Information Seeking Behavior Associated with Willingness for

COVID-19 Vaccination in 60+ Estonians

Marianne Paimre

and Andri Ahven

School of Digital Technologies, Tallinn University, Narva Road 29, Tallinn, Estonia

Criminal Policy Department, Ministry of Justice and Digital Affairs, Suur-Ameerika 1, Tallinn, Estonia

Keywords: Online Health Information-Seeking Behavior, Internet, ICT, Health Behavior, Vaccination, COVID-19, Older

Adults.

Abstract: Research consistently suggests that seeking health information (HI) online can positively impact individuals'

health behavior choices (HBC). However, the relationship between online health information-seeking

behavior (OHISB) and COVID-19 vaccination among older adults – often considered a digitally underserved

group – remained largely underexplored. This study contributes to bridging this gap by investigating the

OHISB of Estonians aged 60+ and its associations with HBC, including COVID-19 vaccination readiness

(CVR). Survey data from 329 respondents revealed that frequent online HI searches, along with better access

to digital devices, higher self-reported digital skills, and higher levels of education and income, were

positively associated with increased CVR. Preference for reliable HI sources, such as international

organizations and physician-curated websites, further reinforced vaccine support, while vaccine refusers

predominantly relied on alternative media. However, no clear association was found between OHISB and

other HBCs, such as healthy eating, physical activity, or drug use, suggesting the need for further investigation.

The study highlights the potential of digital technologies and online health information seeking (OHIS) among

older generations in promoting health-protective behavior during a health crisis. These findings also

underscore the critical role of promoting digital literacy and access to credible HI to enhance public health

outcomes.

1 INTRODUCTION

Online health information seeking (OHIS) is gaining

increasing popularity (Jia et al., 2021). Despite

concerns about misinformation online, it is primarily

regarded as a positive influence on health behavior

(HB), enhancing e-health awareness and enabling

more informed health decisions (Heponiemi et al.,

2022; Arthanat, 2021; Chu et al., 2021). As

individuals face increasing health challenges in later

life, OHIS has become a crucial resource for aging

populations (Jia et al., 2021; Zhao et al., 2022). The

problem is that despite the growing prevalence of

information and communication technology (ICT)

and access to online health information (OHI), many

older adults miss out on these digital advantages or

encounter barriers that can be categorized into

individual, social, and technological challenges

(Zhao et al., 2022). For instance, while nearly all

https://orcid.org/0000-0002-7079-6513

young individuals in Estonia utilize the internet, the

situation is considerably less favorable among older

age groups: among 55-64-year-olds, 11% do not use

the internet, and among those aged 65-74, the figure

is 30% (Statistics Estonia, 2024).

The internet's significance as an information

channel was particularly pronounced during the

COVID-19 pandemic restrictions when individuals

were compelled to forgo or reduce face-to-face

interactions and communication. Although COVID-

19 is no longer classified as a global health

emergency (WHO, 2023), the pandemic offers

valuable lessons for future preparedness, which is

also true regarding HI-seeking (Bachofner et al.,

2024; ECDC, 2023; WHO, 2021).

Older adults (60+), a highly vulnerable group,

faced more significant risks from COVID-19 and

heightened concerns about vaccine side effects,

contributing to skepticism within this demographic

Paimre, M. and Ahven, A.

Information Seeking Behavior Associated with Willingness for COVID-19 Vaccination in 60+ Estonians.

DOI: 10.5220/0013209600003938

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 11th International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE 2025), pages 181-188

ISBN: 978-989-758-743-6; ISSN: 2184-4984

181

(Lampkin, 2023). Despite vaccination being the most

effective protective measure against the virus,

vaccine hesitancy emerged as a significant challenge

at the height of the pandemic, hindering efforts to

eliminate the virus (de Vries et al., 2022; Verputten et

al., 2022). With some exceptions, associations

between HI-seeking and vaccination remained

relatively unexplored during the health crisis among

the older population (e.g., Principe and Weber, 2023).

