Health and self-perceived barriers to internet use among older migrants : a population-based study

This is a sel -a chi ed e sion o an o iginal a icle. This e sion may di e om he o iginal in pagina ion and ypog aphic de ails. Au ho (s): Ti le: Yea : Ve sion: Copy igh : Righ s: Righ s u l: Please ci e he o iginal e sion: CC BY 4.0 h ps://c ea i ecommons.o g/licenses/by/4.0/ Heal h and sel -pe cei ed ba ie s o in e ne use among olde mig an s : a popula ion- based s udy © The Au ho (s) 2022 Published e sion Kou onen, Anne; Kemppainen, Teemu; Taipale, Saka i; Olaki i, An e o; W ede, Si pa; Kemppainen, Lau a Kou onen, A., Kemppainen, T., Taipale, S., Olaki i, A., W ede, S., & Kemppainen, L. (2022). Heal h and sel -pe cei ed ba ie s o in e ne use among olde mig an s : a popula ion-based s udy. BMC Public Heal h, 22, A icle 574. h ps://doi.o g/10.1186/s12889-022-12874-x 2022 Kou onene al. BMC Public Heal h (2022) 22:574 h ps://doi.o g/10.1186/s12889-022-12874-x RESEARCH Heal h andsel -pe cei ed ba ie s oin e ne use amongolde mig an s: apopula ion-based s udy Anne Kou onen1,2*, Teemu Kemppainen3,4, Saka i Taipale5,6, An e o Olaki i1, Si pa W ede1,7 and Lau a Kemppainen1 Abs ac Backg ound: In olde adul s, including hose wi h a mig an backg ound, ill heal h is associa ed wi h less in e ne use. Howe e , i is no known wha a e he speci ic sel -pe cei ed ba ie s o in e ne use among olde mig an s wi h di e en heal h condi ions. The aim o his s udy was o in es iga e he associa ions be ween di e en heal h condi- ions and sel -pe cei ed ba ie s o in e ne use among olde mig an s. Me hods: We used he Ca e, Heal h and Ageing o Russian-speaking Mino i y in Finland (CHARM) s udy, which is a na ionally ep esen a i e su ey o communi y-dwelling Russian-speaking adul s aged ≥50 yea s li ing in Finland (N=1082, 57% men, mean age 63.2 yea s, s anda d de ia ion 8.4 yea s, esponse a e 36%). Pos al su ey da a we e collec ed in 2019. Heal h indica o s we e sel - a ed heal h (SRH), dep essi e symp oms, cogni i e unc ioning, and doc o -diagnosed condi ions. Linea eg ession analyses we e used o in es iga e he associa ions be ween heal h indica o s and a summa y scale consis ing o he ollowing ba ie s o in e ne use: (1) in e ne use is oo complica ed and ha d o lea n; (2) ha ing conce ns abou sa e y issues; (3) in e ne use is oo expensi e; (4) physical limi a ions hinde he in e ne use; (5) memo y p oblems hinde he in e ne use. In addi ion, he wo mos commonly epo ed ba ie s ( he i s wo) we e examined sepa a ely using logis ic eg ession analyses. The analyses we e adjus ed o age, sex, educa ion, ma i al s a us, local language p o iciency, and income suppo , and he heal h condi ions, and we e pe o med wi h weigh s accoun ing o he su ey design and non- esponse. Resul s: A e adjus men s, spine/back p oblems (b=0.13; p=0.049), dep essi e symp oms (b=0.40; p=0.007), and p oblems in lea ning new hings (b=0.60; p<0.0005) we e associa ed wi h highe le el o o e all ba ie s o in e ne use. In addi ion, a numbe o heal h condi ions we e associa ed wi h indi idual ba ie s, albei some heal h condi ions appea ed p o ec i e. Conclusions: In gene al, olde mig an s wi h declining heal h expe ience mo e ba ie s o in e ne use han hei coun e pa s wi h be e heal h. To p o ide be e access o heal hca e o olde adul s, including olde mig an s, apidly changing de ices, so wa e and apps need o be modi ied and adap ed o hose wi h speci ic heal h- ela ed needs. Keywo ds: Digi al in o ma ion echnology, In e ne use, Olde adul s, Mig an s, Dep ession, Ba ie s o in e ne use, Cogni i e unc ioning, Ch onic condi ions © The Au ho (s) 2022. Open Access This a icle is licensed unde a C ea i e Commons A ibu ion 4.0 In e na ional License, which pe mi s use, sha ing, adap a ion, dis ibu ion and ep oduc ion in any medium o o ma , as long as you gi e app op ia e c edi o he o iginal au ho (s) and he sou ce, p o ide a link o he C ea i e Commons licence, and indica e i changes we e made. The images o o he hi d pa y ma e ial in his a icle a e included in he a icle’s C ea i e Commons licence, unless indica ed o he wise in a c edi line o he ma e ial. I ma e ial is no included in he a icle’s C ea i e Commons licence and you in ended use is no pe mi ed by s a u o y egula ion o exceeds he pe mi ed use, you will need o ob ain pe mission di ec ly om he copy igh holde . To iew a copy o his licence, isi h p:// c ea i eco mmons. o g/ licen ses/ by/4. 