Table 1.

Challenges related to digital determinants of health experienced by different vulnerable groups

Digital determinant of health	Older adults	Migrants	Mental health service users	High users of health services	The unemployed
(1) Access to digital resources	Lack of basic computer skills Lack of suitable devices to use digital health services Lack of support and training to take advantage of digital health services Hearing disability reducing the capability to use remote option	Lack of strong electronic identification (e-ID) Insufficient local language skills to use digital health services Lack of specific digital skills required for digital health services.	Inadequate digital skills to take advantage of a variety of digital health services	Inadequate digital skills to access and use digital health services Insufficient English language skills challenging the Internet use Poor health complicates learning and using digital health services Learning to use digital health services requires too much effort	Usability issues challenge finding information on the websites of some health services Dysfunctional, too old or otherwise inappropriate devices hinder the possibilities of using digital health services Dysfunctional internet connections at home
(2) Use of digital resources for health seeking	Digital health services are not applicable for all health care needs	Handling more demanding and complex issues is poorly managed in a digital environment Risk of being misunderstood in a digital environment due to language issues	In the digital environment, interaction and communication are perceived poor Lack of private space complicates the use of digital health services		Lack of private space induces privacy issues and difficulties to concentrate on discussing with a health professional
(3) Digital health literacy
(4) Beliefs about potential of digital health to be helpful or harmful	Fear of using and making mistakes in digital health services Distrust for the quality of remote health services	Security concerns and lack of trust in digital health platforms Fear of making mistakes that can have serious consequences	Security issues complicate the use of digital health services Lack of an incentive to go out of the house when using digital health services	Insufficient data security skills
(5) Values and cultural norms/preferences for use of digital resources	Preferring face-to-face services when living next to a service provider Lack of interest to use computer or smartphones Hesitative attitude towards digital health services	In a digital environment, valued nonverbal and personal communication is lacking	Preferring face-to-face consultation because remote feels unusual	Digital health services are not seen to have added value Identifying the service needs remotely by a health care professional requires more time and patients’ effort “An old-school mind” preferring face-to-face services	Preferring face-to-face consultations because seeing a person’s face makes communication easier Lack of interest in using or learning how to use digital devices
6) Integration of digital resources into community and health infrastructure	Lack of awareness of available digital health services and their value	Lack of digital health services and websites in participants’ native language	Remote option is not always available in health services	Not being informed about a remote option for health services	Digital health consultations not always available Information transfer between different systems does not always function properly Not always possible to interact with the service provider