Digital Inclusion and Older People in Norway: Preventing Technology From Becoming a New Barrier to Care

An older person in Norway may be able to read a newspaper online, exchange messages with family and use a smartphone every day, yet still struggle to log into a health service, interpret a digital hospital letter, manage electronic identification or complete an unfamiliar online form. That distinction is becoming increasingly important as Norwegian public services and health care move more activity into digital channels.

Within the wider Norway Ageing, Long-Term Care & Community Support Knowledge Hub, digital inclusion is therefore not a peripheral technology issue. It affects access to care, participation, autonomy, communication with the fastlege and specialist health service, the ability to manage appointments and prescriptions, and whether ageing-at-home policies remain genuinely accessible as service models become more digital.

Norway enters this challenge from a strong position. Internet use is extremely high, including among older age groups, and digital competence across the population is substantial. Yet current national analysis continues to identify differences associated with age, education and participation in working life. The challenge is increasingly less about whether people are online at all and more about whether they can manage the complex, security-sensitive and constantly changing digital tasks that modern services require.

That changes the policy question. Digital inclusion cannot be measured simply by counting internet connections. It must be judged by whether people can actually exercise their rights, understand information, make choices and obtain help without being disadvantaged by the channel through which a service is delivered.

Norway's digital success creates a more complex inclusion challenge

Norway has spent years developing digital public services, national digital identity infrastructure and increasingly sophisticated digital health services. For many people, this improves convenience substantially.

Appointments can be managed without a telephone queue. Prescriptions can be reviewed digitally. Health information can be accessed from home. Secure messages can replace letters. Relatives can sometimes assist through formal digital representation. Remote consultations and digital home follow-up can reduce travel.

The resulting system is not simply replacing paper with screens. It is changing how citizens interact with the state and the health service.

This makes the definition of digital exclusion more demanding.

A person may own a tablet and still be excluded from an important service. They may know how to use social media but not understand BankID. They may access Helsenorge confidently until an interface changes. They may manage routine tasks but become unable to do so during illness, bereavement or cognitive decline.

Digital competence is therefore situational rather than binary.

The strongest digital inclusion strategies recognise a spectrum ranging from confident independent use through supported use to people who need a reliable non-digital route.

National policy has increasingly recognised digital exclusion as a system responsibility

Norway's strategy Digital hele livet, adopted in 2021, framed digital participation as a whole-of-society issue. The subsequent action plan for increased inclusion in a digital society ran through 2025 and focused on areas including digital infrastructure, access to equipment, basic digital skills, user-friendly digital services and digital judgement.

The end of that action-plan period did not mean the underlying challenge had been resolved.

Digital inclusion remains part of wider national digitalisation policy, while the National eHealth Strategy to 2030 explicitly addresses barriers within health and care services. Its direction combines expanding digital participation with recognising that people differ in their abilities, circumstances and willingness to use digital channels.

This is important because health-related digital exclusion has different consequences from difficulty using a commercial website.

A confusing online retail process may cause inconvenience. Difficulty accessing health information can affect treatment, medication, appointments or the ability to participate in decisions.

The threshold for inclusive design should therefore be correspondingly higher.

Digital competence is not the same as internet use

Recent national analysis suggests that almost the entire Norwegian population now uses internet-based tools in everyday life. At first sight, that could imply that digital exclusion is becoming marginal.

The deeper findings point in another direction.

Age remains an important factor in digital competence, alongside education and exposure to digital systems through employment. Basic activities such as searching for information or sending messages are generally easier than more demanding tasks involving security, judgement, complex navigation or unfamiliar technologies.

For older people, the distinction matters because many high-stakes public services require precisely these more demanding capabilities.

Someone may need to:

• authenticate securely through electronic identification;
• distinguish legitimate health communication from fraud;
• navigate several digital services rather than one;
• interpret clinical or administrative information;
• manage permissions and privacy settings;
• upload or submit information correctly; and
• respond when a system behaves differently from expected.

These are not basic internet-use tasks.

They require confidence, judgement and resilience when something goes wrong.

Scenario: a digitally active woman still cannot manage her health administration

An 82-year-old woman lives independently and uses a smartphone daily. She reads news online, sends photographs to her grandchildren and uses video calls confidently.

Her family therefore assumes that she is digitally independent.

