Introduction
Digital technologies are increasingly recognized as factors that impact health across the lifecourse, prompting growing attention to the digital determinants of health, understood as the conditions of digital environments that influence health outcomes and health equity (Richardson et al. Reference Richardson, Lawrence, Schoenthaler and Mann2022; Chidambaram et al. Reference Chidambaram, Jain, Jain, Mwavu, Baru, Thomas, Greaves, Jayakumar, Jain, Rojo, Ridao Battaglino, Meara, Sounderajah, Celi and Darzi2024). While digital devices, online platforms and algorithmic systems can structure, facilitate and complicate access to health-related information, resources, communities and care (Obermeyer et al. Reference Obermeyer, Powers, Vogeli and Mullainathan2019; Richardson et al. Reference Richardson, Lawrence, Schoenthaler and Mann2022), research from Canada, the United States and the United Kingdom about health promotion shows that technology can also be mobilized to support health-related activities and advance health equity (Crawford and Serhal Reference Crawford and Serhal2020; Richardson et al. Reference Richardson, Lawrence, Schoenthaler and Mann2022; Chidambaram et al. Reference Chidambaram, Jain, Jain, Mwavu, Baru, Thomas, Greaves, Jayakumar, Jain, Rojo, Ridao Battaglino, Meara, Sounderajah, Celi and Darzi2024). Scholarship therefore demonstrates that technology can function as a protective factor that facilitates connection, information-sharing and social support, while also operating as a risk factor that reinforces exclusion, exacerbates inequities and produces new forms of health-related harm (Obermeyer et al. Reference Obermeyer, Powers, Vogeli and Mullainathan2019; Sieck et al. Reference Sieck, Sheon, Ancker, Castek, Callahan and Siefer2021; Gates et al. Reference Gates, Hughes, Thepsourinthone and Dune2022; Moreno et al. Reference Moreno, Belhouari and Dussault2023; Chang et al. Reference Chang, Haynes, Chung, Nelson and Fredriksen-Goldsen2026). As technologies become increasingly embedded in everyday life, understanding how these determinants affect health outcomes has become a priority, particularly for marginalized communities and ageing populations (Richardson et al. Reference Richardson, Lawrence, Schoenthaler and Mann2022; Raihan et al. Reference Raihan, Subroto, Chowdhury, Koch, Ruttan and Turin2025).
International research in gerontology and health promotion have applied health equity frameworks, including the health equity promotion model (HEPM) (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014), to examine how social, cultural and historical factors contribute to health disparities among Two-Spirit, lesbian, gay, bisexual, transgender, queer and other non-cisgender and non-heterosexual (2SLGBTQ+) people in countries such as Chile, Colombia, India, Indonesia, Israel, Japan, New Zealand, Portugal, Spain, Taiwan, Thailand, the Philippines and Vietnam (Pereira et al. Reference Pereira, De Vries, Serrano, Afonso, Esgalhado and Monteiro2020; Lagunas et al. Reference Lagunas, Caceres, Silva, Passi-Solar, Delgado, López-Salvo, Shah and Hughes2022; Sperling Reference Sperling2024; Matthews et al. Reference Matthews, Kittiteerasack, Inwanna, Ogata, Tran-Chi, Loa and Waluyo2025; Chang et al. Reference Chang, Haynes, Chung, Nelson and Fredriksen-Goldsen2026; Kumar et al. Reference Kumar, Mani, Oswald and Fredriksen-Goldsen2026; Moncayo-Quevedo et al. Reference Moncayo-Quevedo, Nelson and Fredriksen-Goldsen2026). The HEPM has been valuable for understanding the health impacts of historical, social and structural conditions because it recognizes both health-promoting and adverse pathways, and it resists deficit-based framings of 2SLGBTQ+ people by emphasizing resilience and agency (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014; Fredriksen-Goldsen and Kim Reference Fredriksen-Goldsen and Kim2017; Fredriksen Goldsen et al. Reference Fredriksen Goldsen, Kim, Jung and Goldsen2019). For social gerontology, this model is useful because it situates health outcomes within lifecourse processes, recognizing how lifetime exposure to marginalization affects wellbeing in later life (Bécares Reference Bécares2021). However, the model does not explicitly identify technology as a determinant of health, an omission that is increasingly consequential as digital platforms are shown to have an impact on social relationships and health-promoting behaviours (Crawford and Serhal Reference Crawford and Serhal2020; Chang et al. Reference Chang, Haynes, Chung, Nelson and Fredriksen-Goldsen2026). For mid-life and older 2SLGBTQ+ adults – an ageing population with marginalized identities that has experienced profound socio-cultural, health and technological transformations in their lifetimes – integrating a technological dimension into the HEPM creates an opportunity to better understand how health equity is facilitated and hindered in this ageing population.
Drawing on focus groups with mid-life and older 2SLGBTQ+ adults in Canada, this article examines how participants engaged with digital platforms to manage their social health during the Covid-19 pandemic. Rather than treating the pandemic as the object of analysis, it is situated as the context where broader dynamics of digital ageing and health equity are examined. Findings show how technology simultaneously functioned as a protective factor that supported social connection, belonging and resilience – and as a risk factor that reproduced isolation, exclusion and inequity. By empirically applying and conceptually expanding the HEPM to include technology, this article both contributes theoretical development to an international health model and exemplifies a Canadian case study with relevance for global research in the gerontology of 2SLGBTQ+ ageing and health promotion. In doing so, it positions technology as integral to understanding and advancing health equity in ageing 2SLGBTQ+ populations.
