Abstract
<sec> <title>BACKGROUND</title> <p>eHealth is transforming healthcare by improving personalized care and efficiency. However, 25% of Europeans lack digital literacy, limiting their ability to benefit from these innovations. This study explores eHealth acceptance across four European countries, among chronic obstructive pulmonary disease (COPD) patients. A group with on average lower digital literacy.</p> </sec> <sec> <title>OBJECTIVE</title> <p>To identify barriers, facilitators, and needs regarding eHealth among COPD patients, and to inform more inclusive, tailored strategies</p> </sec> <sec> <title>METHODS</title> <p>This qualitative focus group study with COPD patients was performed in the Netherlands, Belgium, UK, and Germany. Using digital literacy models (e.g. eHealth Literacy Framework (eHLF), Lily Model, Unified Theory of Technology Acceptance (UTAUT)), we aimed to understand patient experiences and attitudes towards digital health technologies. The study included participants with limited digital skills to ensure representation of those most at risk of digital exclusion.</p> </sec> <sec> <title>RESULTS</title> <p>The focus groups included 62 participants (mean age: 69 ± 7 years, 53% female), with a diagnosis of COPD, from the Netherlands (n = 13), Belgium (n = 19), UK (n = 9), and Germany (n = 21). We made clear that no previous experience with digitalisation or eHealth was needed to participate. Experiences with eHealth applications varied by country, with participants in Belgium and the Netherlands being more familiar and comfortable with these tools, while participants in the UK and Germany reported limited familiarity and access. Participants faced cognitive and skill barriers, such as forgetfulness and difficulty with passwords, which complicated the use of digital health systems. Additionally, system adaptability and device compatibility issues, like outdated technology, further hindered their engagement. Many participants relied on family, healthcare providers, and community resources for support, though seeking assistance often came with its own set of difficulties. One participant illustrated the challenge of understanding the jargon associated with digital technology by saying, "When you were just talking about the cloud earlier, I looked up. Then it hit me, it’s a different kind of cloud."</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Our study revealed that among COPD patients from four European countries, willingness to use eHealth was strongly linked to whether applications were practical, user-friendly, and supported by guidance. Social support and positive attitudes appeared to be more important for eHealth acceptance than technical skills alone. Promoting inclusive eHealth uptake in this group requires explicit attention to privacy concerns, clear and accessible communication, and personalized support throughout the introduction and use of digital health tools.</p> </sec>