After several hospital investigations, however, she receives information through digital health channels that she finds difficult to interpret. She becomes uncertain about which appointment relates to which referral and is anxious about using BankID because of repeated warnings about fraud.

She begins avoiding the digital service rather than risk making a mistake.

The problem is initially invisible. She has internet access, owns a suitable device and would not identify herself as someone who is digitally excluded.

A municipal health professional notices the difficulty during another visit and discusses how she wants information to be managed. With her agreement, her daughter helps through an appropriate representation arrangement, while the woman continues to manage the digital activities she feels confident undertaking herself.

The purpose is not to transfer control to the family. It is to preserve the woman's participation while adding support to the specific tasks that have become difficult.

This illustrates why digital inclusion should be approached through support tailored to the individual. Ability varies by task, and assistance should increase access without removing control unnecessarily.

Helsenorge makes digital access increasingly consequential

Helsenorge has become a major gateway into Norwegian health information and digital health services.

Depending on the services available to the individual, people can access prescriptions, appointments, health records, test results, vaccination information, messages and other health-related functions. Digital dialogue with fastleger and other services has also expanded considerably.

For digitally confident users, this can strengthen transparency and self-management.

For someone who cannot use the platform independently, the risk is that information becomes formally available while remaining practically inaccessible.

That distinction should matter to service governance.

Publishing a letter digitally is not the same as confirming that the person understood it. Making an appointment function available online does not demonstrate equitable access if someone cannot authenticate. Providing a digital questionnaire does not ensure meaningful participation if the language or interface is inaccessible.

Digital service availability should therefore be separated from digital service accessibility.

Electronic identification can become an access threshold

Secure electronic identification is an essential part of Norwegian digital public infrastructure.

It protects sensitive information and allows services to establish that the correct person is accessing health, financial and public-sector systems.

Yet strong authentication can also create an exclusion point.

Older people may struggle because they do not possess the appropriate electronic identification, have forgotten credentials, lack confidence in authentication processes or are worried about fraud. Others may be physically or cognitively unable to complete the process reliably.

There is an unavoidable tension here.

Reducing security to make access easier could expose vulnerable people to serious harm. Maintaining high security without adequate support can exclude those same people from essential services.

The stronger solution lies in designing secure access that recognises different user capabilities, supported by legitimate routes for assistance and representation.

Norway's current e-health roadmap includes continued work to reduce digital barriers, including activity concerning electronic identification and more comprehensive representation solutions. These should be understood as continuing development priorities rather than evidence that every access problem has already been resolved.

Representation can support access without making families informal password holders

One of the most important inclusion mechanisms is the ability for another person to act legitimately on someone's behalf.

Helsenorge allows adults to grant another person authority to use relevant health services on their behalf. Depending on the authority given, the representative may be able to view information, manage appointments, communicate with health services or undertake other permitted activities.

Importantly, representation does not depend entirely on someone being able to complete the process online. Paper-based routes also exist.

This matters because informal workarounds create serious risks.

An older person may otherwise give a family member their electronic identification credentials. The relative may act with entirely good intentions, but shared credentials undermine privacy, accountability and security. It becomes difficult to distinguish who made a decision or accessed sensitive information.

A strong digital inclusion model therefore makes legitimate representation easier than insecure workarounds.

It should also preserve proportionality. A person who needs help booking appointments may not want a relative to access every part of their health record.

This connects with choice and control. Support should expand a person's ability to participate rather than automatically transferring decision-making to whoever is more digitally competent.

Digital exclusion can emerge suddenly as health changes

Digital competence is often treated as a relatively stable personal characteristic.

For older people, it may change rapidly.

A stroke can affect vision or dexterity. Dementia can make multi-stage authentication increasingly difficult. Tremor may make a touchscreen frustrating. Hearing impairment may affect video consultations. Acute illness can reduce concentration. Bereavement may remove the spouse who previously managed the household's digital administration.

This creates an important operational requirement.

Digital ability should sometimes be reassessed when health or support needs change, particularly where the person's access to services depends heavily on digital channels.

An older person who managed all appointments independently six months earlier may now need assistance. Unless staff recognise the change, missed digital communication may be interpreted as disengagement.

That can create a hidden pathway from digital difficulty to poorer access.

Scenario: cognitive change turns a routine login into a care risk

An 86-year-old man has managed his health administration independently for years. He uses Helsenorge, renews prescriptions digitally and receives appointment information electronically.