0/. The C ea i e Commons Public Domain Dedica ion wai e (h p:// c ea i eco mmons. o g/ publi cdoma in/ ze o/1. 0/) applies o he da a made a ailable in his a icle, unless o he wise s a ed in a c edi line o he da a. Open Access *Co espondence: [email p o ec ed] 1 Facul y o Social Sciences, Uni e si y o Helsinki, PO Box 54, 00014 Helsinki, Finland Full lis o au ho in o ma ion is a ailable a he end o he a icle Page 2 o 12 Kou onene al. BMC Public Heal h (2022) 22:574 Backg ound In No he n Eu ope, in e ne use has become a pa o he e e yday li e o he as majo i y o olde adul s. Acco ding o he S a is ics Finland su ey conduc ed in 2020, 97% o he 55 o 64-yea -olds had used he in e - ne in he las h ee mon hs. The co esponding igu es o 65 o 74-yea -olds and 75 o 89-yea -olds we e 88% and 51%, espec i ely [1]. In echnologically ad anced coun ies wi h such high connec ion a es, in e ne use has p ac ically become a necessi y o social inclusion [2]. Public se ices and e e yday communica ion ha e inc easingly gone online, which means ha hose who do no use he in e ne can become excluded no only om he essen ial heal h and o he public se ices, bu also om social ne wo ks, and he socie y a la ge. Non-use s inc easingly consis o he mos ulne able segmen s o he popula ion: he oldes , he leas educa ed, hose wi h ill heal h, and hose who a e socially mos isola ed [3]. In addi ion, some s udies ha e shown ha e hnic mino i- ies and mig an s use he in e ne less [4–13]. In con em- po a y socie ies, digi al and social exclusion a e deeply in e wined. Acco ding o he double jeopa dy hypo h- esis, olde mig an s a e a a pa icula isk o social exclu- sion because o hei age and mig a ion backg ound [14]. Olde mig an s wi h a low socio-economic s a us and heal h p oblems may be especially ulne able: he in e - sec ing domains o old age, ill heal h, low socio-economic s a us, and a mig an backg ound ha e been shown o inc ease he isk o social exclusion [15, 16]. A he same ime, in ansna ional con ex , and ampli ied by he COVID-19 pandemic, he abili y o emain connec ed wi h he iends and amily has become e y s ongly dependen on using digi al echnologies [17]. When popula ions a e ageing, heal h- ela ed ac o s a e becoming inc easingly ele an in unde s anding he “ he digi al di ide” [18], as de e io a ing heal h con- di ions can hampe he use o digi al echnologies. In olde adul s, a ious indica o s o ill heal h and disabil- i y, such as subop imal sel - a ed heal h (SRH) [19–31], men al ill heal h [23, 32], ch onic condi ions [33], ail y [34], declining physical pe o mance [20], limi a ions in physical capaci y [35], ision impai men [35], and cog- ni i e decline, memo y limi a ions and demen ia [17, 20, 22, 35–40] ha e been associa ed wi h a lowe likelihood o digi al echnology use. In esea ch, olde people a e o en conside ed as a homogenous g oup, e en hough his g oup and hei easons o no using he in e ne a e inc easingly di e se [41]. Mo eo e , e en hough he numbe s and p opo ions o mig an s, including olde mig an s, a e apidly inc easing, in he heal h li e a u e he mig a ion- ela ed aspec s o he digi al di ide a e unde explo ed [8], and li le is known abou he posi- ion o olde mig an s in ela ion o digi al di ide [42]. Mos o he s udies on heal h and in e ne use in olde adul s ha e concen a ed on majo i y popula ions. I is no known wha speci ic ba ie s o in e ne use olde mig an s wi h di e en heal h condi ions expe ience. I would be impo an o in es iga e, why hose who do no use he in e ne , do no engage [43]. Fu he mo e, di e en heal h condi ions may a ec in e ne use [20], and ba ie s o use di e en ly. In a Taiwanese s udy pub- lished in 2017, among hose aged 50 and o e , he mos common easons o non-use we e di icul ies ela ed o lea ning, which included ac o s