BackgroundAn ageing population is seen as a threat to the quality of life and health in rural communities, and it is often assumed that e-Health services can address this issue. As successful e-Health implementation in organizations has proven difficult, this systematic literature review considers whether this is so for rural communities. This review identifies the critical implementation factors and, following the change model of Pettigrew and Whipp, classifies them in terms of “context”, “process”, and “content”. Through this lens, we analyze the empirical findings found in the literature to address the question: How do context, process, and content factors of e-Health implementation influence its adoption in rural communities?MethodsWe conducted a systematic literature review. This review included papers that met six inclusion and exclusion criteria and had sufficient methodological quality. Findings were categorized in a classification matrix to identify promoting and restraining implementation factors and to explore whether any interactions between context, process, and content affect adoption.ResultsOf the 5,896 abstracts initially identified, only 51 papers met all our criteria and were included in the review. We distinguished five different perspectives on rural e-Health implementation in these papers. Further, we list the context, process, and content implementation factors found to either promote or restrain rural e-Health adoption. Many implementation factors appear repeatedly, but there are also some contradictory results. Based on a further analysis of the papers’ findings, we argue that interaction effects between context, process, and content elements of change may explain these contradictory results. More specifically, three themes that appear crucial in e-Health implementation in rural communities surfaced: the dual effects of geographical isolation, the targeting of underprivileged groups, and the changes in ownership required for sustainable e-Health adoption.ConclusionsRural e-Health implementation is an emerging, rapidly developing, field. Too often, e-Health adoption fails due to underestimating implementation factors and their interactions. We argue that rural e-Health implementation only leads to sustainable adoption (i.e. it “sticks”) when the implementation carefully considers and aligns the e-Health content (the “clicks”), the pre-existing structures in the context (the “bricks”), and the interventions in the implementation process (the “tricks”).

Purpose – In today’s aging world online communication is often viewed as a means to enhance social connectivity, and therefore well-being, of older adults. However, previous research on the influence of online communication on social connectivity largely disregards older adults, yields conflicting results and fails to assess the – debatable − causal direction of relationship. The purpose of this paper is to overcome these issues by developing four hypotheses related to who uses what, how, with whom. Design/methodology/approach – The authors use a panel data study to test the hypotheses, including 302 older adults. Response rates are between 62 and 75 percent. Findings – The authors find, first, that older adults differentiate between social connectivity with other village members, i.e., village connectivity, and connectivity with friends. Second, the impact of online communication varies among these two types of social connectivity. Where e-mail use has a negative impact on village connectivity, it does not affect connectivity with friends. Facebook use on the other hand has a negative impact on connectivity with friends, but not on village connectivity. The negative effects were not found among those older adults that were already well-connected on forehand, indicating a buffer effect. Practical/implications – Policy makers’ implementing online communication tools to strengthen social connectivity of older adults, may want to carefully select tools based on the type of connectivity they aim to enhance. Impact needs to be monitored. Originality/value – The authors contribute by analyzing how characteristics of online communication tools, i.e., information richness and privacy protection, as well as social connectivity, i.e., geographical proximity and emotional closeness jointly shape older adults’ social connectivity.

Older adults often struggle to adjust to the rapid changes in the digitizing media landscape. In this article, we study, first, how 10 older adults adapt new online media into their daily lives and, by doing so, adjust to the changing “rules of engagement” that guide online-media use in their social surroundings. Second, we analyze how this adaptation process generates change in older adults' social connectedness. Results suggest that older adults' non-use of popular online media results in social exclusion. Enhancing their social connectedness, requires older adults to (partially) conform to new communication norms and values. Based on our findings, we propose three adaptation strategies that enhance both offline and online social connectedness.

We introduce a population-level perspective on the longstanding debate on displacement versus complementarity by recognizing that an individual's social interactions are dependent on emerging media use patterns in the wider population. Our longitudinal, cross-regional analyses at the population-level and individual-level indicate that two opposing forces coexist: individual Internet use and individual face-to-face (f2f) interaction are positively correlated, suggesting complementarity. However, local peers' Internet use and individual f2f interactions are negatively related, suggesting displacement. Interestingly, when social networking site uptake is high, individual Internet non-use is associated with a more pronounced negative association between peers' Internet use and individual-level f2f interactions. We discuss the implications of coexisting individual-level complementarity and population-level displacement for both users and non-users.

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