His daughter begins noticing early cognitive changes. He still appears confident with his phone, but he repeatedly forgets authentication steps and becomes locked out of services.

He misses an appointment after believing that a digital notification was an advertising message.

The immediate response could be to ask his daughter to take over everything.

A more person-centred approach begins by identifying which tasks he can still manage and where support is required. His preferences are discussed, and legitimate representation is arranged for defined health-service functions while he continues to access information himself where possible.

The fastlege and municipal services also become aware that digital messages alone may no longer be a reliable communication route.

The man's cognitive change has therefore altered the communication risk as well as his clinical needs.

This is why accessible information and communication should include the channel through which information is delivered, not merely the wording used within it.

Accessible design reduces the amount of support people need

Some digital exclusion originates in individual capability. Some is created by poor service design.

Complex navigation, small text, unclear language, inconsistent terminology, short timeouts and processes that require users to move between several systems can turn manageable tasks into difficult ones.

Universal design is therefore a core inclusion mechanism.

Accessible digital services should consider visual impairment, motor difficulties, cognitive load, literacy, language and the ability to understand what the service is asking the user to do.

Clear language matters particularly in health care.

A technically accessible portal can still be functionally inaccessible if the information is written in language the person cannot understand.

Strong service design reduces dependence on family members and staff by making more people able to complete tasks independently.

It also improves efficiency. Every confusing digital process generates calls, visits, repeated submissions and staff time spent correcting errors.

Inclusion and productivity are therefore not necessarily competing objectives.

Norway's older population is increasingly diverse

Age is only one dimension of digital exclusion.

An older person may also face barriers related to language, literacy, disability, income, cultural background or limited familiarity with Norwegian institutions.

Norway's ageing population is becoming more diverse, including increasing numbers of older people with immigrant backgrounds.

For someone who speaks limited Norwegian, a digital health interface may combine several challenges at once: authentication, unfamiliar terminology, navigation and interpretation of clinical information.

A family member may become the default interpreter and digital navigator.

That can be helpful, but it should not become the only route to participation where confidential or important decisions are involved.

The broader digital inclusion and access agenda therefore intersects with equality, language support and accessible public services.

A digitally advanced service can still produce unequal access if it assumes a single type of user.

Community-based digital guidance provides infrastructure for independence

Norway has supported digital-skills initiatives aimed specifically at older people, including training and guidance intended to strengthen digital health competence and reduce exclusion.

Municipalities, libraries, voluntary organisations and specialist groups can all play a role.

The value of these services extends beyond teaching people how to use a device.

Effective guidance may help an older person understand electronic identification, recognise fraud, navigate public services, use video consultations or manage digital health information.

The physical setting matters too.

A local, low-threshold service may be easier to approach than a formal course. Peer support can be particularly effective because people may feel more comfortable admitting uncertainty to someone with similar experience.

In 2025, national funding supported municipalities seeking to establish or develop low-threshold digital guidance services, with collaboration between municipalities and voluntary organisations encouraged.

The strategic question after any time-limited grant is how that support becomes sustainable.

Digital inclusion cannot depend indefinitely on short-term projects if digital public services are permanent.

Scenario: municipal digital guidance prevents dependence on adult children

A 74-year-old widower has recently bought a tablet. His son usually helps with online banking and health appointments, but lives several hours away.

The man does not want to call his son whenever he receives a digital message, yet he worries that pressing the wrong button could expose him to fraud.

He attends a low-threshold digital guidance session in his municipality.

Rather than completing tasks on his behalf, the adviser helps him understand authentication, identify legitimate messages and practise finding the functions he uses most often. Written guidance is adapted to the steps he needs rather than covering every possible feature.

Over time he becomes able to manage routine tasks independently.

His son remains available for occasional help, but is no longer the essential gateway between his father and public services.

This small change has a wider significance.

The intervention preserves autonomy, reduces unpaid family administration and increases the likelihood that future digital services will be usable rather than avoided.

It also demonstrates why digital inclusion should be treated as preventative infrastructure. A modest investment in confidence may reduce later demand for repeated staff support.

Health professionals also influence whether digitalisation excludes

Digital inclusion is not solely the responsibility of technology teams.

Health professionals make everyday decisions about communication channels, applications, remote consultations and digital self-management tools.

They therefore need enough digital judgement to recognise when a technology is appropriate for one person but not another.

