Unpacking the influencing factors of telehealth usage among older consumers

Abstract

This research unpacks the challenges and motivations of telehealth usage among older consumers—an understudied population in the extant telehealth literature. Through surveying a sample of older consumers who regularly migrate to winter in the southern areas of the United States, our qualitative analysis uncovers motivations (i.e., convenience, ease of use, efficiency, and a forced option) and challenges (i.e., telehealth limitations, privacy concerns, and lack of trust, access, and skills) of older consumers’ telehealth usage. Furthermore, logistic regression identifies attitude toward telehealth, gender, and health status as significant predictors of telehealth usage behavior. Contributions to theory and practice are also discussed.

Keywords:

• COVID-19
• healthcare services
• older consumers
• telehealth
• understudied markets

Introduction

The COVID-19 pandemic has not impacted all demographics equally (Egan et al., 2022). Older adults have experienced a higher risk for COVID-19 mortality due to factors such as advanced age and age-related chronic diseases and health conditions that heighten the risk for mortality (Shahid et al., 2020). Telehealth was more broadly implemented during the pandemic with its promise to help mitigate the spread of COVID-19 and to help reduce health disparities by improving access, use, and healthcare quality for underrepresented populations such as the elderly (Pierce & Stevermer, 2023). The World Health Organization (WHO) defines telehealth as “healing from a distance,” and more specifically, “the provision of health care remotely by means of a variety of telecommunication tools, including telephones, smartphones, and mobile wireless devices, with or without a video connection” (Dorsey & Topol, 2016).

Despite many encouraging results of telehealth use as documented in the literature (e.g., Weldon & Hagemann, 2022), researchers have expressed concerns about telehealth worsening existing health parities or even introducing new disparities (Egan et al., 2022). For example, Ikram et al. (2020) questioned the viability of telehealth for older patients, particularly the frail elderly, because these patients often struggle with technologies. Moreover, while the current scholarly works on telehealth has provided many interesting insights (see Kruse et al., 2020 for a review), research into the intersection between older consumers—an underrepresented population and an understudied market—and telehealth still is in its embryonic stage. Furthermore, the United States is embracing the coming of an aging population that comes with an increasing need for healthcare, long-term care, and social services to support older adults as they age (Sklar & Robertson, 2020).

The research deficit in understanding older consumers’ telehealth usage or lack thereof, coupled with the demographic shift toward an aging population in the United States, sets the context for the current research. In this research, we examine the reasons why older consumers choose to use or not use telehealth services through qualitatively analyzing open-ended comments collected from surveying a sample of older consumers who regularly migrate to winter in the southern areas of the United States. We also identify predictors of older consumers’ telehealth usage behavior through logistic regression analysis. Our research contributes to theory through exploring telehealth usage from the perspective of consumers aged 60 and above in the post-pandemic era. Moreover, our research extends the current telehealth literature by uncovering the challenges and motivations of telehealth usage among older consumers.

Literature review

Telehealth enables self-management of healthcare through the telehealth system (Go Jefferies et al., 2019) and helps to achieve the goals of disease prevention and care while reducing the costs and waste associated with medical service usage (Tsai et al., 2019). In addition to its economic and ecological benefits, telehealth can substantially improve care by providing access to healthcare for patients in remote locations, who might not otherwise receive it (Turner et al., 2001).

Despite these advantages and the availability of technology enabling telehealth (Green et al., 2016), there are still barriers impeding the integration of telehealth as a standard practice in healthcare. In that context, consumer acceptance of telehealth is a significant prerequisite for removing the barriers and subsequently generating widespread adoption of remote healthcare. Particularly, for achieving a widespread adoption of telehealth, consumer acceptance of telehealth must be especially prevalent among older adults, who are likely more typical end users of telehealth systems (Fisk et al., 2009). Usually, individuals are classified as “older adults” if they are 60 years of age or above (Fisk et al., 2009). Older adults have distinctive physical and psychophysical characteristics that set them apart from other consumer segments (Zhao et al., 2018). According to Venkatesh et al. (2012), it becomes increasingly difficult for people to learn new technologies as they age. Rogers et al. (2017) also suggest that older adults tend to be slower in adopting new technologies. Hence, age might impact a consumer’s reaction toward telehealth adoption.

