New eHealth Users After COVID-19: Adoption and Resistance in Spain

Abstract

Background/Objectives: The advent of the pandemic catalysed the global adoption of digital health services. In Spain, this transition has markedly influenced eHealth accessibility, particularly through mobile-based technologies. This study compares reported real-access experiences of users of digital health at two key moments—2018 (pre-pandemic) and 2025 (post-pandemic)—to identify how access determinants have evolved. Methods: The evolution of users who have accessed digital health resources and their characterization, including the specification of who uses websites and mobile applications, was analyzed using binary logistic regression models for each year. These models incorporated sociodemographic characteristics and patterns of device usage as predictors. Results: Access to digital health services increased significantly between 2018 and 2025. The proportion of the population using such services increased from 50.2% to 85.4%. The use of mobile applications grew from 24.4% to 80.2%. In 2018, access was linked to a wider range of factors, including age, education, municipality size, self-rated health, and computer or tablet use. In contrast, the 2025 model revealed a more concentrated set of determinants. Age emerged as the primary barrier, especially >65 years, reducing the likelihood of eHealth access. Meanwhile, frequent use of digital devices (e.g., computers, smartwatches) was positively correlated with accessing eHealth. Conclusions: The study reveals an increase in access to digital health services in Spain, accompanied by shifts in the factors influencing this access. Notwithstanding technological advances, the digital divide could persist as a major impediment to access for the groups mentioned earlier. This analysis suggests the need for targeted digital inclusion measures, especially as mobile platforms are becoming the main entry point to healthcare services.