such as eeling no need, eeling unable o oo busy o lea n, no in e es ed, and no able o use English [44]. In a Swedish s udy om 2020 he mos common easons o being a non-use o he in e ne included no knowing how o use he in e - ne and ha ing no need/in e es ; whe eas no possibili y o b oadband, being oo busy, high cos s and secu i y issues we e men ioned less o en [22]. In a Sco ish quali- a i e s udy (2017), lack o ins uc ions and guidance, lack o knowledge and con idence, heal h- ela ed ac o s and cos s eme ged as ba ie s o in e ac ing wi h ab- le compu e s [45]. In addi ion, among olde mig an s, local language p o iciency has been ound o be he mos impo an ba ie o he e ec i e u ilisa ion o he in e - ne o seeking heal h in o ma ion [42]. As a No dic wel a e s a e, Finland has comp ehensi e social igh s gua an eed by legisla ion, and an ex ensi e ax- inanced public heal h and social wel a e sec o . O e he las decade, he Finnish s a e has implemen ed as digi alisa ion p ojec s in he public sec o . Howe e , li le a en ion has been paid o he ba ie s ha digi alisa ion o heal h and social wel a e se ices may c ea e o he ul- ilmen o social igh s in gene al, and o people a isk o social exclusion (e.g. olde mig an s), in pa icula . The aim o his s udy was o in es iga e he asso- cia ions be ween di e en dimensions o ill heal h and sel -pe cei ed ba ie s o in e ne use among olde Rus- sian-speaking mig an s li ing in Finland. Me hods Da a The da a we e d awn om he Ca e, Heal h and Ageing o Russian-Speaking Mino i y in Finland (CHARM) su - ey ha was collec ed in 2019 [23]. The a ge popula ion o he s udy was Russian-speaking communi y-dwell- ing olde adul s (50 yea s o age o olde ) who pe ma- nen ly eside in Finland. Russian-speake s a e he la ges mig an g oup in Finland, making up abou 20% o he coun y’s mig an popula ion. The s udy was designed o collec da a on pa icipan s’ heal h and well-being, public se ice expe iences, digi al inclusion, and access o di e en ypes o ca e. A andom sample o 3000 people was d awn om he egis e o he Digi al and Page 3 o 12 Kou onene al. BMC Public Heal h (2022) 22:574 Popula ion Da a Se ices Agency; hei egis e co e s all pe sons egis e ed as pe manen ly li ing in Finland. The sample was s a i ied by gende . Response a e was 36% (N=1082; 57% men; mean age 63.2 yea s, s anda d de ia ion 8.4 yea s). The ques ionnai e was a ailable in Russian and Finnish. Non- esponse bias was adjus ed o by weigh ing he su ey esponses. Fo ha , he Finnish Tax Adminis a ion egis e da a om 2017 we e used o model he esponse p opensi y [46]. The ax admin- is a ion da a included in o ma ion on ea nings, capi al income, unemploymen bene i s, and pensions. S udy pa icipa ion was olun a y, and he pa ici- pan s we e in o med o hei igh o wi hd aw a any ime wi hou any consequences. In o med consen was ob ained om all pa icipan s. The E hical Re iew Boa d in he Humani ies and Social and Beha iou al Sciences a he Uni e si y o Helsinki app o ed he s udy p o ocol (#6/2019). Heal h indica o s All s udy a iables we e sel - epo ed. The pa icipan s we e asked i hey had e e been diagnosed wi h any o he ollowing condi ions commonly expe ienced in his age g oup (yes s no): high blood p essu e / hype en- sion, spine de e io a ion, scia ica o o he back p oblem, os eoa h i is o join de e io a ion, heuma oid a h i is o o he heuma oid disease, dep ession o o he men al heal h p oblem, as hma, diabe es, memo y diso de (Alz- heime ’s o o he demen ia), cance , some o he ch onic disease o heal h p oblem. Dep essi e symp oms we e measu ed by he eigh - i em Cen e o Epidemiologic S udies Dep ession Scale (CES-D )[47], wi h a sco e o nine o mo e poin s indica - ing dep essi e symp oms [48]. Sel - a ed heal h (SRH) was assessed wi h he ollow- ing ques ion: “In gene al, would you say you heal h now is…?” )[49]. Pa icipan s a ed hei heal h on a 5-poin scale. A dicho omous a iable was c ea ed by ca ego is- ing he answe s in o good (good o a he good) and sub- op imal (a e age, ai ly poo and poo ) [50, 51]. Th ee aspec s o cogni i e unc ioning, ha is, sel - a ed memo y, concen a