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Background Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults’ needs for eHealth services, and thus, these health solutions require further exploration. Objective The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults’ (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults’ learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults’ own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use.

This paper presents a case study on a robotic medication-dispensing service used in the everyday lives of older people in Finnish Lapland through the concept of domestication. The study took an ethnographic approach. A total of 11 service users, practical nurses, and other health-care professionals participated; the service users averaged age 81 years (M= 81.4, SD = 5.4). The data comprised semistructured interviews complemented by observations and photographs at service users’ homes. We concluded that the domestication of the service was successful, although the service users sometimes felt that it limited their lives. The service users stated that learning and subsequently using the service was easy with social network support. The participants indicated their reasons for hesitation in using the service related primarily to concerns in trying new technology, the technical features of the robot, and cognitive or physical difficulties. The service supports “aging in place,” which is in line with the Finnish care policy.

This research seeks to better understand how older people living in sparsely populated areas learn and then use eHealth applications in their everyday lives. The study was conducted in northern Sweden and Lapland in northern Finland, the most sparsely populated areas in these countries. The study focused on the use of following eHealth services: a medication-dispensing service, a virtual health room and a self-monitoring system. Research data were collected through semi-structured interviews and observations. The study included 19 participants, aged from 63 to 89 years. The following research questions guided the study: In what ways was the respondents' learning and use of the eHealth service a social practice? How are such practices affected by cultural identities? The results show that digital selfcare technologies can be very user friendly, easy to use, and sometimes, require very little learning effort from older users. However, the results also show that engaging in eHealth and learning how to use digital self-help services requires constant learning of different competences, not just digital but also competences that are medical and administrative. In addition, the use of eHealth required support from the respondents' children, grandchildren, neighbors, and friends. Therefore, the digital self-care technologies contributed to a broader redistribution of responsibility from individual users and health and social care to informal support networks surrounding the respondents. Finally, the results indicated that respondents' motives for learning and using the digital services often expressed cultural identities that affected such conceptions.

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