Research acknowledges two types of reactions associated with accepting new services or products—resistance and innovation acceptance (Tsai et al., 2019). Consumer resistance, as defined by Kim and Kankanhalli (2009), encompasses opposition to the adoption of new technology and the subsequent changes it introduces, thereby creating obstacles to telehealth acceptance. Various variables contribute to this resistance, including privacy concerns (Sanders & Bashshur, 1995), lack of education and training (Sintonen & Immonen, 2013), usage difficulties (Fisk et al., 2009), and ingrained habits (Tsai et al., 2019).

Conversely, innovation acceptance denotes the willingness to embrace and utilize technology. Factors such as consumer attitude toward and knowledge of technology, perceived ease of use (Rogers et al., 2017), usefulness (Sintonen & Immonen, 2013; Tsai et al., 2019), and comfort and aesthetics of technology (Charness et al. 2015) significantly contribute to acceptance and adoption of technology. Similarly, variables like perceived need or benefit of using a specific type of technology (Fisk et al., 2009), performance expectancy, and hedonic motivation play crucial roles in facilitating innovation acceptance and adoption (Schmitz et al., 2022).

However, research is ambiguous regarding certain factors affecting the adoption of telehealth. For instance, Tsai et al. (2019) found a positive relationship between perceived usefulness and attitude and intention to adopt telehealth. Schmitz et al. (2022) reported that perceived security has a significant impact on remote healthcare usage intention. In contrast, Sintonen and Immonen (2013) argue that although perceived usefulness and perceived security correlate with intention to adopt remote healthcare services, their effects vary depending on the health condition of older adult users (i.e., frail elderly vs. well-coping elderly). Moreover, while Scott Kruse et al. (2018) identified privacy concerns as a barrier to the adoption of telehealth, Demiris et al. (2013) found no such concerns among older adults in the context of using telehealth systems.

Additionally, researchers have emphasized that gender and age may affect telehealth adoption intention. For example, Fisk et al. (2009) noted that older adults use fewer technologies compared to younger and middle-aged adults, and that older women use fewer technologies than men. In contrast, Zhou et al. (2019) did not find any gender differences in consumers’ intention to adopt telehealth. Thus, despite earlier research on telehealth adoption by various stakeholders, including providers and patients, and the use of different technology adoption frameworks to isolate the factors that affect adoption, research is needed to thoroughly explore telehealth adoption from the perspective of older adult consumers in a post-pandemic period. Furthermore, this research aims to reconcile the contrasting findings evident in the literature by examining telehealth adoption, as it is experienced and expressed, through the older adult consumers’ voice and by uncovering the factors that inhibit or contribute to the adoption of telehealth. By incorporating factors of telehealth adoption as perceived by older adult consumers with other essential technological variables from traditional information technology adoption literature in a quantitative analysis, we provide a more complete theoretical framework for telehealth adoption research among older adult consumers.

Method

Data collection

Each year, hundreds and thousands of retired and semi-retired individuals from the more northern areas of the United States and Canada travel to winter in warmer places such as Florida, Arizona, and Texas. Among the many winter destination choices, the Rio Grande Valley (RGV) in far South Texas has become popular because of its tropical warm weather, low cost of living, and cultural diversity. The local economy benefits enormously from those who choose the RGV as their winter destination and the local residents fondly refer to these seasonal migrants as Winter Texans. Winter Texans served as the sampling frame for this study.

Data were collected by the publisher of a local newspaper publication (i.e., Winter Texan Tims) that targets seniors and retirees who visit far South Texas during winter months, and we were granted permission to use the data for academic research purposes. A total of 20,000 questionnaires were inserted in the newspaper. The primary purpose of the questionnaire was to determine the economic impact of the wintering visitors on the regional economy but also had the purpose of examining perceptions of these seniors about telehealth services. Respondents had the option to complete the survey online or mail it to the provided address. A total of 349 responses were received, with just over one-third (123) of them completed online. The low response rate could be due to a reduced Winter Texans population during the COVID-19 pandemic because travel restrictions and health and safety concerns have prevented more Winter Texans from visiting their winter destination. The average age of respondents was 74; 51.3% had an associate, bachelor’s, or advanced degree; and 56% reported having an annual household income of between $30,000 and $79,000. Most of the sample were Caucasian (97.1%), with 54.5% female respondents. Table 1 summarizes the sample characteristics of the study participants.