Despite the growing academic focus on OHISB

among older adults and its impact on HB, further

investigation is needed, particularly in countries with

varying levels of digital health infrastructure and

access, such as Estonia, where disparities in digital

health literacy may pose challenges.

Estonia’s advanced e-government, ranked top

three globally (UN, 2020) and 9th in the EU’s Digital

Economy and Society Index (2022) (European

Commission, 2024), contrasts with its high elderly

poverty rate – 40.6% in 2021, compared to the EU

average of 16.8% (Eurostat, 2023). Exploring OHISB

among Estonian older adults is vital to inform health

communication, design digital health tools, and

prepare for future health crises.

The study aims to analyze online health

information seeking among Estonian older adults

aged 60 and above and explore its relationship to

health behavior choices, including their readiness for

COVID-19 vaccination. To guide the study, we

propose the following research questions:

1. What is the OHISB among Estonian older

adults aged 60 and above?

2. How is OHISB related to their health behavior

choices (HBC), including COVID-19 vaccination

readiness (CVR)?

The following section reviews prior research on

older adults’ OHISB and its relation to HB, followed

by details on the sample, method, results, discussion,

conclusions, and references. Abbreviations are

clarified in a table in the appendix (see Appendix).

2 LITERATURE REVIEW

This chapter reviews previous research on OHISB

among older adults, focusing on influencing factors,

the role of the COVID-19 pandemic, and OHISB’s

association with HBC.

2.1 OHISB in Older Adults

The internet is increasingly pivotal in older adults' HI-

seeking, providing accessible and convenient ways to

manage their health (Bachofner et al., 2024; Ma et al.,

2023). Older adults’ OHISB is influenced by factors

beyond socioeconomic status, including age,

education, income, technological skills, access

methods, psychological attitudes, cognitive ability,

and social networks (Bachofner et al., 2024; Enwald

et al., 2017). Younger older adults with higher

education and income levels engage more frequently,

with women seeking OHI more often than men (Choi,

2019; Enwald et al., 2017). Trust in reliable sources

and technological proficiency are critical, as

misinformation deters use (Zhao et al., 2022; Jia et

al., 2021). Chronic conditions and health awareness

also drive OHIS engagement (Ma et al., 2023;

Pourrazavi et al., 2022; Enwald et al., 2024).

Although the COVID-19 pandemic appeared to

drive digital technology use – a prerequisite for OHIS

– studies reveal a growing digital divide, both

generationally and within older age groups (ELSA,

2021; Martínez-Alcalá et al., 2021; Crick, 2020; van

Deursen, 2020; van Dijk, 2020). During COVID-19,

low ICT adoption left many older adults isolated from

social interaction and digital services, with those of

lower education and income particularly vulnerable

to digital exclusion, limiting access to OHI and

services (Crick, 2020; Seifert, 2020; van Deursen,

2020; van Dijk, 2020). Factors like age, loneliness,

and neighborhood deprivation hindered engagement,

while higher education and income promoted it

(Kung & Steptoe, 2023).

Statistics reveal that in Estonia, the pandemic led

to increased digital engagement among older adults.

Weekly internet use among Estonians aged 55-75

rose from 69% in 2019 to 74% by 2021 (Eurostat,

2023a). Despite growth, many older adults still face

barriers like low digital skills and limited technology

access. There is a lack of research on the OHISB of

Estonians aged 60+ during COVID-19, with most

studies focusing on welfare states and neglecting

Eastern European older adults and their HI behavior.

2.2 Associations Between OHISB and

Health Behavior

A key consideration in online HI seeking and use is

whether it facilitates improved HBC and contributes

to better health outcomes. The relationship between

OHISB and HB is multifaceted (Koh, 2023;

Dadaczynski et al., 2021). Seeking HI online has been

broadly linked to positive health outcomes, as

increased knowledge about health issues can lead to

better management of health, treatment adherence,

and preventive strategies (Allington et al., 2021;

Dadaczynski et al., 2021). This is particularly

beneficial for older adults who may experience

ICT4AWE 2025 - 11th International Conference on Information and Communication Technologies for Ageing Well and e-Health

182

complex health needs, as OHISB offers them

opportunities to manage uncertainties and become

more proactive in their healthcare (Ausserhofer et al.,

2022).

