“Technology is Not Hard, Lack of Access is Hard:” An Exploratory, Mixed Methods Study Exploring Technology Readiness, eHealth Literacy, and Perceptions about Artificial Intelligence Among Older Adults in Permanent Supportive Housing (Preprint)

<sec> <title>BACKGROUND</title> <p>Older adults with a history of homelessness experience substantial health inequities and may face difficulty maintaining engagement with care while waiting for appointments or treatment. Digital and artificial intelligence (AI)-enabled tools could provide support during this interval. Yet, little is known about the technology readiness, digital literacy, or AI perceptions of older adults living in permanent supportive housing (PSH).</p> </sec> <sec> <title>OBJECTIVE</title> <p>This study aimed to characterize technology access, eHealth literacy, health information behaviors, executive functioning challenges, and technology readiness among older adults in PSH. It also aimed to explore their preferences, concerns, and priorities regarding AI-enabled health support.</p> </sec> <sec> <title>METHODS</title> <p>We conducted a cross-sectional, convergent mixed methods study at one PSH site for adults with a history of chronic homelessness in Austin, Texas. Participants completed interviewer-administered surveys assessing technology access and acceptance, technology readiness, eHealth literacy, health information orientation, and executive functioning. This process was followed by open-ended questions about health information seeking, technology use, AI, and intervention design. Quantitative data were summarized descriptively and examined using bivariate correlations and multiple linear regression. Qualitative responses were analyzed using an interrelated inductive-deductive content analysis, and findings were integrated during interpretation.</p> </sec> <sec> <title>RESULTS</title> <p>Among 55 participants (mean age 63.4 years), most had cell phones, although 85.5% experienced service disruptions in the prior year. Participants demonstrated moderate-to-high technology readiness and acceptance, with eHealth literacy independently associated with greater technology enthusiasm. Qualitative findings identified trust, relationship-centered and multimodal communication, technology access and usability barriers, mixed perceptions of AI, and accessibility needs as central themes. Integrated findings showed that digital capability often coexisted with unstable access, usability challenges, and AI skepticism. Human support facilitated engagement rather than compensating for limited technology skills, while concerns about AI centered on accuracy, privacy, transparency, and credibility.</p> </sec> <sec> <title>CONCLUSIONS</title> <p>Older adults living in PSH demonstrated meaningful willingness and capacity to engage with digital health technologies, including AI-enabled health tools, but readiness alone may be insufficient to support adoption. Technology engagement was shaped by access, usability, trust, perceived benefit, and relational support. AI skepticism often reflected concerns about accuracy, privacy, transparency, and credibility rather than limited digital capability. Future digital health interventions should minimize access and navigation burdens, accommodate cognitive and physical limitations, provide transparent and credible information, and incorporate trusted human support. AI-enabled tools should complement relationships that support healthcare engagement among older adults with histories of homelessness.</p> </sec>