A digital-first pathway should not become a digital-only mindset.

Professionals should be able to identify when someone needs:

• additional explanation or demonstration;
• accessible or translated information;
• support from an authorised representative;
• a telephone or face-to-face alternative;
• adapted equipment; or
• review because their ability to use the service has changed.

This is part of the wider workforce challenge created by digital transformation. Staff need competence not only in using technology but in judging its suitability.

The Digital Transformation Readiness Assessment can help organisations examining comparable issues test whether digital strategy, workforce capability, inclusion and implementation are developing together rather than treating adoption as a purely technical programme.

Non-digital alternatives remain part of equitable access

A mature digital society does not necessarily require every interaction to become digital.

Some older people will not be able to use certain digital services independently even with good training and accessible design. Others may choose not to.

That does not mean digitalisation should stop.

It means the system needs proportionate alternatives for essential services.

The policy challenge is to avoid two unhelpful extremes.

One is maintaining every historic process unchanged, preventing digital services from delivering efficiency or convenience. The other is making digital access effectively mandatory even where people cannot participate safely.

The stronger approach is assisted digital design: digital processes for those who can use them, support for those who need help and alternative routes where digital participation is not realistic.

This principle is particularly important for health and care because exclusion can affect statutory rights, treatment and safety rather than convenience alone.

Fraud and cyber security create a distinctive older-person risk

Confidence in digital services is shaped by security.

Older people are repeatedly warned not to share credentials, not to click suspicious links and not to respond to fraudulent messages. Those warnings are necessary.

They can also produce fear.

Someone who has difficulty distinguishing legitimate digital health communication from fraud may respond by avoiding both.

Digital literacy therefore includes the ability to recognise trustworthy services and understand how legitimate organisations communicate.

This becomes even more important as artificial intelligence makes fraudulent messages and impersonation more convincing.

Digital inclusion programmes should not treat cyber security as an advanced topic reserved for confident users. It is central to enabling hesitant users to participate safely.

The wider digital safeguarding and technology-enabled risk agenda should therefore include both protection from malicious activity and protection from exclusion caused by fear of malicious activity.

Technology-enabled care can create exclusion inside the home

Welfare technology and digital home follow-up can support independence, but they can also create a new divide between people who can participate confidently and those who cannot.

An electronic medication dispenser may require little digital competence once installed. A remote-monitoring pathway may demand more active engagement. Video consultations can work extremely well for some people while creating difficulties for someone with hearing impairment, poor connectivity or cognitive change.

The assessment should therefore begin with the service objective rather than assuming that digital delivery is inherently preferable.

This connects with technology and digital support for older people. The value of technology depends upon the fit between the tool, the person's capabilities and the surrounding support model.

Scenario: remote follow-up works only after the pathway is adapted

An older woman with a chronic respiratory condition is offered digital home follow-up. She is capable of taking the required measurements but struggles to navigate the application and becomes anxious when unfamiliar notifications appear.

The first assumption is that the pathway may be unsuitable for her.

Instead, the team examines which part is creating the barrier.

The clinical task itself is manageable. The problem is the interface and her lack of confidence about what each message means.

Staff provide additional training, simplify the routine and agree what she should do if she receives an unfamiliar notification. Her daughter is involved only to the extent the woman wants.

The adapted pathway becomes workable.

If the service had judged suitability solely on her first unsuccessful attempt, she might have been excluded from a model that could improve access and reduce travel. If staff had insisted that she manage without adaptation, the same technology might have increased anxiety.

The scenario demonstrates a broader principle: equitable digital care sometimes requires more support at the beginning in order to enable greater independence later.

Governance should look for who is missing, not only who is using the service

Digital-service dashboards often focus on adoption.

They may show the number of users registered, messages sent, appointments booked online or people enrolled in remote monitoring.

Those metrics tell only part of the story.

Inclusive governance also asks who is not using the service and why.

Useful questions include:

• Does uptake vary substantially by age or geography?
• How many people need assisted digital support?
• Are people abandoning digital processes before completion?
• Which accessibility barriers generate repeat contact?
• How often are non-digital alternatives required?
• Are authorised representation mechanisms being used safely?
• Are missed appointments or communications associated with digital access problems?

This moves the discussion from technology adoption towards service equity.

It also connects with quality data and performance metrics. Aggregate success can conceal exclusion among a smaller group unless organisations deliberately look for it.