Social health, technology and ageing
Social health, defined as having an adequate quality and quantity of relationships to fulfil the need for genuine human connection, is a critical component of people’s overall health and wellbeing (Doyle and Link Reference Doyle and Link2024). In gerontology, social health is understood as central to healthy ageing, given its associations with positive physical and cognitive outcomes in later life (Waite et al. Reference Waite, Duvoisin and Kotwal2021). However, the distribution of social health benefits is not equal across populations, as research from Australia (Hughes Reference Hughes2016), Portugal (Pereira et al. Reference Pereira, Serrano, de Vries, Esgalhado, Afonso and Monteiro2018), the Netherlands (Fokkema and Kuyper Reference Fokkema and Kuyper2009), the United States (Kim and Fredriksen-Goldsen Reference Kim and Fredriksen-Goldsen2016; Hsieh and Liu Reference Hsieh and Liu2021) and the United Kingdom (Wilkens Reference Wilkens2015; Kneale et al. Reference Kneale, Henley, Thomas and French2021) suggests that social isolation and loneliness are impacted by age, gender and sexual orientation.
In response to worldwide concerns about the rise of social isolation and loneliness in diverse ageing populations (World Health Organization 2024), fuelled in part by the Covid-19 pandemic (Sepúlveda-Loyola et al. Reference Sepúlveda-Loyola, Rodríguez-Sánchez, Pérez-Rodríguez, Ganz, Torralba, Oliveira and Rodríguez-Mañas2020; Kasar and Karaman Reference Kasar and Karaman2021), digital platforms such as social media sites, online forums, messaging apps and video-conferencing tools have been increasingly identified as spaces that can facilitate relationships, foster community and promote the health and wellbeing of older generations (Kebede et al. Reference Kebede, Ozolins, Holst and Galvin2022; Sen et al. Reference Sen, Prybutok and Prybutok2022; Grotto and Buja Reference Grotto and Buja2025; Garnett et al. Reference Garnett, Yurkiv, Connelly, Booth and Donelle2026).
Although digital platforms offer social health benefits, access to digital devices and reliable internet varies significantly across age groups in Canada, with older adults having lower levels of connectivity and engagement compared to younger cohorts (Davidson and Schimmele Reference Davidson and Schimmele2019). For example, only about 83.7 per cent of Canadians aged 65 and older reported at-home internet access in 2022, with that percentage dropping to 75.7 per cent among those aged 75 and older (Statistics Canada 2024). Older generations often struggle with digital literacy or feeling comfortable using technology (Oh et al. Reference Oh, Kim, Kim, Oh, Chu and Choi2021; Kim et al. Reference Kim, Freddolino and Greenhow2023), and these problems are exacerbated by stigma and ageism that may prevent seniors from seeking help or support (Gudynaite et al. Reference Gudynaite, Zamalijeva, Pakalniskiene and Gegieckaite2025). Dominant societal discourses can also reinforce stereotypes about ageing (e.g. older people are technologically inept) and valorize productivity and independence (e.g. seniors’ contributions are not as valuable as those of younger generations), while marginalizing those whose experiences do not conform to these ideals (Lupton Reference Lupton2017; Gudynaite et al. Reference Gudynaite, Zamalijeva, Pakalniskiene and Gegieckaite2025). Since barriers such as these affect who can engage with and benefit from digital platforms, technology use must be critically examined within the socio-cultural conditions that can influence health equity among ageing adults.
Mid-life and older 2SLGBTQ+ adults
The social health and wellbeing of mid-life and older 2SLGBTQ+ adults have long been impacted by distinct historical and structural conditions. Research from North America, South America, Europe and Asia indicates that long-standing stigma, discrimination and social exclusion embedded in broader structural and socio-cultural conditions contribute to health inequities in ageing 2SLGBTQ+ populations (Baiocco et al. Reference Baiocco, Antoniucci, Pistella, Alessandri, Alivernini, Borghi, Chirico, Filosa, Fini, Palombi, Rosati, Tavolucci and Lucidi2024; Yi et al. Reference Yi, Lee, Park, Choi and Kim2017; Hua et al. Reference Hua, Yang and Goldsen2019; Patterson et al. Reference Patterson, Sepúlveda and White2021; Wilson et al. Reference Wilson, Stinchcombe and Regalado2021; Crenitte et al. Reference Crenitte, de Melo, Jacob-Filho and Avelino-Silva2023; Sperling Reference Sperling2024; Matthews et al. Reference Matthews, Kittiteerasack, Inwanna, Ogata, Tran-Chi, Loa and Waluyo2025; Kumar et al. Reference Kumar, Mani, Oswald and Fredriksen-Goldsen2026). In Canada and the United States, mid-life and older 2SLGBTQ+ adults lived through the HIV/AIDS epidemic of the 1980s, which resulted in an enormous number of deaths, lost social connections, lasting mental and physical health impacts and the stigmatization of 2SLGBTQ+ identities (Kim, Fredriksen-Goldsen et al. Reference Kim, Fredriksen-Goldsen, Bryan and Muraco2017; Wilson et al. Reference Wilson, Stinchcombe and Regalado2021). While there have been incremental policy and societal shifts over the past few decades, 2SLGBTQ+ people in North America still face high rates of discrimination (Government of Canada 2023; GLAAD 2025), which are compounded by ageism and age-related barriers (Wilson et al. Reference Wilson, Stinchcombe and Regalado2021). These historic and contemporary conditions have also contributed to reduced social support networks among ageing 2SLGBTQ+ adults, exacerbating risks of negative social, mental and physical health outcomes (Fredriksen-Goldsen and Kim Reference Fredriksen-Goldsen and Kim2017; Wilson et al. Reference Wilson, Stinchcombe and Regalado2021; McMullen-Roach et al. Reference McMullen-Roach, Kumar, Inacio and Murray2025).
