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Accepted for/Published in: JMIR Aging

Date Submitted: Jul 14, 2019
Open Peer Review Period: Jul 17, 2019 - Sep 6, 2019
Date Accepted: Feb 7, 2020
(closed for review but you can still tweet)

The final, peer-reviewed published version of this preprint can be found here:

The Use of Internet-Based Health and Care Services by Elderly People in Europe and the Importance of the Country Context: Multilevel Study

Merkel S, Hess M

The Use of Internet-Based Health and Care Services by Elderly People in Europe and the Importance of the Country Context: Multilevel Study

JMIR Aging 2020;3(1):e15491

DOI: 10.2196/15491

PMID: 32490837

PMCID: 7301259

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Internet Healthcare in Europe

  • Sebastian Merkel; 
  • Moritz Hess; 



Digital healthcare is becoming more and more important but also bears the risk of further increasing the digital divide as not all persons have the skills and knowledge to fully benefit from potential advantages. In particular, older persons have less experience with the internet and, hence, are in danger of being excluded. Knowledge on influences on eHealth adoption of older persons helps to develop and promote strategies in order to decrease the digital divide.


This study examined if and how older people are using the new digital possibilities to access healthcare. Moreover, it examined what personal characteristics are associated with using eHealth and if there are country differences.


Data for this study came from the Special Eurobarometer 460 (SB 460), which collected data on Europeans handling with and attitudes towards digital technologies, robots and artificial intelligence including a question on the use of online healthcare of 27,901 EU citizens age of 15 and older. Multilevel logistic regression models were used to analyze the association of using the internet for healthcare services with several individual and country level variables.


Results show that on the individual level being younger, higher educated, higher social class, living in an urban area and being politically more right is positively and significantly correlated with a higher probability to use eHealth. On the country level the share of older people, who had participated in any training activity within the last month, was positively correlated with the share of older people using eHealth.


The probability to use eHealth and all its accompanying advantages strongly depends on the socio-economic background and should be of concern to policy makers and politicians. Training and educational programs might be helpful to mitigate these differences.


Please cite as:

Merkel S, Hess M

Internet Healthcare in Europe

JMIR Preprints. 14/07/2019:15491

DOI: 10.2196/preprints.15491


PMID: 32490837

PMCID: 7301259

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