Rural-Urban Gaps in Elderly E-Health Utilisation in the Digital Age: Insights from Assam

Abstract

This study investigates rural-urban disparities in digital healthcare utilisation among elderly populations in Assam, with a focus on the mediating role of digital literacy. Primary survey data from 400 respondents aged 60 and above were used to construct a Digital Literacy Index (DLI) and a Digital Healthcare Utilisation Index (DHUI) via Principal Component Analysis. Multiple regression analysis identified age, education, income, living arrangements, and digital literacy as significant determinants, with rural residence linked to lower utilisation odds. The Oaxaca-Blinder decomposition revealed a DHUI gap of 2.946 units, of which 73% was explained by differences in characteristics, primarily digital literacy, education, and income. Digital literacy alone accounted for over one-third of the explained gap, while the unexplained component pointed to infrastructural, contextual, and socio-cultural barriers. Findings show that low education, economic constraints, and limited digital skills disproportionately hinder rural elderly from accessing e-health services despite greater healthcare needs. The study indicates digital literacy as the most actionable factor, advocating tailored, age-sensitive training, simplified interfaces, and social support mechanisms. Addressing these disparities is essential to prevent digital health initiatives from exacerbating inequalities and to ensure equitable inclusion of elderly populations in India’s evolving digital health ecosystem.