Table 1. Sample characteristics of the participants.

Sample characteristics	n	%	M	SD
Gender
Male	156	45.48
Female	187	54.52
Education
Associate, bachelor’s, or advanced degree	179	51.73
Some college but no degree	84	24.28
High school or less	83	23.99
Income
High ($80K and above)	94	30.03
Medium (between $40K and $79,999)	165	52.72
Low ($39,999 and lower)	54	17.25
Age			74	7.43

Measures

In the survey, we asked respondents to indicate whether they have previously used telehealth (1 = yes; 0 = no) to assess their self-reported telehealth usage behavior. For those who responded “Yes” to the question, they were subsequently asked to indicate how likely they would continue to use telehealth in the future. For those who responded “No” to the question, they were then asked to indicate how likely they would use telehealth if they had access to telehealth. We then asked respondents to list three reasons and write in open comments on why they chose to use or not to use telehealth. Additionally, we measured participants’ attitude toward telehealth, their perceptions of usefulness, efficiency, and benefits of using telehealth, and their trust in and privacy concerns toward telehealth services. We also measured participants’ self-reported health status.

Specifically, attitude toward telehealth was assessed with four items based on Tsai et al. (2019; “I think telehealth is a good option for patients,” “I like telehealth as a healthcare option,” “I think favorably about telehealth,” and “I think telehealth can provide patients with a pleasant experience”; Cronbach’s α = 0.959). Perceived usefulness and perceived efficiency of using telehealth were both single-item measures based on Sintonen and Immonen (2013) and the performance expectancy dimension in Venkatesh et al. (2012) Extended Unified Theory of Acceptance and Use of Technology Model (UTAUT2) (i.e., “Telehealth would be useful in healthcare” and “Telehealth would be an efficient way to communicate with health professionals”). Perceived benefits were measured with two items based on Sintonen and Immonen (2013; “Using telehealth might result in clear benefits for following up my own health and treatment” and “Benefits acquired with telehealth could ease the work of health care professionals”; Cronbach’s α = 0.898). Trust in telehealth was assessed with three items based on Sheng and Simpson (2015; “All in all, I have complete trust in telehealth care,” “In general, telehealth care can be relied upon,” and “I am confident that telehealth care can be trusted”; Cronbach’s α = 0.964). Privacy concerns were measured with two items based on Lee et al. (2003) and Salisbury et al. (2001) (i.e., “I feel comfortable providing my personal information through telehealth devices such as computers, smartphones, and apps” and “I see that transferring my personal information through telehealth would be as safe as through a phone call”; Cronbach’s α = 0.926). Health status was assessed using Jelicic and Kempen’s (1999) single-item scale (i.e., “Would you say your health in general is excellent, very good, good, fair, or poor?”). Attitude toward telehealth, perceived usefulness, efficiency, and benefits of using telehealth, and trust in and privacy concerns toward telehealth services were assessed on a five-point Likert scale ranging from 1 (disagree) to 5 (agree). Health status was assessed on a five-point rating scale ranging from 1 (poor) to 5 (excellent).

Results

Almost 60% (59.3%) of the respondents reported that they have not used telehealth previously. Among these respondents, only 12% indicated that they would be extremely likely to use telehealth if they had telehealth access. Of those who have used telehealth, only 9.2% indicated that they would be extremely likely to continue using telehealth in the future.

We received a total number of 516 open comments from respondents on why they chose to use or not to use telehealth. Of these comments, 222 were reasons for using telehealth, and 294 were reasons for not using telehealth. We focused on the qualitative analysis of these open comments by conducting an inductive, bottom-up thematic analysis to identify relevant themes and patterns associated with reasons for using and for not using telehealth. We followed Spiggle’s (1994) approach to analyzing and interpreting qualitative data as well as the multistage process recommended by Braun and Clarke (2006) that includes generating initial codes, searching for themes, and reviewing and refining themes. Disagreements regarding the coding and categorization of themes were discussed and resolved when we reached a consensus. Themes emerging from this process are summarized in Table 2 and visually depicted in Figure 1. We discuss each theme below.