Frequent online engagement and diverse

information sources enhance health benefits, with

regular HI seekers adopting preventive measures

more readily (Zhuang & Cobb, 2022; Chu et al.,

2021). However, limited digital literacy among older

adults can lead to misunderstandings or discourage

protective behaviors, as seen in social media-driven

vaccine hesitancy (Eriksson-Backa et al., 2018;

Zhang et al., 2024). Excessive social media use has

been linked to higher hesitancy (Moon et al., 2023),

while credible sources reduce it, as shown during the

pandemic (Principe & Weber, 2023). Disparities in

access and skills limit these benefits for older adults.

The digital divide among older adults affects

OHISB’s impact on HB, with higher education,

income, and digital skills enabling greater

engagement, better awareness of treatments, effective

risk management, and easier access to online

healthcare (van Deursen, 2020; van Dijk, 2020; Kung

& Steptoe, 2023). Misinformation on social media

and alternative platforms – especially evident during

crises like COVID-19 – can discourage protective HB

(Borah et al., 2022; Castellano-Tejedor et al., 2022;

Bendau et al., 2021; Figueiras et al., 2021; Cuello-

Garcia et al., 2020). Chu et al. (2021) found that

accessing diverse information sources during

COVID-19 increased engagement in protective

health behaviors among older adults.

The COVID-19 pandemic emphasized digital

information's role in preventive HBs like CVR and

the risks of misinformation (Principe & Weber, 2023;

Koh, 2023). It highlighted both the potential and

challenges of OHISB for older adults, showing the

need for credible, user-friendly online health

resources.

Considering the high value placed on digital

services in Estonia and the increasing digital

engagement among older adults, it is likely that many

were online during the COVID-19 pandemic,

searching also for HI. Based on previous studies, it

can be assumed that the HBC of those who search for

HI online differs from those who remain offline.

3 SAMPLE AND METHOD

This study relies on data from a more extensive

survey conducted among older Estonian adults by the

market research company Norstat in 2020. The

company drew a sample from a research panel of

more than 20,000 respondents, inviting them to

participate in online, telephone, and face-to-face

interviews. All people were randomly selected from

earlier surveys (primarily phone interviews) to

include sufficiently varied socio-demographic

groups. According to quotas, a representative sample

was assembled while rigorously ensuring that the

number of responses outlined in the quota was

collected from each subset (e.g., a particular age

group). Although the original sample included 500

respondents aged 50 and over, this study focuses

exclusively on people aged 60 and above.

3.1 Participants

The age group 60+ comprised 329 respondents, of

whom 155 participants were questioned online and

174 over the phone between 20 July and 3 August.

The sample is characterized by the following socio-

economic indicators in the table below (see Table 1).

Table 1: Sample Characteristics (N).

Variable Male Female Total

Nationality Estonian 82 164 246

Othe

39 44 83

Education Basic 8 17 25

Secondar

19 43 62

Vocational 42 64 106

Highe

52 84 136

Position at

work

Employee 8 8 16

ecialist 18 20 38

Mana

3 4 7

Entre

reneu

5 4 9

Pensione

84 168 252

Othe

3 4 7

Monthly

income (in

euros)

Up to 150 0 3 3

151

–

350 3 21 24

351

–

550 40 97 137

551

–

750 31 55 86

751

–

1000 14 14 28

1001

–

1250 9 9 18

1251

–

1500 8 2 10

Over 1500 4 4 8

Not known 12 3 15

3.2 Questionnaire

The entire questionnaire included 15 substantive

multiple-choice questions as well as questions

regarding the socio-demographic profile of the

respondents (gender, age, nationality, education

level, employed/unemployed) and monthly income.

The entire questionnaire can be found here.