Despite this, research from Canada, the United States, the United Kingdom and Taiwan shows that mid-life and older 2SLGBTQ+ adults actively seek social connections and opportunities to interact with friends, family and community, often via technology (Kim, Lee et al. Reference Kim, Lee, Christensen and Merighi2017; Mock et al. Reference Mock, Walker, Humble, de Vries, Gutman, Gahagan, Chamberland, Aubert and Fast2020; Nedeljko Reference Nedeljko2022). Digital platforms provide spaces where 2SLGBTQ+ adults can create social connections and develop intimate relationships (Griffin and Fingerman Reference Griffin and Fingerman2017; Gates et al. Reference Gates, Hughes, Thepsourinthone and Dune2022), share information and resources related to health and wellbeing (Mock et al. Reference Mock, Walker, Humble, de Vries, Gutman, Gahagan, Chamberland, Aubert and Fast2020) and participate in community activities (Marmo et al. Reference Marmo, Pardasani and Vincent2021). Moreover, 2SLGBTQ+ people have developed technological skills that allow them to build connections and manage their health via digital platforms, including during times of crisis. For example, gay men who used dating apps like Grindr for socio-sexual relationships (Zervoulis et al. Reference Zervoulis, Smith, Reed and Dinos2020) and trans people who used forums such as Reddit or Tumblr for health-related discussions (Cavalcante Reference Cavalcante2017; Cipolletta et al. Reference Cipolletta, Votadoro and Faccio2017) leveraged their technological skills during the Covid-19 pandemic to support their physical, mental and social wellbeing (Hafford‐letchfield et al. Reference Hafford-Letchfield, Toze and Westwood2021). Though their use of digital platforms has evolved over time, 2SLGBTQ+ people benefit from the affordances of technology because they can connect in safe spaces outside mainstream society that are curated to their needs and welcoming to their identities (Cipolletta et al. Reference Cipolletta, Votadoro and Faccio2017). Since digital platforms can be understood as tools that help mid-life and older 2SLGBTQ+ adults manage various aspects of their health, including their social health, technology should be recognized for its health promotion potential in ageing populations.
Digital ageing, inequality and health equity
Within gerontology, scholarship on ageing and technology has often examined older adults’ adoption of digital technologies as indicators of ‘successful’ ageing, frequently linking technological engagement to independence, productivity and social participation (Betlej Reference Betlej2023; Yeh et al. Reference Yeh, Chang, Yang and Yang2025). Other scholars have advanced the concept of digital ageing, positioning ageing and technology as co-constitutive processes and emphasizing that digital technologies play an active role in shaping people’s later-in-life experiences, rather than simply mediating connections (Peine and Neven Reference Peine and Neven2019). As a gerontological concept, digital ageing challenges earlier frameworks that positioned technology adoption as merely an indicator of ‘successful’ ageing, understood as a biomedical framing that reduced older adults’ digital engagement to questions of competence and independence. Instead, digital ageing calls attention to the socio-technical processes through which later life is actively shaped and creates opportunities for gerontological inquiry into how digital environments influence identity development, social connections and the health of diverse ageing populations.
Research on digital ageing, such as Fakoya et al.’s (Reference Fakoya, McCorry and Donnelly2020) scoping review of 33 reviews spanning 21 countries on interventions targeting loneliness and/or social isolation among seniors, highlights how social connection is increasingly mediated through socio-technical arrangements. Across the reviews synthesized, technology-mediated strategies, such as telephone befriending, video-conferencing calls, computer and internet training programmes and online support groups, were identified as mechanisms for fostering social connection and engagement (Fakoya et al. Reference Fakoya, McCorry and Donnelly2020). Through the lens of digital ageing, these interventions illustrate how digital platforms and related technologies can actively support interpersonal connection and community belonging in later life, thereby helping mitigate social isolation and loneliness among ageing populations.
However, disparities in access to and use of digital technologies, which has often been referred to as the ‘digital divide’ (Compaine Reference Compaine2001), can contribute to health inequities (Saeed and Masters Reference Saeed and Masters2021). Systematic reviews of worldwide research show that the digital divide is shaped by socio-demographic factors, such as age, gender, race and ethnicity, education, income, disability, migration status and geographic location (Scheerder et al. Reference Scheerder, Van Deursen and Van Dijk2017; Lythreatis et al. Reference Lythreatis, Singh and El-Kassar2022; Raihan et al. Reference Raihan, Subroto, Chowdhury, Koch, Ruttan and Turin2025) as well as individual skills, competence, digital literacy, motivation, risk perceptions, values, attitudes and beliefs (Scheerder et al. Reference Scheerder, Van Deursen and Van Dijk2017; Kebede et al. Reference Kebede, Ozolins, Holst and Galvin2022; Lythreatis et al. Reference Lythreatis, Singh and El-Kassar2022). There are also structural and systemic barriers that can exacerbate the digital divide, including broadband infrastructure, affordability, technological and algorithmic biases, and exclusionary telehealth and health system designs (Scheerder et al. Reference Scheerder, Van Deursen and Van Dijk2017; Raihan et al. Reference Raihan, Subroto, Chowdhury, Koch, Ruttan and Turin2025).
Taken together, this scholarship shows that digital technologies are neither inherently health-promoting nor inherently exclusionary; rather, their effects on ageing populations are structured by broader social and systemic conditions. As digital environments become integral to everyday life and health systems, meaningful access to and engagement with digital technologies function as determinants of social health, and health more broadly. However, current international research has examined the technological and social needs of mid-life and older adults (Courtin and Knapp Reference Courtin and Knapp2017; Kebede et al. Reference Kebede, Ozolins, Holst and Galvin2022), with less attention paid to 2SLGBTQ+ populations (Breder and Bockting Reference Breder and Bockting2023), and existing work on technology and social health has largely focused on younger generations (Berger et al. Reference Berger, Taba, Marino, Lim and Skinner2022). More research is therefore needed to understand how digital environments intersect with structural inequities to shape the health experiences of mid-life and older 2SLGBTQ+ adults.