Figure 1. Motivating and inhibiting factors of telehealth usage among older consumers.

Table 2. Themes of reasons for using and not using telehealth.

Reasons for using telehealth			Reasons for not using telehealth
Theme	Code	Quotes	Theme	Code	Quotes
Convenience and ease of use	Convenience	“CONVENIENT!”	Telehealth limitations	Limited in the types of healthcare services provided	“in some situations it would not work”
		“can do it from home”			“does not take b/p, temp or show actual care in person”
		“no Dr visit required”			“can’t do blood work”
		“being able to stay home when ill”			“I felt my problem should be physically examined”
		“less anxiety”			“Some Dr examinations cannot be done”
	Availability	“Available 24/7 at all times!”		Lacking in in-person interaction	“less personal than a face to face visit with my healthcare provider”
		“better, quicker appointment availability”			“no personal interaction”
		“doctor available”			“Doctor can’t see me”
		“availability of staff”
	Ease of use	“easy to use”			“lacks personal contact”
		“easier to do”			“Doctors need to see patient to diagnose.”
Efficiency	Quick response	“Quick simple answers”	Privacy concerns and lack of trust	Privacy concerns	“Do not want my info hacked!!”
		“efficient use of time”			“breach of confidentiality”
		“more efficient”			“many computer hackers”
		“quicker response from doctor”			“security of information”
		“quick service”			“less secure”
	Efficient communication	“faster transfer of information”		Lack of trust	“Don’t trust it.”
		“The doctor or nurse can communicate with you as they are”			“lack of trust for privacy”
		“better, quicker appointment availability”			“afraid of scams”
		“ease of accessing health care pro”			“don’t feel info is safe”
A forced option	Restrictions due to the pandemic	“COVID lockdown prevented in-person visit.”	Lack of access and skills	Lack of access	“don’t have computer, tv, smart phone”
		“DR. would not see us in person”			“not familiar with it”
		“covid restrictions”			“no way to use it”
	The only option	“only way for my husband to see dr.”			“no internet, have to drive to wifi”
		“forced to”		Lack of skills	“technology hard for seniors”
		“no other choice”
	Doctor request	“Doctor requested it”			“inadequate knowledge of device use”
		“Doctor wouldn’t let patients come in”			“not computer smart”
		“MY DOCTOR SUGGESTED IT”			“confusions with directions”

Reasons for using telehealth

Our analysis of the reasons why consumers chose to use telehealth services uncovered three major themes, i.e., convenience and ease of use, efficiency, and a forced option. We discuss each theme below.

Convenience and ease of use

Convenience surfaced as an important benefit that motivated our respondents to use telehealth. For example, while one respondent stated: “CONVENIENT,” another noted: “Available 24/7 at all times!” Telehealth’s convenience is also manifested in the availability of medical staff and the ability to consult with healthcare providers without the need to leave home. For example, some respondents mentioned “availability of staff” and “better, quicker appointment availability” as the reason why they chose to use telehealth. Others noted “can do it from home,” “don’t have to wait in a waiting room,” and “communicate with dr. while travel.”

The convenience of using telehealth becomes more salient when consumers find driving and traveling challenging and not desirable. Comments such as “handicapped,” “couldn’t leave the house,” “unable to travel,” “couldn’t leave my husband,” and “distance from primary caregiver” speak to the viability of telehealth as a healthcare service option for consumers who are home-bound and unable to travel outside of their home.

Relatedly, ease of use is another benefit that motivates consumers to use telehealth services. Consumers’ appreciation of this benefit is evidenced by many respondents’ comments, such as “ease of use,” “easy to use,” “easier to do,” and “easy,” regarding why they chose to use telehealth services.

Efficiency

The efficiency of telehealth services manifests in two ways. One is that consumers perceive telehealth as a quick, efficient healthcare service that saves them time. Many respondents indicated that they chose to use telehealth because “it’s faster,” “speedy,” and “more efficient.”

