A doctoral dissertation defended at Tallinn University shows that people over 50 differ significantly in their ability to benefit from digital health information. Some need considerably more support than others.

"Since e‑services have moved online and the web offers an abundance of health information, it has become one of the main environments where people obtain information," says Marianne Paimre, PhD in Information Society Technologies at Tallinn University. At the same time, statistics show that internet use in Estonia begins to decline already in people's 50s, and some retirees do not use the internet at all.

In her recently defended dissertation, Paimre took a close look at how older Estonians search for health information in digital environments. She interviewed older adults and conducted a survey involving nearly 500 people over the age of 50. "The ability to find, evaluate, and use health information is unevenly distributed in society. Therefore, digital health is also an issue of social inequality," she notes.

Doctors remain the primary source of information

Paimre's study showed that the ways people over 50 search for health information online vary widely. "Some searched daily, but most did so irregularly and occasionally. Twelve percent of respondents said they had never searched for health information online," she says. Another 16 percent reported that they had never used a computer.

Although Paimre initially assumed that willingness to search for information online would depend primarily on age, the study clearly showed the influence of education level. "People with higher education searched for health information online significantly more than those with lower education," she explains. It also emerged that information is mostly sought based on symptoms — that is, interest arises only when the person or someone close to them already has a health concern.

"It was somewhat surprising that although people searched quite a lot for information, they were not very good at evaluating it," the new PhD notes. Nearly half — 47 percent — said they rely mainly on the first Google search result. As many as 68 percent said they find it difficult to judge whether the information they find is relevant and trustworthy for their situation.

Older adults who do not use computers at all considered the internet superficial, unfamiliar, and irrelevant. For them — as well as for respondents overall — the most trusted source of health information remains a doctor or other healthcare professional. "The fear often expressed in the media that Google or artificial intelligence will become the new doctor and push medical professionals aside did not emerge in my study," Paimre says.

Respondents were also asked to name other important sources of health information. These included professional media websites, health supplements, and portals such as inimene.ee, as well as Wikipedia. "There were also older people who used social media, forums, and alternative media," the researcher adds.

A gender difference also became apparent: men showed significantly greater interest in various health apps and digital services than women. "We tend to think that men don't take care of their health and are indifferent. Yet my study showed that when health information comes through digital environments or technologies, men show strong interest," says Paimre. In other words, the digital sphere may be an effective place to reach men with health-related topics.

Reliable sources encouraged vaccination

In her dissertation, Paimre also examined the connection between seeking and using health information and health-related behavior. Since her survey was conducted at the beginning of the COVID-19 pandemic, she focused particularly on willingness to get vaccinated. "Although vaccines were not yet available, I asked people whether they would be willing to be vaccinated," she recalls.

Her findings revealed an interesting link: those who searched for health information more actively online and used higher-quality sources — such as journalism and reputable health portals — were far more willing to be vaccinated. This connection did not appear with other health behaviors, such as physical activity or dietary choices.

"Perhaps this type of link emerges especially with urgent or important topical issues, such as the pandemic," she suggests. Among older respondents, men also showed greater interest in vaccination than women.

Paimre notes that it is often assumed that if information is available, people will change their behavior accordingly. "My work shows that this is not necessarily the case — the link appeared with vaccination, but not in other situations," she concludes.

More opportunities to develop digital skills

In light of her research, Paimre says that the main issue in Estonia is not the first-level digital divide — whether people have access to the internet and digital services. A more serious challenge lies in the second- and third-level digital divide. In other words, it is not enough to provide access; it is equally important to ensure that people can find relevant information, assess its quality, and use it to improve their health and well-being.

"The third level means the ability to actually benefit from all this — whether people can do something meaningful with the information they find online to improve their health and well-being," she explains. According to Paimre, reducing the digital divide in Estonia requires focusing on digital skills and the benefits people can derive from them.

How can this be done? First, it is important to identify who exactly needs support. As her research showed, older adults' digital skills vary greatly. "There were people aged 75 and older who said they manage very well online. We cannot approach them in the same way as their peers who lack basic skills," she says.

Those with no experience using computers or the internet emphasized that one-off training sessions would not help them. "They need a place and a person who can continually introduce them to smart devices and won't get impatient with their questions," Paimre states. Currently, libraries often fulfill this role, although developing digital skills is not their primary responsibility.

One possible solution, she suggests, is to develop older adults' digital skills in local community centers, social centers, and hobby groups. Many older people also live alone, and past initiatives have been temporary. "What is needed is something more permanent, where older people of different skill levels can turn for help," Paimre recommends.

Marianne Paimre, a doctoral candidate at the Institute of Digital Technologies at Tallinn University, defended her dissertation titled "Patterns of Online Health Information-Seeking Behaviour and Related Factors Among Estonian Older Adults" on June 10. The work was supervised by Professor Sirje Virkus from Tallinn University. The opponents were Emeritus Professor Ágústa Pálsdóttir of the University of Iceland and Associate Professor Nafiz Zaman Shuva of the City University of New York.

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