The Quality Dashboard Builder can help organisations structure a broader view of adoption, accessibility, outcomes and risk when examining digitally enabled care. It is not a Norwegian regulatory tool, but the principle of balancing utilisation with quality and equity is internationally relevant.

Municipal variation can affect digital inclusion as much as national infrastructure

Norway's national digital systems provide important common infrastructure, but people's practical experience often depends on local implementation.

Municipalities differ in size, geography, digital capability, available guidance services and the extent to which welfare technology and digital health pathways have been embedded.

A large urban municipality may sustain dedicated digital-inclusion support. A small rural municipality may depend more heavily on libraries, voluntary organisations or intermunicipal cooperation.

Local variation is not automatically evidence of poor quality. Different populations require different arrangements.

However, variation becomes problematic when access to essential services depends excessively on where a person lives.

National infrastructure, standards and guidance therefore need to be combined with sufficient local implementation capacity.

The Governance Maturity Assessment offers organisations considering similar questions a way to test whether responsibility, escalation, evidence and oversight are sufficiently developed around major service transformation. The relevant Norwegian governance arrangements remain those established through Norwegian law, municipalities and national health authorities.

Digital inclusion should be designed into transformation rather than repaired afterwards

One of the most important lessons from digital public services internationally is that exclusion is easier to prevent during design than to correct after implementation.

If services test only with digitally confident users, accessibility problems may emerge only after launch.

If older people, people with disabilities and people requiring language support are involved earlier, developers can identify barriers before they become embedded in a national or municipal workflow.

This requires meaningful user involvement rather than symbolic consultation.

People need to test real tasks: logging in, finding information, understanding messages, recovering from mistakes and identifying where they would seek help.

The principle aligns closely with co-production and lived experience. Digital inclusion improves when service designers treat people experiencing barriers as contributors to better system design rather than simply recipients of remedial training.

The future risk is not that older people will remain permanently offline

The digital profile of older people will continue to change.

Future generations entering their seventies and eighties will generally have more lifetime experience with digital technology than today's oldest population.

That does not mean digital exclusion will disappear.

Technology itself will continue changing. Authentication methods, artificial intelligence, automated decision support and new forms of remote care will introduce unfamiliar requirements. Age-related sensory, cognitive and physical changes will continue to affect people's ability to use systems they previously managed well.

The future challenge is therefore dynamic.

Norway should not build digital-inclusion policy around an assumption that today's digitally excluded group will simply age out of the population.

The stronger model is permanent inclusive capability: accessible design, human support, legitimate representation, adaptable communication and alternatives where necessary.

International learning lies in separating digital participation from digital independence

Norway's experience offers an important lesson to other highly digital health and care systems.

High internet penetration can create false reassurance.

A population may be overwhelmingly online while still containing people who cannot independently manage high-stakes digital services.

The transferable lesson lies less in Norway's particular infrastructure and more in the distinction between participation and capability.

Governments can expand digital services while simultaneously recognising that some people will need assistance. Secure representation can be developed without normalising password sharing. Accessible design can reduce support requirements without assuming universal capability. Non-digital routes can remain available for essential functions without preventing the wider system from modernising.

Digital inclusion is therefore not an argument against digital transformation.

It is one of the conditions for doing digital transformation well.

Conclusion

Norway's digital maturity creates enormous opportunity for older people's care. Health information, appointments, communication, prescriptions, welfare technology and remote support can increasingly be accessed without unnecessary travel or administrative delay. For many older people, these developments strengthen autonomy.

The strategic challenge is ensuring that the same transformation does not create a new access threshold for people whose digital competence, health, language, confidence or ability to authenticate differs from the assumed user.

That requires a more sophisticated definition of inclusion. Owning a smartphone is not enough. Being online is not enough. A person must be able to understand the service, use it safely, obtain help when necessary and retain a viable route to essential care if independent digital use is not realistic.

Norway's strongest future position will come from embedding those principles into ordinary service design: accessible interfaces, digital guidance, legitimate representation, workforce judgement, alternatives where required and governance that examines who is missing as carefully as it measures who has adopted the new channel.

As ageing-at-home and digital health develop together, inclusion becomes part of care quality itself. Technology should widen older people's options, not determine whether they can participate. The success of Norway's digital transformation will ultimately depend not on how many services move online, but on whether people remain able to reach them.