Health promotion frameworks and digital determinants of health
The HEPM encourages an examination of health inequities among 2SLGBTQ+ populations (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014). Developed in the United States, this model integrates historical, social, structural and individual-level factors to explore how intersecting forms of marginalization impact health outcomes across the lifecourse (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014). This model considers both protective and risk factors while avoiding deficit-based framings of 2SLGBTQ+ people by emphasizing their resilience and agency (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014, Reference Fredriksen Goldsen, Kim, Jung and Goldsen2019; Fredriksen-Goldsen and Kim Reference Fredriksen-Goldsen and Kim2017).
Despite its strengths, the HEPM does not explicitly recognize technology as a determinant of health. This omission is increasingly consequential given the growing role of digital platforms in health promotion (Crawford and Serhal Reference Crawford and Serhal2020; Richardson et al. Reference Richardson, Lawrence, Schoenthaler and Mann2022; Chidambaram et al. Reference Chidambaram, Jain, Jain, Mwavu, Baru, Thomas, Greaves, Jayakumar, Jain, Rojo, Ridao Battaglino, Meara, Sounderajah, Celi and Darzi2024), including in ageing populations (Courtin and Knapp Reference Courtin and Knapp2017; Peine and Neven Reference Peine and Neven2019; Fakoya et al. Reference Fakoya, McCorry and Donnelly2020) and 2SLGBTQ+ populations (Berger et al. Reference Berger, Taba, Marino, Lim and Skinner2022; Breder and Bockting Reference Breder and Bockting2023). The lack of attention paid to technology has distinct consequences for research in gerontology, public health and related fields. For the gerontology of 2SLGBTQ+ ageing, it risks obscuring how technology increasingly impacts the ageing process, affecting access to community, care and social connection in ways that intersect with the structural inequities that gerontological research has long sought to address (Peine and Neven Reference Peine and Neven2019; Betlej Reference Betlej2023). For public health and health promotion, it means that existing frameworks may overlook technology’s role in affecting both positive and negative health outcomes, even though structural and environmental determinants have been recognized in international frameworks for health promotion (McLeroy et al. Reference McLeroy, Bibeau, Steckler and Glanz1988; World Health Organization 2008, 2010; Frieden Reference Frieden2010).
Recently, health promotion scholars have argued that digital determinants of health constitute a distinct and consequential category of influence on health and health equity, operating alongside and in interaction with social determinants of health (Crawford and Serhal Reference Crawford and Serhal2020; Sieck et al. Reference Sieck, Sheon, Ancker, Castek, Callahan and Siefer2021). Rather than referring solely to access to technology, digital determinants encompass the design, governance, availability, usability and social organization of digital systems, as well as the forms of literacy and agency that impact how individuals engage with digital environments (Richardson et al. Reference Richardson, Lawrence, Schoenthaler and Mann2022; Chidambaram et al. Reference Chidambaram, Jain, Jain, Mwavu, Baru, Thomas, Greaves, Jayakumar, Jain, Rojo, Ridao Battaglino, Meara, Sounderajah, Celi and Darzi2024). These determinants can generate both direct and indirect effects on health by structuring access to information, services and social connection, while also introducing new risks related to exclusion, surveillance, misinformation and algorithmic bias (Kickbusch and Holly Reference Kickbusch and Holly2023; Tefera et al. Reference Tefera, Williams, Stankov and Kickbusch2025). Digital determinants of health extend health promotion frameworks by situating health equity within the socio-technological conditions that affect health outcomes. Integrating a technological dimension into the HEPM strengthens its capacity to understand the health experiences and outcomes of ageing 2SLGBTQ+ populations in an increasingly digital world.
Purpose
As society becomes increasingly digital, it is important to understand the unique needs of diverse ageing populations and how technology can be used to promote both individuals’ and communities’ health. As such, this article has two overarching objectives. First, it aims to investigate how mid-life and older 2SLGBTQ+ adults used technology to meet their social needs and support their social health during the Covid-19 pandemic. Second, it integrates a technological dimension into the HEPM (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014) and exemplifies how the model can be applied to a Canadian context, thereby serving as a case study for future international research. Thus, while this research examines how participants used digital platforms to maintain and promote their social health during a critical time, the broader goal of this article is to show how technology functions as a determinant of health in ageing 2SLGBTQ+ populations. With this dual empirical and theoretical contribution, this article seeks to advance the gerontology of 2SLGBTQ+ ageing by positioning technology as integral to understanding and promoting health equity in digital ageing, with broader implications for health promotion research and practice.
Methods
As part of a larger research project that investigated the social health and technological needs of 2SLGBTQ+ adults, this study examined how mid-life and older 2SLGBTQ+ adults have built and maintained friendships, relationships and community through digital platforms, and how these technologies have impacted their social health. Data were collected via focus groups. This method was chosen because it creates a comfortable, empowering environment where participants feel at ease discussing sensitive topics (Farquhar and Das Reference Farquhar and Das1999; Robinson Reference Robinson1999), thereby making it well suited for exploring complex issues within 2SLGBTQ+ communities (LaVaccare et al. Reference LaVaccare, Diamant, Friedman, Singh, Baker, Rodriguez, Cohen, Dary and Pregler2018; Karakaya and Kutlu Reference Karakaya and Kutlu2021; Redden et al. Reference Redden, Gahagan, Kia, Humble, Stinchcombe, Manning, Ecker, de Vries, Gambold, Oliver and Thomas2023). This study was approved by the Dalhousie University Research Ethics Board (#2023-6758).