Another facet of telehealth efficiency is that consumers’ medical needs can be quickly addressed. These medical needs are sometimes urgent. For example, one respondent wrote: “needed in an emergency,” and another cited “urgency of health issue” as the reason for using telehealth. For non-urgent situations such as prescription refill, checking on test results, and consultation with healthcare providers, consumers find telehealth services an efficient means to meeting their medical needs. For example, some respondents considered telehealth services good for “small problems” and “minor problems,” while others used telehealth for “annual/rx renewal,” “get test results without having to see doctor,” “discussing symptoms,” and “communicating with my doctor.”

A forced option

A third theme emerged from our analysis is that to some consumers, telehealth is perceived as the only option that is forced upon them for various reasons. One respondent noted: “only option to get an appt.” Another wrote: “only way for my husband to see dr.”

One reason for this perception is that consumers are concerned about the likelihood that visiting doctors’ office in person may cause them to contract COVID-19 and other communicable diseases. For example, one respondent noted: “because of covid exposure.” Another wrote: “decrease exposure to communicable diseases.” Another reason as mentioned by many of our respondents is that limited access to clinics, hospitals, and other medical facilities due to pandemic restrictions left them no other options but telehealth. One respondent explained: “COVID lockdown prevented in-person visit.” Another wrote: “COVID preventing office visits.” Several respondents also mentioned that they had to use telehealth because their doctors requested them to do so.

Reasons for not using telehealth

Three themes emerged from our analysis of the reasons why consumers chose not to use telehealth services, i.e., telehealth limitations, privacy concerns and lack of trust, and lack of access and skills. We discuss each theme below.

Telehealth limitations

One obstacle of telehealth use relates to the limitations of telehealth as a healthcare service option. Many respondents voiced quality concerns about telehealth. Some of the concerns stem from the perception that telehealth is limited in its scope in providing patient care. For example, one respondent commented: “in some situations it would not work.” Another noted that telehealth “does not take b/p, temp or show actual care in person.” Yet another respondent bluntly put: “Don’t believe it will do the job!”

Another limitation is the lack of face-to-face, personal interactions between consumers and healthcare providers. Comments such as “lacks personal contact,” “lose doctor contact,” “no personal interaction,” and “less personal than a face to face visit with my healthcare provider” are frequently cited by our respondents as a top reason for not using telehealth.

Privacy concerns and lack of trust

Another theme focuses on consumers’ privacy concerns and lack of trust in telehealth services. As reflected in many respondents’ comments, consumers are wary about the security and privacy of their personal medical information, which has led to a lack of trust in telehealth. For example, one respondent stated: “Do not want my info hacked!!.” Another wrote: “Don’t trust it.” Others voiced frustration about “too much information out there,” “breach of confidentiality,” “many computer hackers,” “security of information,” and “lack of trust for privacy,” and cited these concerns as reasons for not using telehealth.

Lack of access and skills

A third theme concerns the lack of access to telehealth services due to consumers not having the technologies necessary for using telehealth services. One respondent wrote: “don’t have computer, tv, smart phone.” Another explained: “no internet, have to drive to wifi.” Additionally, some consumers may feel that they lack the skills in using these technologies. For example, one respondent wrote: “Don’t feel comfortable with smartphone.” Another commented: “technology hard for seniors.” And others mentioned “not computer savvy,” “not tech savvy,” and “inadequate knowledge of device use.”

Additional analysis using logistic regression

We conducted additional analysis to examine predictors of older consumers’ telehealth usage behavior using logistic regressions whereby telehealth usage was coded as 1 representing “I have used telehealth in the past,” and 0 representing “I have not used telehealth in the past.” Informed by our qualitative analysis findings and building upon the Technology Acceptance Model (TAM) (Davis, 1989) and existing research into telehealth adoption intention, we included attitude toward telehealth, perceived usefulness and benefit of telehealth, telehealth efficiency, privacy concerns, trust in telehealth, perceived health status, and gender as predictors in the regression model.