For this article, nine questions were selected,

focusing on (O)HISB, HB, self-reported health, ICT

Information Seeking Behavior Associated with Willingness for COVID-19 Vaccination in 60+ Estonians

183

access, and willingness to adopt ICT for health

purposes. The respondents were asked to choose

between multiple-answer options for all questions.

The response options varied by question, including

yes/no choices, such as access to a digital device, and

multiple-choice selections for preferences, like

information sources. Digital competence and general

health status were rated on a 5-point Likert scale,

while the frequency of health information-seeking

was measured with four options, ranging from weekly

to infrequently. There were no open-ended questions.

3.3 Data Analysis

The data were processed mathematically and

statistically with Microsoft Excel using cross-

tabulation analysis. For all questions, the following

key (i.e., most applied) variables characterizing the

respondents were considered: gender, age, education,

and self-reported health assessment.

4 RESULTS

This chapter summarizes the study's key findings,

focusing on OHISB among Estonians aged 60 and

over and its associations with HBC.

4.1 Health Information Behavior

36% of respondents sought HI monthly, including

12% weekly or more, while 42% needed it only a few

times annually. Poorer health increased HI needs.

Family physicians and healthcare institutions were

the primary sources for 75%, followed by the internet

(48%), print media (38%), television/radio (32%),

and friends/family (27%). Respondents mainly

searched for HI on specific illnesses (65%) and

disease prevention (45%). Medication information

was sought by 29%, health data via the national portal

by 22%, and 12% had other purposes.

Among those with access to a computer or smart

device (70%, n=231), 16% reported never searching

for HI online. In contrast, nearly a quarter (23%) had

done so within the past seven days, and 29% had

searched for HI online within six months or less

frequently. For internet users, essential sources of HI

online included random sources that appear at the top

of search results from Google or other engines (45%).

Specialized health and disease-related portals and

websites were used by 38%. A third (33%)

highlighted professional journalism, such as online

news outlets and their health sections. Other sources

were mentioned less frequently. Nearly one-fifth

(19%) cited Wikipedia. In comparison, 14%

mentioned scientific databases, open-access websites

offering scientific information, and forums and

discussion groups where people share experiences

with doctors and illnesses. Social media platforms

(Facebook, Twitter, YouTube, etc.) were mentioned

by 11%. Only 10% referred to the websites of

international organizations, government agencies,

and official institutions, while 15% selected “other.”

The issues highlighted included the inability to

determine whether the information found could be

trusted (37%). A third (32%) had difficulties selecting

relevant information. However, the majority (45%)

did not experience any problems.

Education level played a role: 64% of men with

higher education searched for HI online during the

last month, compared to 44% with lower education.

Among women, 57% with higher education sought

HI, versus 54% without a university degree.

4.2 HBC and Links with OHISB

Among all respondents, 64% (n=209) reported

walking or cycling, while 29% mentioned swimming

or going to the gym. Other forms of physical activity,

such as gardening, were reported by 66%.

Additionally, 61% tried maintaining a healthy diet,

which rose to 72% among internet users. Meanwhile,

21% stated they consumed fatty or sugary foods, with

internet users reporting this significantly less often at

14%. Approximately 28% of respondents reported a

predominantly sedentary lifestyle, with internet users

sitting more (61%).

Regarding vaccination, 54% expressed

willingness, 29% were unsure, and 16% were

unwilling. Men (65%) were more willing to vaccinate

than women (48%), with older men (71%) being the

most likely. Older women were less likely, with only

46% of those aged 70+ agreeing. Higher education

and income correlated with greater willingness, with

65% of higher-educated respondents supporting

vaccination, compared to 28% with primary

education, where opposition was 44%.

Individuals with computer access were more

likely to receive the vaccine (60%) than those without

access (42%). Of those for whom the internet was an

essential source of HI, 63% were willing to get

vaccinated, 27% hesitated, and 10% opposed

vaccination. Respondents who more frequently

experienced the need for HI exhibited a greater

willingness to vaccinate – 61% among those who felt

this need at least weekly compared to 48% among

those who felt it only a few times per quarter.

