts: Qualitative Systematic...

The global population is aging rapidly, straining health care and social systems. Amid digital transformation, older adults face pronounced obstacles to participating in and benefiting from health communication. Prior syntheses emphasized technology adoption or clinical effectiveness, and health communication reviews focused on formal or home-based care. How older adults experience digital health communication as an everyday, relational process in community contexts and how trust and responsibility take shape remain underexplored.

This study aimed to synthesize the experiences of older adults engaging in digital health communication in community contexts.

We searched PubMed, CINAHL, Embase, PsycINFO, Scopus, ProQuest Health & Medical Collection, Web of Science Core Collection, CNKI, and Wanfang from inception to June 2026. Qualitative and mixed methods studies on the digital health communication experiences of community-dwelling older adults (aged ≥50 y) were included; purely quantitative studies were excluded. Two researchers independently screened records, appraised the studies using the CASP (Critical Appraisal Skills Programme) tool, and extracted qualitative data. Findings were synthesized using the Noblit and Hare meta-ethnography, and confidence was assessed using the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research) approach. The review was registered with PROSPERO and reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), PRISMA-S (PRISMA Extension for Reporting Literature Searches in Systematic Reviews), and ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research).

The integration of 14 studies across 8 countries yielded 4 themes. Older adults' objectives in community digital health communication encompass obtaining or sharing health information, maintaining health, and learning technology to avoid falling behind. Engagement enhanced health management, improved access to health care services, knowledge, and skills, and increased social participation. Trust was built primarily on patient-provider relationships and authoritative platforms, while accountability was distributed across individuals, families, health care providers, and communities, despite imbalances such as technological dependency and difficulty verifying information. Adaptation to technology was dual in nature: social support, patient-provider trust, and technological affinity were key drivers, whereas insufficient digital literacy, technology anxiety, cost constraints, physiological limitations, and privacy concerns constituted significant barriers.

This meta-ethnography treats community-based digital health communication as a communicative practice in its own right. It reframes the community not as a setting in which communication occurs but as a determinant of whether it works and characterizes engagement as an evolving negotiation of motivation, trust, and responsibility. Findings argue for moving beyond efficiency-oriented service delivery toward building community capacity and supporting older adults' autonomy and digital health literacy. Twelve out of 14 studies were of moderate quality, and eligibility was limited to Chinese- or English-language abstracts, which may limit representativeness.