Background The COVID-19 pandemic has given an unprecedented boost to already increased digital health services, which can place many vulnerable groups at risk of digital exclusion. To improve the likelihood of achieving digital health equity, it is necessary to identify and address the elements that may prevent vulnerable groups from benefiting from digital health services. This study examined the challenges experienced by vulnerable groups in using digital health services during the COVID-19 pandemic. Methods Qualitative descriptive design was utilized. Semi-structured interviews were conducted between October 2020 and May 2021. The participants (N = 74) were older adults, migrants, mental health service users, high users of health services, and the unemployed. Qualitative content analysis with both inductive and deductive approach was used to analyze the data. Challenges related to the use of digital health services were interpreted through digital determinants of health from the Digital Health Equity Framework. Results For most of the participants the access to digital health services was hampered by insufficient digital, and / or local language skills. The lack of support and training, poor health, as well as the lack of strong e-identification or suitable devices also prevented the access. Digital services were not perceived to be applicable for all situations or capable of replacing face-to-face services due to the poor communication in the digital environment. Fears and the lack of trust regarding digital platforms were expressed as well as concerns related to the security of the services. Contact with a health care professional was also considered less personal and more prone to misunderstandings in the digital environment than in face-to-face services. Finally, digital alternatives were not always available as desired by participants, or participants were unaware of existing digital services and their value. Conclusion Several development needs in the implementation of digital health services were identified that could improve equal access to and benefits gained from digital services in the future. While digital health services are increasing, traditional face-to-face services will still need to be offered alongside the digital ones to ensure equal access to services.

Governments are rapidly digitalising public services to increase cost-effectiveness of the public sector. This study examines older migrants’ use of digital public health and social welfare services from the perspective of social exclusion. The study uses a mixed methods approach, drawing on representative survey data of Russian-speaking migrants in Finland and qualitative interviews with third-sector representatives who assist Russian-speaking migrants with digital service use. Our quantitative results show that a sizeable proportion of Russian-speaking older adults are excluded from digital services. In particular, those with lower socio-economic status, poor local language skills and without Finnish education are at higher risk of exclusion. Our qualitative results describe the multiple ways the exclusion from digital services intersects with other disadvantages in the everyday lives of Russian-speaking older adults. We argue that digitalisation of these services may foster social exclusion and endanger the realisation of these people's social rights.

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