ion, and lea ning abili y we e measu ed by h ee i ems assessing he unc ioning o 1) memo y; 2) concen a ion; 3) capabili y o lea n new in o ma ion and hings; using a i e-poin scale (1= e y poo ly, 2=poo ly, 3=sa is ac o ily, 4=well, 5= e y well) [52]. Cogni i e unc ioning a iables we e dicho omised using 2 as a cu -o poin ( e y poo o poo unc ioning s o he ). Sel ‑ epo ed ba ie s oin e ne use Sel - epo ed ba ie s o in e ne use we e measu ed wi h he ollowing ques ion: “Some imes, he use o he in e ne can eel di icul . A e he e some hings ha hampe you in e ne use? (choose 1-3 mos ele an op ions)”. Pa icipan s had o choose he ele an op ions o he ollowing: 1) In e ne use is oo complica ed o ha d o lea n; (2) I ha e conce ns abou in e ne sa e y issues; (3) Someone else akes ca e o he ma e s ha equi e in e ne use o me (“p oxy use”); (4) In e ne use is oo expensi e; (5) In e ne use is di icul because o my poo eyesigh o o he physical easons (e.g. s i ness o inge s); (6) Memo y p oblems hinde my in e ne use; 7) I am no in e es ed in he con en s o he in e ne ; 8) I do no ha e ime o in e ne use; 9) I do no ha e hese kinds o p oblems wi h he in e ne use. Mul iple co espondence analysis (MCA) was applied as a dimension educ ion me hod o c ea e a a iable indica ing o e all ba ie s o in e ne use based on i ems 1, 2, 4, 5, 6 and 9. These six i ems we e selec ed o indica e he p oblems o in e ne use ele an o he pe spec i e o ou s udy. I ems 3 (“p oxy use”) and 7 (no in e es ed) a e no ac ual ba ie s o in e ne use. MCA can be con- side ed analogous o p incipal componen analysis wi h he possibili y o using ca ego ical a iables. Simila ly o o he dimensions educ ion echniques, i p o ides he ad an age o inc eased eliabili y and con en alidi y in he ope a ionalisa ion o complex concep s [53]. We pe - o med MCA using Bu ’s app oach and ex ac ed s and- a d no malized coo dina es [54–56]. In addi ion o MCA app oach, he wo mos common ba ie s ( he i s wo) we e examined sepa a ely as ou comes. Thus, we u ilise ou ou come a iables in ou analysis. Co a ia es Co a ia es included he ollowing socio-demog aphic cha ac e is ics: sex, age (squa ed), ma i al s a us (ma - ied o cohabi ing s o he ), educa ional le el in he coun y o o igin, p o iciency in local languages, and eceip o means- es ed income suppo bene i (yes s no) du ing he las 12 mon hs as a measu e o po e y [57]. The highes educa ional le el in he coun y o o i- gin was ca ego ised based on he old So ie educa ional sys em as ha ing no o only basic educa ion; oca ional aining; highe educa ion. Sel - epo ed local language p o iciency was assessed on a ou -poin scale, which o he analysis was dicho omised in o good (“I use Finnish o Swedish language in a ious ways in di e en si ua- ions” and “I can pa icipa e on e e yday con e sa ions in Finnish o Swedish”), and poo (“I can cope wi h simple e e yday si ua ions in Finnish o Swedish” and “I do no speak ei he language a all”). S a is ical analysis Two nes ed models we e speci ied o explo e he socio-demog aphic and heal h- ela ed p edic o s o Page 4 o 12 Kou onene al. BMC Public Heal h (2022) 22:574 sel - epo ed ba ie s o in e ne use. Model 1 included all socio-demog aphic a iables, while Model 2 u he adjus ed o all heal h indica o s. The models o MCA- based ou come a iable we e es ima ed as linea eg es- sion models, whe eas hose o single-i em ou comes we e speci ied as logis ic eg ession models. Possible cu ilin- ea i y ega ding he age a iable was es ed o all ou - comes adding age squa ed o he models. All models we e es ima ed accoun ing o esponse-p opensi y adjus ed sampling weigh s. Mo eo e , clus e - obus a iance es i- ma ion was used wi h adminis a i e egions as clus e s. To de ec possible mul icollinea i y, a iance in la ion ac o s we e examined: he maximum was 1.53, which is well below 10, he o -used limi o conce n. S a a e sion 15.1 was used o all analyses. Resul s Table1 p esen s he cha ac e is ics o he sample and shows ha he majo i y o he pa icipan s (75%) we e ma ied o cohabi ing, 50% had acqui ed a highe edu- ca ion deg ee in hei coun y o o igin, and 38% a ed hei