Eligible participants were required to be aged 50 or older; identify as Two-Spirit, lesbian, gay, bisexual, transgender, queer or another non-cisgender or non-heterosexual identity (2SLGBTQ+); live in Ontario, Québec or Atlantic Canada (i.e. New Brunswick, Prince Edward Island, Nova Scotia, and Newfoundland and Labrador); and speak either English or French. Participants were recruited in collaboration with 2SLGBTQ+ community organizations, which included distributing bilingual recruitment materials (e.g. digital and print flyers, social media posts) to partners’ networks as well as snowball sampling. Once eligible participants were identified, the research team and community partners worked together to schedule the focus groups.
Before starting a focus group, the consent form was provided to participants and reviewed with them. The form detailed the study’s purpose, procedures, potential benefits and risks, confidentiality measures and data management protocol. The form also included information about relevant support services and resources available to mid-life and older 2SLGBTQ+ adults and contact information for the research team. All participants gave either verbal or written consent.
Data collection
Participants completed a demographic questionnaire that asked about their identity (e.g. age, gender, sexual orientation, race), their use of technology (e.g. what digital platforms they used, how many hours per week they used these platforms on average) and their level of health (i.e. ‘On a scale from 1 to 5 – with 1 being perfect, and 5 being terrible – how would you rate your health?’). Since participants were not required to answer every question on the questionnaire, the demographic information provided in Table 1 is based on available responses.
Demographic information of participants
Table 1 Long description
Demographic breakdown for 23 participants across gender, sexual orientation, relationship status, race, language, and residence, reported as counts and percentages of provided responses. Gender responses were 11 cisgender men (48%), 9 cisgender women (39%), 1 other (4%), and 2 who preferred not to respond (7%). Sexual orientation was mainly gay (13, 57%) and lesbian (7, 30%), with bisexual, queer, and other each reported by 1 participant (4% each). Relationship status includes 9 single (60%), 3 married (20%), 1 separated (6.7%), and 2 other (13.3%), with 8 participants giving no response for relationship status. Race was predominantly White (19, 90.5%), with 2 reporting other (9.5%) and 2 giving no response for race. Language was mostly English (18, 78%) versus French (5, 22%), and residence was more urban (14, 60%) than rural (9, 40%). Percentages are based on provided responses within each category, so categories with missing responses may not reflect the full sample.
In total, 23 mid-life and older 2SLGBTQ+ adults participated in four focus groups, which were held in May–August 2023. Participants’ ages ranged from 58 to 78, with an average age of 68. Most participants were cisgender (n = 20; 87%) and identified as either gay (n = 13; 57%) or lesbian (n = 7; 30%). Despite efforts to recruit a diverse sample, most participants were White (n = 19; 83%), and there was no known representation from Indigenous peoples. Although no participants identified as Two-Spirit, this article still includes ‘2S’ in the acronym ‘2SLGBTQ+’ to call attention to this population, acknowledge their position as First Nations peoples in Canada and recognize the diversity and intersectionality of identity (Vincent Reference Vincent2018).
No participants openly identified as trans, but a few selected ‘other’ or ‘prefer not to respond’ in the demographic questionnaire. This may indicate the presence of diverse gender identities, uncertainty around gender (including the language to describe it) or a decision not to disclose (Vincent Reference Vincent2018; Slade et al. Reference Slade, Gross, Niwa, McKillop and Guptill2021). Gender and sexual identities are fluid, particularly across the lifespan, so it is possible that participants were exploring their identities, not publicly out or uncomfortable disclosing their identities owing to concerns about safety, stigma or exclusion (Rood et al. Reference Rood, Maroney, Puckett, Berman, Reisner and Pantalone2017; Vincent Reference Vincent2018; Slade et al. Reference Slade, Gross, Niwa, McKillop and Guptill2021). This article retains the ‘T’ in the umbrella acronym to recognize the possibility of participant non-disclosure; the fluidity and development of 2SLGBTQ+ identities, particularly as people age; and the relevance of this work to diverse 2SLGBTQ+ communities.
Participants spoke either English (n = 18; 78%) or French (n = 5; 22%), resided in both urban (n = 14; 60%) and rural areas (n = 9; 40%), and reported an average health rating of 2.3 out of 5 (n = 14; 61%). Participants’ use of technology ranged from 1 to 30 hours per week, with a mean of 11.5 hours (n = 12; 52%). They reported using many different digital platforms, including video calling apps like Zoom, Skype, Microsoft Teams and FaceTime; social media platforms like Facebook, Instagram and Twitter/X; dating/hook-up apps like Tinder, Grindr, Scruff, Gay Daddy and Silver Daddy; and messaging services like email, texting and Facebook Messenger. Although all participants had access to at least one digital device, they reported a range of comfort in using technology.
The focus groups consisted of three to nine participants and lasted 45–90 minutes. One focus group was with lesbian women, one was with gay men and the other two included participants with a mix of genders and sexual orientations. A hybrid approach was taken to facilitate participation across geographic regions, which included one in-person focus group with no technology; one in-person focus group with some participants on Zoom; one focus group on Zoom; and one focus group with both Zoom and telephone calls. Three focus groups were conducted in English and one focus group was conducted in French. All focus groups were audio recorded and the recordings were transcribed verbatim. The French transcript was translated into English. Transcripts were de-identified and anonymized.
In each focus group, participants were asked what digital platforms they used, what risks and benefits they faced, and how technology impacted their health. They were also encouraged to discuss pandemic-specific experiences and connections to their identities (e.g. age, gender, sexual orientation). Other questions asked participants about digital barriers and their socio-technological and health needs, and how community organizations could better serve ageing 2SLGBTQ+ populations.
