  Citation: Rasekaba, T.M.; Pereira, P.; Rani. G, V.; Johnson, R.; McKechnie, R.; Blackberry, I. Exploring Telehealth Readiness in a Resource Limited Setting: Digital and Health Literacy among Older People in Rural India (DAHLIA). Geriatrics 2022, 7, 28. https://doi.org/10.3390/ geriatrics7020028 Academic Editor: Phyo Kyaw Myint Received: 31 January 2022 Accepted: 25 February 2022 Published: 1 March 2022 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). geriatrics Article Exploring Telehealth Readiness in a Resource Limited Setting: Digital and Health Literacy among Older People in Rural India (DAHLIA) Tshepo Mokuedi Rasekaba 1, *, Pratibha Pereira 2,3 , Vinaya Rani. G 3 , Riya Johnson 3 , Rebecca McKechnie 1 and Irene Blackberry 1 1 John Richards Centre for Rural Ageing Research, La Trobe University, Wodonga, VIC 3689, Australia; bec.mckechnie@icloud.com (R.M.); i.blackberry@latrobe.edu.au (I.B.) 2 Department of Geriatric Medicine, JSS Medical College, Mahathma Gandhi Road, Mysore, Mysuru 570004, India; ppatta08@gmail.com 3 Clinical Development Services Agency-Centre of Clinical Research Excellence (CDSA-CCRE), JSS Hospital, JSS Academy of Higher Education and Research, Mahathma Gandhi Road, Mysore, Mysuru 570004, India; vinayagowd@gmail.com (V.R.G.); riyajohnson24@gmail.com (R.J.) * Correspondence: t.rasekaba@latrobe.edu.au; Fax: +61-2-6024-9737 Abstract: An ageing population, disproportionally affecting developing countries, increases demand on healthcare systems. Digital health offers access to healthcare for older people, particularly those residing in rural areas, as is the case for 71% of older adults in India. This research examined technology uptake and digital and health literacy (eHEALS) among a sample of 150 older adults in rural Mysore and Suttur, India. The study utilised mixed-method, with descriptive analysis of quantitative data and thematic analysis of qualitative data. Low rates of digital (11%) and health literacy (3–27% across domains) were identified. Mobile phone ownership was 50%, but very few owned or used a smartphone and less than 10% used the Internet to contact health professionals. Qualitative analysis found low technology usage, driven by limited exposure and confidence in using digital devices. Barriers to usage included poor traditional literacy and physical aspects of ageing like poor vision. Social support from neighbours, family and local primary healthcare staff may enable adoption of digital health. Access to healthcare through digital means among Indian rural older adults needs to consider low rates of both digital and health literacy and leverage the value of support from family and primary healthcare providers. Keywords: digital health literacy; health literacy; older adults; ageing; rural 1. Introduction The World Health Organisation anticipates that by 2050 the number of people aged over 60 years will have doubled to over two billion, up from 900 million in 2015 [1]. The effect of this demographic change will be experienced disproportionately, with the greatest increases in aged populations occurring in developing countries. In India, the number of people aged over 60 years is expected to increase to 315 million people by 2050, more than three times the number registered in 2011 [1,2]. Of concern are the potential economic and social implications that an increasing ageing population may have on communities and healthcare systems [2–4]. Ageing is associated with increased risk of chronic conditions such as hearing loss, dia- betes, cardiovascular disease, chronic obstructive pulmonary disease, cataracts, Alzheimer’s and other dementias, depression and osteoarthritis [1]. These conditions challenge the independence and quality of life of older people [5], exerting a significant burden on individuals, communities and healthcare systems [2]. The resultant increases in chronic conditions and corresponding decrease in independence that will accompany a larger aged population are associated with increased utilisation of healthcare services, greater costs Geriatrics 2022, 7, 28. https://doi.org/10.3390/geriatrics7020028 https://www.mdpi.com/journal/geriatrics