local language (Finnish o Swedish) skills as good. As many as 42% o he pa icipan s had ecei ed means- es ed income suppo o e he las 12 mon hs; his indi- ca es widesp ead po e y in his g oup as in 2020 he co esponding igu e o he whole popula ion o Finland was 7.5%, and o people o e 65 yea s o age i was only 1.8% [58]. Dep essi e symp oms we e commonly expe- ienced (18%). Rega ding sel - a ed heal h, 60% o he pa icipan s a ed hei heal h as poo o ai ly poo . Sel - a ed p oblems wi h memo y, concen a ion o lea ning we e a e. The p e alence o diagnosed diseases anged om commonly epo ed high blood p essu e / hype - ension (48%) o a ely epo ed memo y diso de s (2%). Abou hal o he pa icipan s epo ed ha hey did no ha e p oblems wi h he in e ne use. Ele en pe cen ound in e ne oo complica ed o ha d o lea n, and almos one qua e we e wo ied abou in e ne sa e y issues. Cos , poo eyesigh o o he physical p oblems o memo y p oblems we e only a ely pe cei ed as ba ie s o in e ne use. Table1 u he shows bi a ia e associa ions be ween he p edic o s and ou come a iables. Va ious socio- demog aphic ac o s we e associa ed wi h he h ee ou come measu es. Fo example, age was posi i ely co ela ed wi h he MCA measu e o ba ie s ( =0.30; p<0.0005) and was associa ed wi h a highe likelihood o he expe ience ha in e ne is oo complica ed (odds a io, OR=1.10; p<0.0005). Conce ning heal h indica- o s, he e we e se e al s a is ically signi ican bi a ia e associa ions wi h he MCA ou come, and he di icul y ou come, bu less wi h he hi d, he sa e y ou come. Fo ins ance, hose who epo ed ha hey ha e a diagnosed memo y diso de had a 0.78 uni s highe mean in he MCA ou come (p=0.012) han hose wi hou his diag- nosis, which equals o 78% o he ou come measu e’s s anda d de ia ion (SD). To de e mine whe he heal h condi ions we e associ- a ed wi h sel - epo ed o e all ba ie s o in e ne use a e accoun ing o po en ial con ounde s, we eg essed sel - epo ed ba ie s (MCA ou come) on co a ia es and he p esence o di e en heal h condi ions. As Table2 shows, ba ie s o in e ne use seemed o inc ease wi h age (Model 2.1: b=0.04; p<0.0005; Model 2.2: b=0.03; p<0.0005); he squa ed e m was no s a is ically sig- ni ican and was hus omi ed o e ain a pa simoni- ous model. Highe educa ion was associa ed wi h ewe ba ie s: Model 2.1 shows a s a is ically signi ican g adien whe e oca ional educa ion adds 0.19 uni s (p=0.007, while he lowes educa ional le el adds 0.36 uni s (p=0.025) o he MCA ou come (SD=1.00). Wi h he inclusion o heal h indica o s, hese esul s los some powe , bu he pa e n was simila . Rega ding heal h indica o s (Model 2.2), spine/back p oblems (b=0.13; p=0.049), dep essi e symp oms (b=0.40; p=0.007), and di icul ies in lea ning new hings (b=0.60; p<0.0005) we e s a is ically signi ican . In e ms o he s anda d de ia ion (SD) o he ou come a iable, he e ec sizes anged om 13% (spine/back) o 60% (di icul ies in lea ning new hings). Tables 3 and 4 display he associa ions be ween he co a ia es, heal h condi ions and he wo mos common ba ie s o in e ne use. In Models 3.1 and 3.2 (Table3), age, p o iciency o Finnish/Swedish, and educa ion appea ed as consis en and s a is ically signi ican p edic- o s o eeling ha in e ne is oo complica ed and ha d o lea n. Again, wi h inc easing age, his ba ie became mo e common (Model 3.2: odds a io, OR=1.10; 95% con idence in e al (CI): 1.09-1.11); and like abo e, he squa e e m was no s a is ically signi ican . Mas e ing well he local languages seemed o lessen he isk o expe- iencing his ba ie (Model 3.2: OR=0.62; 95% CI: 0.40- 0.95). Finally, he e was a clea educa ional g adien wi h ORs inc easing om 1.73 ( oca ional educa ion; 95% CI: 1.22-2.46) o 5.36 (lowes le el; 95% CI: 1.91-15.05). Rega ding heal h indica o s, ha ing os eoa h i is (OR=1.53; 95% CI: 1.05-2.22 and expe ienced di icul- ies in lea ning new hings (OR=4.53; 95% CI: 2.22-9.24) we e associa ed wi h a highe likelihood o epo ing ha in e ne use is oo complica ed and ha d o lea n. In con as , i a pa icipan had as hma (OR=0.33; 95% CI: 0.12-0.87), diabe es (OR=0.63; 95% CI: 0.40-0.99) o p oblems wi h