Later in this article, when the results of this study are presented, the genders and sexual orientations of individual participants are not specified. Similarly, pseudonyms are not assigned. Instead, participants are referred to using the gender-neutral pronoun ‘they’ or in the singular (e.g. ‘one participant said …’). These choices were made to protect participant anonymity, avoid reification or over-categorization and shift analysis away from individuals and towards patterns across the dataset. One focus group is identified as for lesbian women and another as for gay men, based on the mandates of their respective community organizations. The remaining two focus groups were conducted with an organization for ageing 2SLGBTQ+ adults more broadly, and thus those participants are referred to as part of a mixed focus group.
Data analysis
Data were analysed according to Braun and Clarke’s (Reference Braun and Clarke2006) approach to thematic analysis, guided by the HEPM (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014). This model examines risk and protective factors at multiple levels (i.e. individual, interpersonal, community and societal) and emphasizes the promotion of health and wellbeing in 2SLGBTQ+ populations. In this study, the model’s attention to environmental context was expanded to consider the role of technology. Additionally, the lifecourse perspective embedded in the HEPM facilitated analysis of how experiences of marginalization affect one’s health over time, thereby enabling a comprehensive examination of mid-life and older 2SLGBTQ+ adults’ health, including the obstacles and opportunities they encountered when using digital platforms.
Data analysis occurred in six distinct yet interrelated phases. In the first phase, the team became familiarized with the dataset through repeated readings of the transcripts, with general observations and initial impressions documented. A mind-mapping technique (Wheeldon and Ahlberg Reference Wheeldon, Ahlberg and Liamputtong2017) was used to identify and explore points of potential analytic interest. Initial codes were independently generated by members of the team in the second phase, while the third phase involved the team comparing codes and grouping them into preliminary themes. In the fourth phase, themes were independently reviewed and revised to ensure that they accurately reflected both individual extracts and the dataset as a whole. The fifth phase consisted of an iterative process of refining, defining and finalizing themes through discussion of convergences and divergences until the team reached consensus. For the sixth and final phase, the results and discussion sections of this article were written.
Results
Four themes, presented here, reveal how technology functioned as a determinant of health among mid-life and older 2SLGBTQ+ adults during the Covid-19 pandemic. The first theme recognizes technology as a social health resource that helped this population maintain relationships, have socio-sexual interactions, engage in intergenerational exchange and access identity-affirming spaces. The second theme examines invisibility and the limits of digital connections, thereby investigating the negative effects, pressures and potential consequences of technology. The third theme explores differences in participants’ experiences with digital access and digital ageing, such as feeling left behind, overcoming technological challenges and confronting stigma, discrimination, ageism and other barriers. The fourth theme goes beyond social health issues to consider the mental and physical health consequences of technology. Throughout this section, participant quotes are provided to illustrate the themes and subthemes.
Technology as a social health resource
Participants reported using a range of digital platforms to connect with people during the Covid-19 pandemic. Notably, messaging apps were often used to stay in touch with friends and family and mitigate social isolation, with one participant from a mixed focus group saying: ‘I love texting. For me, it’s an easier way of getting in touch without interrupting somebody’s dinner or conversation or whatever.’ Other participants expressed similar appreciation for the convenience of messaging, saying that they texted and sent messages more frequently now than before the pandemic.
Several participants talked about using dating apps to maintain social and sexual connections when in-person encounters were restricted by pandemic lockdowns. For instance, one participant stated: ‘Everything’s dwindled off now, everything’s online. I’ll just meet you on Grindr or whatever it is.’ Similarly, one participant from the focus group with gay men explained how sexual behaviours changed during the pandemic:
I used to go to saunas, and then you couldn’t go to saunas because it’s dangerous and no one wants to get Covid and die, and so hook-up apps became more and more a way of expressing myself in terms of a sexual being and hooking up and meeting people.
For ageing gay men in particular, digital platforms offered a way to pursue socio-sexual interactions while reducing the likelihood of Covid-19 transmission, which held greater risks for older populations. The shift to online spaces was not without its challenges, however. Participants frequently described navigating the tension between protecting their physical health and attending to their social health, with one participant from a mixed focus group saying: ‘I don’t want to go out there, and yet at the same time I need to, I need to see people, I need to interact.’
Video-conferencing platforms were also identified as a helpful resource for managing social health. Participants would attend online activities and events offered by 2SLGBTQ+ community organizations, with one participant from the focus group with gay men noting: ‘[Zoom] helps breaks the isolation. The technology becomes vitally important, and because of the pandemic, we discovered how important it became.’ Social media platforms such as Facebook, Instagram and Twitter/X were also used by participants to discover and participate in community-organized online activities.
Participants emphasized the value of connecting with 2SLGBTQ+ communities. For instance, one participant from the focus group with lesbian women talked about the importance of maintaining relationships with other queer women:
At some point, I felt the need to connect with something that was more in line with my deepest nature, in terms of how I wanted to spend my time … I felt the need to be more surrounded by lesbians … There’s a whole connection to that community, but really it has nothing to do with technology.
Periods of social isolation prompted this participant to reflect on priorities and recognize the value of connections with other lesbian women. Other participants also discussed the social benefits of technology, including one participant from the focus group with gay men who said: ‘For me, the benefit during the pandemic, especially, was … just being able to stay in touch with people, which was amazing.’ One participant from a mixed focus group explained that keeping ties with ‘queer friends’ was so important because ‘I feel like I can be myself’, while another participant from the focus group with lesbian women said: ‘I don’t want to lose [human contact]. I think it’s so important after what we went through.’ In this sense, technology functioned as a social health resource by helping mid-life and older 2SLGBTQ+ adults maintain meaningful connections that would otherwise not have been possible during the pandemic.
