The Double Burden: The Digital Exclusion and Identity Crisis of Elderly Patients in Rural China

Abstract

The rapid digitalization of China's healthcare system, a phenomenon that accelerated during the Covid-19 pandemic, had two negative consequences for a significant portion of elderly persons in China. The first is an unfortunate practical outcome: their exclusion from many health services such as online medical appointment platforms, e-prescription requests, obtaining e-referrals, and sharing electronic medical records. The second is an emotionally debilitating identity crisis as elderly persons' former status as knowledgeable senior mentors was replaced with social perceptions of them as helpless and ignorant souls reliant on more youthful persons for guidance and assistance. This article adopts a grounded theory to explore the phenomenon from the perception of excluded elderly persons using participatory observation and in-depth interviews of 44 elderly clients of a rural hospital in the Shandong province in eastern China. The study shows that the current focus on direct practical aspects of digital exclusion may fail to capture the impact and ancillary consequences such as a painful loss of self-esteem by the digitally excluded. As the study illustrates, the practical aspects can all be overcome through intervention by those who aid the digitally excluded but this help may exacerbate the rarely considered ancillary harms of digital exclusion. Studies of digital exclusion will make more significant contributions to our understanding of the phenomenon if they look beyond the obvious direct consequences of digital exclusion to consider possible ancillary and flow-on effects.