concen a ion (OR=0.31; 95% CI: 0.10- 0.99), hey we e less likely o epo his pa icula ba ie o in e ne use. Page 5 o 12 Kou onene al. BMC Public Heal h (2022) 22:574 Table 1 Cha ac e is ics o he sample and he bi a ia e associa ions be ween p edic o s and ou come a iables Ba ie s o in e ne use (MCA) In e ne oo complica ed In e ne sa e y conce ns Va iable Coun % Mean p%p%p Gende 0.786 0.544 0.941 Female 466 43.1 -0.01 11.59 23.82 Male 616 56.9 0.01 10.71 23.86 Age 1082 63.2 (8.4) 0.30 <0.0005 1.10 <0.0005 0.98 0.365 Ma i al s a us 0.013 <0.0005 0.387 Ma ied o cohabi ing 796 74.6 ‑0.05 9.67 25.38 O he 271 25.4 0.14 15.50 20.66 Command o Finnish o Swedish <0.0005 <0.0005 0.023 Poo 634 62.2 0.08 14.04 21.92 Good 385 37.8 ‑0.17 5.45 26.75 Highes educa ion in he coun y o o igin <0.0005 <0.0005 0.502 Highe educa ion 541 50.0 ‑0.12 7.02 23.66 Voca ional educa ion 459 42.4 0.09 13.94 24.62 Gene al/No educa ion/Missing 82 7.6 0.25 21.95 20.73 Income suppo <0.0005 <0.0005 0.020 No 592 58.4 ‑0.12 7.26 27.03 Yes 421 41.6 0.11 15.44 19.95 In e ne p oblems Use is oo complica ed and i is oo ha d o lea n 120 11.1 . . . . . . I am conce ned abou in e ne sa e y issues 258 23.8 . . . . . . Someone else han mysel akes ca e o he ma e s ha equi e in e ne use 160 14.8 . . . . . . Use o in e ne is oo expensi e 38 3.5 . . . . . . Use o in e ne is complica ed by he limi ed eyesigh , hea ing o o he physical easons 56 5.2 . . . . . . Memo y p oblems hinde he in e ne use 20 1.9 . . . . . . I ha e no aced any o such p oblems 563 52.0 . . . . . . Diagnosed diseases High blood p essu e, hype ension 515 47.6 0.13 <0.0005 13.79 <0.0005 24.47 0.703 Spine de e io a ion, scia ica o o he back p oblem 344 31.8 0.07 0.095 11.52 0.410 26.45 0.102 Os eoa h i is, join de e io a ion 304 28.1 0.14 0.012 15.46 <0.0005 23.03 0.740 Rheuma oid a h i is o o he heuma oid disease 121 11.2 0.23 0.027 15.70 0.203 25.62 0.151 Dep ession o o he men al heal h p oblems 106 9.8 0.16 0.155 16.04 0.008 19.81 0.301 As hma 72 6.7 0.14 0.144 9.72 0.942 25.00 0.687 Diabe es 144 13.3 0.14 0.226 11.81 0.971 26.39 0.587 Memo y diso de s (Alzheime ’s o demen ia) 19 1.8 0.78 0.012 31.58 0.007 21.05 0.294 Cance 76 7.0 0.12 0.258 10.53 0.999 18.42 0.857 O he ch onic disease o heal h p oblem 374 34.6 0.10 0.081 13.64 0.020 21.39 0.062 Dep essi e symp oms (CES‑D) <0.0005 0.024 0.009 No 772 71.4 ‑0.13 9.46 22.41 Yes 194 17.9 0.39 18.56 30.41 Missing 116 10.7 0.21 9.48 22.41 Sel ‑ a ed heal h <0.0005 <0.0005 0.055 Good o ai ly good 431 40.2 ‑0.29 5.34 21.35 A e age o poo 640 59.8 0.18 14.69 25.47 Memo y: poo o e y poo 64 6.0 0.55 0.006 28.13 0.002 17.19 0.410 Concen a ion: poo o e y poo 27 2.6 0.79 <0.0005 33.33 <0.0005 11.11 0.261 New in o ma ion and lea ning: poo o e y poo 79 7.6 0.82 <0.0005 35.44 <0.0005 24.05 0.976 Foo no e: S a is ical es s pe o med wi h clus e - obus a iance es ima ion & su ey weigh s Resul s wi h a p- alue ≤ 0.05 in bold Cell con en s o age: coun , mean (SD); co ela ion, p; odds a io, OR, p; OR, p Page 6 o 12 Kou onene al. BMC Public Heal h (2022) 22:574 In e ms o expe iencing in e ne ela ed sa e y con- ce ns, age had a cu ilinea pa e n wi h he ou come (Fig.1; Table4): as Fig.1 shows, he p obabili y o such conce ns inc eases o almos hi y pe cen a 65 yea s, a e which i s a s o ma kedly dec ease. In con as o he esul s in Table3, good command o Finnish/Swedish was associa ed wi h a highe likelihood ha he pa icipan was conce ned abou he in e ne sa e y (Model 4.2: OR=1.35; 95% CI: 1.01-1.80). Receip o income suppo was ela ed o a lowe likelihood o such conce n (Model 4.2: OR=0.64; 95% CI: 0.47-0.86). Model 4.2 u he shows ha back p oblems (OR=1.45; 95% CI: 1.03-2.04), dep essi e symp oms (OR=2.13; 95% CI: 1.11-4.11p=0.024), and p oblems wi h lea ning new hings (OR=1.86; 95% CI: 1.02-3.40) we e associa ed wi h a highe likelihood o ha ing conce ns abou in e - ne sa e y issues, whe eas hose in he e y he e ogenous ca ego y o “o he diseases” we e less likely o epo his issue (OR=0.67; 95% CI: 0.48-0.92). We conduc ed wo obus ness checks: (1) a model whe e he dep essi e symp oms a iable did no include a