Invisibility and the limits of digital connections
Although digital platforms and other technologies operated as a social health resource, participants described losses associated with the shift to online spaces, particularly in relation to community visibility and presence. Many noted that physical gatherings at Pride events and community centres were restricted during pandemic lockdowns, contributing to a sense that 2SLGBTQ+ networks had been weakened. As one participant from the focus group with lesbian women explained:
What limited networks we had, what limited availability we had to be visible, for example the Pride march and stuff like that, during the pandemic, that was gone. We lost that interaction and that visibility. The fragile networks we had were crushed, so we lost what sense of community we had even more.
Some participants also expressed concern that 2SLGBTQ+ people were being ‘forced’ online, becoming ‘totally invisible for Pride’ and other important community-building events. One participant from a mixed focus group emphasized the difficulty of recreating diverse, intergenerational community spaces online: ‘There’s no community centre or a place where everyone – older, younger, allies, everyone – can come together. There’s no such place. And to find that place online, I don’t know how to do it. And I don’t know that it exists either.’ For these participants, the shift to digital platforms restricted valuable opportunities for in-person connection and raised concerns about the erosion of 2SLGBTQ+ visibility.
There were several participants who asserted that diminishing the visibility of 2SLGBTQ+ people by shifting online could have broad social and political risks. For instance, one participant from a mixed focus group warned that ‘if public perception shifts against queer people because we’re invisible’, this could lead to a ‘slippery slope of losing our rights and losing our sense of community’. Another participant from a mixed focus group reflected on growing up in earlier decades and expressed fear about current backlash against 2SLGBTQ+ communities:
I know what it was like to grow up in the 60s and 70s and I wouldn’t wish that on young people today, but that’s what it’s coming to. Like this backlash against trans people and everybody really – not just trans people – it’s huge and it’s terrifying and it seems like all those milestones we fought for, for so long, are eroding quickly.
Echoing those concerns about shifting online, another participant from a mixed focus group stated: ‘I didn’t have a voice, and I feel the little voice that I did have was taken away from me.’
Some participants drew similarities between the Covid-19 pandemic of the 2020s and the AIDS epidemic of the 1980s and 1990s, explaining that it was difficult for 2SLGBTQ+ people to connect with friends, biological family and chosen family during these public health crises. Participants also noted the similar concern of transmitting an unfamiliar virus to people close to them, whether via social or sexual interactions. One participant from a mixed focus group explained:
Everybody has gone back to isolation, away from each other. Everybody was afraid to have sex with each other and hang out with each other – they didn’t know how there was contact, how would you catch it and stuff, so it was quite similar. But I don’t believe that Covid did as much damage as AIDS did for our sense of community. This time, everything’s gone to technology, so everything’s dwindled off now. The sense of community has collapsed, everything’s online. I’ll meet you on Grindr or whatever it is.
Although this participant recognized that they could still connect with people online during the pandemic, they saw both public health crises as destructive to 2SLGBTQ+ community, restricting people’s ability to meet in person and engage in social activities. Similarly, another participant from a mixed focus group said: ‘I think it’s similar to the AIDS crisis back in the 80s. … They took over, kidnapped our community and took over our dances, our social events and everything else.’
Limitations on physical gatherings among 2SLGBTQ+ people also meant that ageing populations could be forgotten by younger generations. As one participant from a mixed focus group explained:
Growing up in the 70s and living through the 80s and the AIDS epidemic and all the personal and social struggle that we went through, and the loss – it was so much. And now, I turn around and there’s a whole generation of young queers who have no use for me, you know? And it’s so obvious. That cold shoulder, that turning away – don’t get me started. It really hurts my feelings that there’s this whole bunch of young people that have no use for older queers.
This participant expressed frustration that, unlike the AIDS epidemic which fostered collective mobilization across diverse 2SLGBTQ+ communities, the Covid-19 pandemic did not generate a comparable sense of unity or solidarity among queer and trans people. Despite widespread social isolation, the pandemic did little to bridge generational divides, potentially undermining the social health of mid-life and older 2SLGBTQ+ adults – and possibly younger 2SLGBTQ+ people as well – by limiting opportunities for intergenerational exchange and mutual care.
Differences in digital access and digital ageing
Access to and comfort with technology varied greatly among the mid-life and older 2SLGBTQ+ participants. Notably, many were frustrated that technology was constantly changing, with frequent platform and software updates. One participant from the focus group with gay men said: ‘I find that with the pace of technology nowadays and the advancements, it’s really easy to get left behind.’ Another participant from a mixed focus group disliked the steep learning curves, saying: ‘I find it discouraging because I want to know what I’m doing, and often times I don’t know everything that I’m doing and it’s frustrating.’
Several participants talked about their devices as obstacles they had to overcome to maintain social connections, including one participant from the focus group with gay men who said: ‘Using a laptop, using a desktop, using an iPad, they all have different functionalities. That’s a job sometimes trying to figure out, moving from one modality to another.’ Another participant from the focus group with gay men was similarly annoyed with these differences and the need to constantly adapt: ‘Every bit of technology, every platform has its own rules.’
However, participants urged against making assumptions about the technological access or capacities of mid-life and older 2SLGBTQ+ adults. One participant from the focus group with gay men emphasized that ‘there’s a huge range of comfort levels in terms of the technology with our age group’, while another participant from the focus group with lesbian women asserted that technology could segregate certain 2SLGBTQ+ adults, ‘either because they are much less skilled or just simply disinterested by technology’. There was another participant from the focus group with lesbian women who similarly called attention to disparities in ageing 2SLGBTQ+ adults’ access to digital devices, saying that ‘not everyone has a cell phone’.