Individuals who had searched for HI online within the

ICT4AWE 2025 - 11th International Conference on Information and Communication Technologies for Ageing Well and e-Health

184

past month demonstrated a higher willingness to get

vaccinated (69%) than those who reported not

seeking HI online (39%).

Health-related digital applications and services

were more appealing to those interested in

vaccination. Only 5% of vaccine refusers were

interested in such applications, compared to 90% of

vaccine acceptors. Likewise, 64% of those interested

in vaccination considered it essential to communicate

with a doctor remotely (via a computer or smart

device) during the pandemic. In comparison, the

figure for those who refused was only 7%. The digital

competence category presented no significant

variations. However, those who had never used a

computer were likelier to refuse vaccination (35%) –

conversely, only 7% of those who rated their

computer skills as excellent refused.

For vaccine supporters, professional press (73%),

specific health-related websites created by healthcare

professionals (69%), websites of international

organizations and government agencies (67%), as

well as research databases (61%) were significantly

more important compared to those uninterested in

vaccination, whose corresponding figures were 3%,

2%, 4%, and 9%, respectively. While individuals

willing to vaccinate were drawn to more reputable

and reliable information sources, their interests

extended beyond these. They frequently reported

using blogs (83%), forums, and discussion groups for

personal experiences (78%), and Wikipedia (77%),

reflecting a diverse range of information sources. In

contrast, non-vaccinators primarily relied on

alternative medicine websites (27%), alternative

media outlets (30%), blogs (17%), videos (14%), and

social media platforms (12%).

No significant differences were observed for

OHISB and other health choices, such as healthy

eating, drug use, and exercising. Only internet users

reported a sedentary lifestyle more frequently.

The internet is a significant source of HI for

Estonians aged 60+, alongside healthcare

professionals and other sources. It is particularly

favored by more educated individuals. Those who

searched for HI online and expressed willingness to

use health-related digital applications were more

inclined toward vaccination.

5 DISCUSSION

The results of this study reveal insights into OHISB

and its relationship with health choices, particularly

with COVID-19 vaccine readiness. In the following

section, we address our research questions.

1. What is the OHISB among Estonian older

adults aged 60 and above?

As highlighted in previous studies from other

countries (Enwald et al., 2024; Chu et al., 2021; Choi,

2019; Pálsdóttir, 2012), most respondents relied on

traditional healthcare providers, such as family

physicians, as their primary source. However, the

internet also played a crucial role among 60+

Estonians, with almost half of the respondents (48%)

identifying it as a primary HI resource. Almost a

quarter (23%) of respondents with access to a

computer have searched HI online during the last

seven days. Still, 16% reported never searching for

health information online. The reasons behind this

could be explored in future studies, particularly

focusing on accessibility barriers.

For internet users, critical sources of HI online

included random sources appearing at the top of

Google or other search engine results (45%), raising

concerns about older adults' ability to assess the

quality of this information and thus highlighting

issues regarding digital literacy. Many respondents

sought information about specific illnesses,

indicating that "Dr. Google" plays a vital role as an

advisor and diagnostician, while a smaller portion

explored preventive health measures and

medications.

It seems that Estonian seniors are interested in

digital technology in the health context. Greater

emphasis should be placed on enhancing digital

skills, including the ability to discern relevant health

information and detect misinformation, while also

fostering interest among those who have not yet

adopted ICT.

2. How is OHISB related to their health HBC,

including CVR?

The data also shows that those who actively searched

for HI online, particularly within the last seven days,

were far more likely to express willingness to

vaccinate than those who rarely or never searched

online. Furthermore, individuals who received HI

both from online and traditional sources (e.g.,

doctors) were more inclined to agree to vaccination.

This is associated with the results of Chu et al. (2021),

indicating that individuals accessing information

from multiple and traditional sources demonstrated

greater adherence to protective health behaviors,

highlighting the importance of accessing information

from diverse sources during a health crisis.