The results, as summarized in Table 3, showed that the overall model was significant (Wald statistic = 13.499, p < .001) with a Nagelkerke R² value of 0.211. The overall percentage that the model correctly predicted telehealth usage behavior was 67.1%. Of all the predicting variables included in the model, attitude toward telehealth was significant (β = 0.71, SE = 0.25, p = .005), indicating that the more positive a consumer’s attitude toward telehealth, the more likely that the consumer has used telehealth. Perceived health status was also significant (β = −0.58, SE = 0.18, p = .001). The negative coefficient suggests that the healthier the consumer, the less likely the consumer has used telehealth. Gender was a third significant predictor (β = 0.79, SE = 0.28, p = .004). Because gender was coded as a binary variable (1 = male; 2 = female), the positive coefficient indicates that compared to male consumers, female consumers were more likely to have previously used telehealth services. Telehealth efficiency was marginally significant (β = 0.52, SE = 0.30, p = .089). However, perceived usefulness and benefit of telehealth, privacy concerns, and trust did not predict consumers’ telehealth usage behavior.

Table 3. Summary of logistic regression results.

Variable	B	SE	Wald	df	Sig.	Exp(B)
Attitude toward telehealth (Tsai et al., 2019; Cronbach’s α = 0.959) I think telehealth is a good option for patients. I like telehealth as a healthcare option. I think favorably about telehealth. I think telehealth can provide patients with a pleasant experience.	.708	.253	7.846	1	.005	2.029
Usefulness (Sintonen & Immonen, 2013) Telehealth would be useful in healthcare.	−.390	.298	1.714	1	.191	.677
Efficiency (Venkatesh et al., 2012) Telehealth would be an efficient way to communicate with health professionals.	.518	.304	2.894	1	.089	1.678
Benefit (Sintonen & Immonen, 2013; Cronbach’s α = 0.898). Using telehealth might result in clear benefits for following up my own health and treatment. Benefits acquired with telehealth could ease the work of health care professionals.	−.452	.285	2.518	1	.113	.636
Privacy concerns (Lee et al., 2003; Salisbury et al., 2001; Cronbach’s α = 0.926) I feel comfortable providing my personal information through telehealth devices such as computers, smartphones, and apps. (reverse-coded) I see that transferring my personal information through telehealth would be as safe as through a phone call. (reverse-coded)	.036	.197	.033	1	.857	1.036
Trust (Sheng & Simpson, 2015; Cronbach’s α = 0.964) All in all, I have complete trust in telehealth care. In general, telehealth care can be relied upon. I am confident that telehealth care can be trusted.	.140	.248	.320	1	.571	1.151
Health (Jelicic & Kempen, 1999) Would you say your health in general is excellent, very good, good, fair, or poor?	−.578	.176	10.761	1	.001	.561
Gender What is your gender? (1 = male; 2 = female)	.793	.279	8.071	1	.004	2.209

Discussion

The changing landscape of the healthcare industry with the introduction of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) in 2006 and HVBP (Hospital Value-Based Purchasing) in 2010 as part of Affordable Care Act has linked penalties and incentives to patient care. As such, over $1 billion in Medicare reimbursements are now associated with patient care scores. With exponential growth in hospital investments in telehealth technology as well as the rising expectation that these investments will improve the overall efficiency and delivery of patient care experience, hospital healthcare administrators are charged with justifying these expenditures by ensuring new technology is adopted and accepted by patients. Against this backdrop as well as the demographic shift toward an aging population in the United States, our research examines telehealth usage among older consumers and makes theoretical contributions through uncovering the challenges and motivations of telehealth use among older consumers—an underrepresented population and an understudied market in the existing body of literature on telehealth.

Theoretical and practical implications

Results from the qualitative analysis revealed that the convenience and ease of use of telehealth and telehealth efficiency were important benefits that motivated telehealth usage among older consumers. This finding supports prior research that showed that perceived service usefulness (e.g., Sintonen & Immonen, 2013; Tsai et al., 2019) and relative advantage of using telehealth services (Schmitz et al., 2022) increased telehealth usage intention. Therefore, health marketing strategies directed to increase telehealth adoption among older consumers should highlight the convenience, efficiency, and ease of use of telehealth services in promotional materials. Specifically, messaging that focuses on saving time and effort by using telehealth can be compelling for older consumers, encouraging the integration of this underserved and vulnerable segment into the evolving landscape of healthcare, where digitalization of health service delivery becomes increasingly prevalent (Parkinson, 2022; Parkinson & Davey, 2023).