sepa a e ca ego y o missing cases; and (2) an es ima- ion wi hou su ey weigh s. Conce ning he MCA ou - come, he esul s o he ollowing a iables we e ound o be ully obus : age, dep ession symp oms, and lea n- ing p oblems. Rega ding he expe ience o in e ne being Table 2 The associa ions o co a ia es and heal h condi ions wi h o e all ba ie s o in e ne use Foo no es: Clus e - obus a iance es ima ion. Su ey weigh s accoun ed o Resul s wi h a p- alue ≤ 0.05 in bold CI con idence in e al Model 2.1 Model 2.2 b p 95% CI b p 95% CI Female -0.03 0.561 -0.13 0.07 -0.09 0.164 -0.21 0.04 Age 0.04 <0.0005 0.02 0.05 0.03 <0.0005 0.02 0.04 Ma ied o cohabi ing -0.10 0.122 -0.23 0.03 -0.08 0.255 -0.21 0.06 Good command o Finnish/Swedish -0.05 0.448 -0.17 0.08 -0.02 0.743 -0.13 0.09 Highes educa ion in he coun y o o igin Voca ional educa ion 0.19 0.007 0.06 0.32 0.14 0.040 0.01 0.27 Gene al/No educa ion/Missing 0.36 0.025 0.05 0.66 0.32 0.077 -0.04 0.67 Receip o income suppo 0.02 0.710 -0.11 0.16 -0.07 0.360 -0.21 0.08 Diagnosed diseases High blood p essu e, hype ension . . . . 0.10 0.086 -0.01 0.21 Spine de e io a ion, scia ica o o he back p oblem . . . . 0.13 0.049 0.00 0.26 Os eoa h i is, join de e io a ion . . . . -0.04 0.401 -0.14 0.06 Rheuma oid a h i is o o he heuma oid disease . . . . 0.03 0.754 -0.19 0.26 Dep ession o o he men al heal h p oblems . . . . 0.08 0.603 -0.23 0.39 As hma . . . . -0.17 0.252 -0.47 0.13 Diabe es . . . . -0.03 0.718 -0.22 0.15 Memo y diso de s (Alzheime ’s o demen ia) . . . . 0.40 0.259 -0.32 1.13 Cance . . . . 0.01 0.930 -0.31 0.34 O he ch onic disease o heal h p oblem . . . . -0.09 0.320 -0.26 0.09 Dep essi e symp oms (CES‑D) Yes .. ..0.40 0.007 0.13 0.67 Missing . . . . 0.28 0.014 0.06 0.49 Sel ‑ a ed heal h: a e age o poo . . . . 0.10 0.175 -0.05 0.25 Memo y: poo o e y poo . . . . -0.16 0.223 -0.44 0.11 Concen a ion: poo o e y poo . . . . -0.10 0.774 -0.80 0.61 New in o ma ion and lea ning: poo o e y poo . . . . 0.60 <0.0005 0.35 0.84 Cons an -2.23 <0.0005 -2.82 -1.64 -2.01 <0.0005 -2.48 -1.54 n 942 908 R squa ed 0.106 0.167 Page 7 o 12 Kou onene al. BMC Public Heal h (2022) 22:574 oo complica ed, he ollowing esul s we e ully obus : age, educa ion, as hma, and lea ning p oblems. Co e- spondingly o he las ou come, ully obus esul s we e ound o age, income suppo and dep essi e symp oms. (Resul s a e a ailable by eques .) Discussion Based on a ep esen a i e su ey among olde Russian- speaking mig an s in Finland, his s udy in es iga ed he associa ions be ween di e en heal h condi ions and sel - epo ed ba ie s o in e ne use. Ou s udy con i ms ea lie indings ha people do no ha e jus one simple ba ie o in e ne use [43]. The mos commonly men ioned ba ie s we e ha he in e ne is oo complica ed o ha d o lea n, and sa e y conce ns. Howe e , sligh ly o e hal o he pa icipan s epo ed ha hey did no ha e any p oblems wi h he in e ne use. In he p esen s udy, dep essi e symp oms we e consis - en ly associa ed wi h sel - epo ed ba ie s o in e ne use. Ea lie s udies ha e shown an associa ion be ween in e - ne use and dep ession in olde adul s [23, 33, 59–61]. The indings om a sys ema ic e iew indica ed a posi i e associa ion be ween in e ne use and good men al heal h and wellbeing among olde adul s [32]. The psychoso- cial links connec ing in e ne use and men al heal h can Table 3 The associa ions o co a ia es and heal h condi ions wi h he expe ience ha in e ne is oo complica ed and ha d o lea n Foo no es: Clus e - obus a iance es ima ion. Su ey weigh s accoun ed o Resul s wi h a p- alue ≤ 0.05 in bold OR odds a io; CI con idence in e al Model 3.1 Model 3.2 OR p95% CI OR p95% CI Female 1.27 0.250 0.84 1.92 0.99 0.975 0.60 1.64 Age 1.11 <0.0005 1.10 1.12 1.10 <0.0005 1.09 1.11 Ma ied o cohabi ing 0.85 0.329 0.62 1.17 0.78 0.196 0.54 1.13 Good command o Finnish/Swedish 0.58 0.001 0.42 0.80 0.62 0.027 0.40 0.95 Highes educa ion in he coun y o o igin . . . . . . . . Voca ional educa ion 1.81 <0.0005 1.44 2.26 1.73 0.002 1.22 2.46 Gene al/No educa ion/Missing 4.04 0.010 1.39 11.75 5.36 0.001 1.91 15.05 Receip o income suppo 1.87 0.069 0.95 3.69 1.58 0.243 0.73 3.38 Diagnosed diseases ... . . . . . High blood p essu e, hype ension . .. . 