Vaccine opponents were more likely to rely on

alternative media and treatment websites, which often

Information Seeking Behavior Associated with Willingness for COVID-19 Vaccination in 60+ Estonians

185

disseminate unverified or misleading information. In

contrast, vaccine supporters placed greater trust in

professional sources like international organizations,

government agencies, and doctor-created websites.

This aligns with earlier studies showing that

misinformation, primarily disseminated through

social media and alternative platforms, can hinder

protective health behaviors (e.g., Borah et al., 2022;

Castellano-Tejedor et al., 2022; Bendau et al., 2021).

This underscores the need to combat misinformation

and ensure reliable, evidence-based HI is easily

accessible.

Individuals with higher digital competence,

particularly those with advanced computer skills,

were more willing to vaccinate. This suggests that

improving digital literacy could be vital in increasing

vaccine uptake as digital tools become more

prominent in HI dissemination. Moreover, digital

services, such as remote doctor communication, were

notably more appealing to those who supported

vaccination. This further emphasizes the link between

digital engagement and positive health behaviors,

suggesting that expanding access to telehealth and

other digital health services could enhance vaccine

acceptance and other health-related decisions.

However, no definitive connection was identified

between digital engagement/OHISB and behaviors

such as healthy eating, exercise, or drug use, which

warrants further investigation. A sedentary lifestyle

among internet users was an exception.

The link between OHISB and CVR could indicate

that vaccination was perceived as a critical response

to the immediate health threat of contracting the virus

during the COVID-19 pandemic, and other health

activities, such as healthy eating and exercising, were

of secondary importance in the context of the crisis.

However, this aspect still requires closer

investigation.

Individuals who are more open to technology and

innovation may also be more receptive to the

COVID-19 vaccine as a novel solution. Engagement

with OHIS, credible HI sources and health apps likely

reflects higher digital health literacy, driving

proactive health and preventive behaviors during a

crisis. However, further research is needed to explore

these associations and their underlying factors.

The study highlights key points for future research

on health information behavior and health decisions

in older adults. The small 60+ sample limits

generalizations and necessitated the use of descriptive

statistics, but findings stress the need for studies on

this group’s behavior. Conducted early in the

pandemic – pre-vaccine rollout – the survey reflects

that time but misses insights into vaccine hesitancy

tied to misinformation. Gender disparities also stand

out, with women showing more interest in online HI-

seeking but less vaccination willingness. Future

studies with a significantly larger sample would allow

for more detailed analysis and should address

confounding factors – e.g., socioeconomic status,

social circles, and biases – to deepen understanding.

6 CONCLUSIONS

This study underscores the vital role of the internet in

obtaining HI among 60+ people living in Estonians,

in a country where digital technologies hold great

potential to facilitate aging. People who were more

willing to vaccinate were often not only better

educated but also more interested in digital

technologies and frequent seekers of HI online. This

provides a basis for further exploration of the

connections between tech-savviness and health-

related choices.

People with higher CVR had a wide selection of

OHI sources, preferring reliable ones, highlighting

the importance of access to multiple and reliable HI

sources. Conversely, reliance on alternative media

correlated with vaccine hesitancy, reinforcing the

need to emphasize educating older adults on

identifying and relying on trustworthy health

information sources.

A strategic communication and community

engagement plan should be mindful that older adults'

frequency of seeking online HI, use of multiple and

diverse information sources, and readiness to utilize

digital technologies for health purposes may

positively correlate with their readiness for critical

decisions, such as vaccine adoption, which is

especially important during a health crisis.

Promoting digital literacy, expanding access to

trustworthy HI, and integrating digital services with

traditional healthcare are essential strategies to

improve public health outcomes, especially as digital

health continues to grow in importance.

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APPENDIX

Abbreviations:

CVR COVID-19 vaccination readiness

HB health behavio

HBC health behavior choices

HI health information

ICT

information and communication

technolo

OHI online health information

OHIS online health information seekin

OHISB

online health information-seeking

ehavio

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