Our results also showed that consumers sometimes use telehealth services involuntarily and feel that telehealth has been “forced” upon them either due to doctors’ request or clinics being closed during the pandemic. This finding is new in that prior studies examining predictors of telehealth usage primarily focus on voluntary usage situations (e.g., Johnson, 2023; Schmitz et al., 2022; Sintonen & Immonen, 2013; Tsai et al., 2019), and therefore it adds to the ongoing academic discourse on telehealth adoption and use. Health marketing strategies directed to increase telehealth adoption among older consumers should focus on providing thorough information about the reliability and effectiveness of telehealth services to consumers who may have used telehealth involuntarily, providing them an opportunity to make assessments and informed decision about adopting telehealth services (Parkinson & Davey, 2023).

Furthermore, our qualitative analysis identified three obstacles of telehealth usage among older consumers, that is, telehealth limitations, privacy concerns and lack of trust, and lack of access and skills. These results align with prior research examining barriers of telehealth usage among the elderly (e.g., Ikram et al. 2020; Kruse et al., 2020; Weldon & Hagemann, 2022). Interestingly, however, results from logistic regression analysis showed that privacy concerns and trust did not predict consumers’ telehealth usage. This result seems to contradict the findings from our qualitative analysis. One possible explanation is that although consumers harbor privacy and trust concerns about telehealth, those concerns are overridden by their medical and healthcare needs, especially when telehealth is the only option for them to receive patient care. Health marketers should acknowledge and address the obstacles identified in the study to encourage more widespread telehealth adoption among older consumers. Offering guidance regarding the use of telehealth and providing information about the benefits and quality of telehealth services can potentially help alleviate the effects associated with lack of trust and privacy concerns (Shen et al., 2019), overcome the perception of telehealth limitations (Snoswell et al., 2023), and equip individuals with the necessary skills for using telehealth technology.

Moreover, the analysis revealed that although perceived usefulness and benefit of telehealth and telehealth efficiency did not predict telehealth usage, consumers’ general attitude toward telehealth was a significant predictor. This finding suggests that consumers’ overall feelings and beliefs about telehealth services outweigh assessments of individual telehealth attributes. Thus, health marketers should consider creating a positive perception of telehealth services through messaging that emphasizes the overall benefits of telehealth to foster a more positive attitude among older consumers.

Our analysis also uncovered a gender difference in telehealth usage whereby we found that among the elderly, female consumers were more likely to have used telehealth in the past than their male counterparts. This finding adds to previous telehealth research that examines the ways in which female and male consumers differ in their perceptions of and usage intention toward telehealth (e.g., Pierce & Stevermer, 2023; Schmitz et al., 2022). More importantly, the finding challenges earlier published research that shows that male consumers tend to be early adopters of fitness and health-related technological products than female consumers (e.g., Venkatesh et al., 2003). Health marketers can target female consumers as potential “influencers” who can spread the positive word-of-mouth of telehealth services among their partners and friends. The result that perceived health status negatively correlated with the odds of telehealth usage suggests that consumers’ optimistic outlook of their health may impede their motivation to utilize telehealth services. This finding provides evidence of the optimistic biases that have been well documented in health communication literature (e.g., Vahabi, 2007). Health marketers need to be mindful of such cognitive biases and should incorporate compelling reasons into health marketing campaigns to stimulate the consideration of telehealth as a valuable resource for preventive and continuing healthcare.

Limitations and future research

It is important to note that our sample consisted primarily of Caucasian participants who migrated to far South Texas during winter months each year. These older consumers tend to be more educated, more active, and have higher incomes than their similarly aged U.S. counterparts. These sample characteristics, which may not be representative of older consumers in general, may limit the generalizability of our findings. To overcome this limitation and gain a more complete picture of telehealth adoption among older adult consumers, future research could employ a nationally representative sample to verify results and to identify the impact of race, ethnicity, and socio-economic status on telehealth adoption. Additionally, as technology is rapidly evolving, research should also explore the influence of these technological changes on telehealth adoption. Future research could also employ a longitudinal design to track older consumers’ telehealth usage behavior over time to uncover factors that contribute to their continued use of telehealth technology and services.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.