1.44 0.158 0.87 2.41 Spine de e io a ion, scia ica o o he back p oblem . .. . 0.66 0.105 0.40 1.09 Os eoa h i is, join de e io a ion . .. . 1.53 0.027 1.05 2.22 Rheuma oid a h i is o o he heuma oid disease . .. . 1.07 0.907 0.34 3.33 Dep ession o o he men al heal h p oblems . .. . 2.03 0.132 0.81 5.13 As hma . .. . 0.33 0.025 0.12 0.87 Diabe es . .. . 0.63 0.047 0.40 0.99 Memo y diso de s (Alzheime ’s o demen ia) . .. . 8.86 0.060 0.91 85.99 Cance . .. . 0.81 0.663 0.31 2.09 O he ch onic disease o heal h p oblem . .. . 1.27 0.472 0.67 2.41 Dep essi e symp oms (CES‑D) ... . . . . . Yes ... . 1.93 0.074 0.94 3.98 Missing . .. . 0.50 0.070 0.24 1.06 Sel ‑ a ed heal h: a e age o poo . .. . 1.02 0.913 0.70 1.49 Memo y: poo o e y poo . .. . 0.50 0.103 0.21 1.15 Concen a ion: poo o e y poo . .. . 0.31 0.048 0.10 0.99 New in o ma ion and lea ning: poo o e y poo . .. . 4.53 <0.0005 2.22 9.24 Cons an 0.00 <0.0005 0.00 0.00 0.00 <0.0005 0.00 0.00 n 942 908 Pseudo R squa ed 0.187 0.240 Page 8 o 12 Kou onene al. BMC Public Heal h (2022) 22:574 include enhanced in e pe sonal in e ac ions, inc eased access o esou ces and se ices as well as empowe ed social inclusion [32]. In e ne use can dec ease loneli- ness and social isola ion [59], which a e associa ed wi h dep ession [62]. In pa icula , in e ne use o social pu - poses has been shown o indi ec ly impac wellbeing ia educed loneliness and inc eased social engagemen , whe eas in e ne use o in o ma ional and ins umen al (i.e., managing pe sonal adminis a ion and daily ac i i- ies) pu poses has been shown o impac well-being h ough engagemen in a wide ange o ac i i ies [63]. In ou s udy, e en hough dep essi e symp oms we e associa ed wi h mo e ba ie s, diagnosed men al dis- o de s we e no . I is possible ha in a highly digi al- ised se ice sys em, some le el o digi al inclusion is equi ed o be e en able o ob ain a diagnosis. On he o he hand, since he diagnosis may da e se e al yea s o e en decades back in ime, cu en sel - epo ed dep essi e symp oms may be e indica e he cu en men al heal h s a us o he pa icipan . In ou s udy, hose who epo ed p oblems in hei cogni i e unc ioning, mo e speci ically in hei abili y o Table 4 The associa ions o co a ia es and heal h condi ions wi h ha ing conce ns abou in e ne sa e y Foo no es: Clus e - obus a iance es ima ion. Su ey weigh s accoun ed o Resul s wi h a p- alue ≤ 0.05 in bold OR odds a io; CI con idence in e al Model 4.1 Model 4.2 OR p95% CI OR p 95% CI Female 0.95 0.715 0.75 1.22 0.90 0.441 0.68 1.18 Age 1.54 0.003 1.16 2.05 1.68 0.007 1.15 2.46 Age squa ed 1.00 0.002 0.99 1.00 1.00 0.005 0.99 1.00 Ma ied o cohabi ing 1.08 0.570 0.83 1.39 1.07 0.649 0.80 1.42 Good command o Finnish/Swedish 1.30 0.055 0.99 1.70 1.35 0.045 1.01 1.80 Highes educa ion in he coun y o o igin Voca ional educa ion 1.13 0.553 0.75 1.71 1.02 0.931 0.63 1.65 Gene al/No educa ion/Missing 1.14 0.643 0.66 1.97 0.98 0.942 0.54 1.76 Receip o income suppo 0.69 0.009 0.52 0.91 0.64 0.004 0.47 0.86 Diagnosed diseases High blood p essu e, hype ension . .. . 1.02 0.893 0.75 1.40 Spine de e io a ion, scia ica o o he back p oblem . ...1.45 0.032 1.03 2.04 Os eoa h i is, join de e io a ion . .. . 0.81 0.133 0.61 1.07 Rheuma oid a h i is o o he heuma oid disease . .. . 0.98 0.936 0.66 1.46 Dep ession o o he men al heal h p oblems . .. . 0.65 0.273 0.30 1.41 As hma . .. . 0.92 0.809 0.46 1.82 Diabe es . .. . 1.05 0.871 0.56 1.99 Memo y diso de s (Alzheime ’s o demen ia) . .. . 2.37 0.486 0.21 26.78 Cance . .. . 0.82 0.669 0.33 2.04 O he ch onic disease o heal h p oblem . ...0.67 0.015 0.48 0.92 Dep essi e symp oms (CES‑D) Yes ....2.13 0.024 1.11 4.11 Missing . ...2.33 0.003 1.33 4.06 Sel ‑ a ed heal h: a e age o poo . .. . 1.31 0.147 0.91 1.89 Memo y: poo o e y poo . .. . 0.84 0.556 0.46 1.51 Concen a ion: poo o e y poo . .. . 0.30 0.220 0.04 2.07 New in o ma ion and lea ning: poo o e y poo . ...1.86 0.043 1.02 3.40 Cons an 0.00 <0.0005 0.00 0.00 0.00 0.006 0.00 0.01 n 942 908 Pseudo R squa ed 0.021 0.056