Economic barriers also impacted digital inclusion, with one participant from a mixed focus group explaining that ‘many of us can’t afford internet or don’t know how to use it, or both’. Another participant from a mixed focus group asserted that these disparities could exacerbate digital inequities:
Technology has its advantages, but the disadvantage is the range of people we can reach. A lot of people don’t have web resources, they don’t necessarily have a computer capable of doing what needs to be done other than email, and that’s where I got the impression that there were two classes of seniors. There are the tech-savvy ‘connected’ seniors, and then there are the non-tech-savvy ‘disconnected’ seniors.
For this participant, technology created two classes of ageing populations during the pandemic, thereby segregating mid-life and older 2SLGBTQ+ adults into those who could access requisite social supports and those who could not. Since this digital divide was understood as contributing to social isolation and exacerbating social health inequities, another participant from a mixed focus group asserted that ‘if you’re working with technology – not just rainbow seniors or seniors – it has to be accessible’.
Participants reflected on how identity shaped their social health and experiences with technology, with one from the focus group with lesbian women stating that ‘many lesbians are feminists, independent and take care of themselves’ and thought ‘that has made it easier for us to use different technologies’. Other participants in the same focus group contested the apparent link between 2SLGBTQ+ identities and technological skills, with one saying that it ‘depends on the person’ and another expressing uncertainty about it being ‘linked to our gender identity’, even though ‘this independent identity as a lesbian, yes, has probably helped me have a certain capacity for solving problems’.
Several participants said that health and age were more influential factors in determining their social health or experiences with technology, with one participant from the focus group with lesbian women asserting that ‘the only identities that played a factor were being older and being sick; … sexual orientation really had nothing to do with my experiences’. Similarly, one participant from a mixed focus group explained that age affected who they could connect with: ‘I’m very anxious about engaging people online. With a certain amount of younger people, I really take a back seat because I’ve been challenged or ignored one way or the other for being an old person.’ Another participant talked about being labelled a ‘boomer’ by younger generations because of the challenges they sometimes encountered with technology. Overall, participants emphasized that ageing, rather than gender or sexual orientation, had the greatest effect on their experiences with digital platforms and technology.
Physical and mental health consequences of technology
In addition to social impacts, participants discussed the physical and mental health consequences of technology use. Notably, many explained that prolonged screen time and sedentary behaviour contributed to physical discomfort, pain and reduced mobility, with one participant from a mixed focus group saying that ‘the biggest drawback of all this technology has been it allows me to be very still, physically still, which as I get older, it just takes a bigger and bigger toll on everything’. There was a ‘bionic’ participant from a mixed focus group who talked about having new hips and facing mobility problems because technology made it so easy to be sedentary, while another participant from a mixed focus group said that using technology negatively affected their mobility, sleep quality and weight:
It’s a lot of screens and a lot of sitting. My neck is a gigantic mess now, more so than it was a year ago. I’ve got stenosis. Everything seized up because I’d been staring at screens. I can’t sleep, so I’ll play on my phone which just perpetuates that. I’ve gained 20 pounds in the year that I sat here, and everything has stiffened up and tightened up.
For these participants, muscle stiffness, pain, insomnia and weight gain were some of the physical health consequences associated with increased technology use.
Participants also worried about the negative impacts of technology on their mental health, including one participant from the focus group with gay men who talked about digital platforms being ‘very addictive, like extremely addictive’ and having trouble ‘finding the discipline in myself to be able to stop’. Others expressed concern about dwindling emotional connections because of increased reliance on technology, including one participant from the focus group with lesbian women who said: ‘I’m afraid of technology because it can slowly isolate us … we end up lacking affection, we become dissocialized.’ Another participant from a mixed focus group reported feeling depressed during pandemic lockdowns because of social withdrawal, even though they could still connect with people online: ‘My mood changed, I became a little bit depressed because of it and it wasn’t great.’ There was one participant from a mixed focus group who stated that excessive technology use during the pandemic use was ‘impacting our health, our emotional and mental wellbeing’, while several others emphasized the importance of finding the right balance with technology so that it does not become ‘unhealthy’. Overall, while participants acknowledged that technology helped them manage their social health, they also emphasized its physical and mental consequences on their broader health and wellbeing.
Discussion
This article empirically examined how mid-life and older 2SLGBTQ+ adults in Canada used digital platforms to support their social health during the Covid-19 pandemic, and it advances a theoretical contribution by expanding the HEPM (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014) to more explicitly consider technology as a factor affecting 2SLGBTQ+ health outcomes. For the gerontology of 2SLGBTQ+ ageing, this contribution is important because it connects the model’s lifecourse orientation with digital environments through which community belonging, social connection and health-promoting practices are negotiated. The findings show that technology functioned simultaneously as a health-promoting resource and a source of risk, impacting mid-life and older 2SLGBTQ+ adults’ social connections, visibility, access to social supports, and physical and mental health. By recognizing technology as a determinant of health, this article contributes to scholarship in gerontology and health promotion by showing how digital platforms are embedded in the everyday lives of ageing 2SLGBTQ+ populations and how changes in technology, society and culture must be considered in models of 2SLGBTQ+ health promotion.
Technology, digital ageing and 2SLGBTQ+ agency
Mid-life and older 2SLGBTQ+ participants showed agency as they used technology, and they frequently described a willingness to learn, adapt to and employ digital platforms to meet their social needs. This finding challenges common deficit-based narratives that frame older adults as resistant or inept technology users (Wandke et al. Reference Wandke, Sengpiel and Sönksen2012; Watson Reference Watson2018) as well as deficit-based gerontological frameworks such as biomedical models of ‘successful’ ageing and perspectives that treat later-life decline as the normative trajectory (Rowe and Kahn Reference Rowe and Kahn1997). This finding demonstrates that mid-life and older 2SLGBTQ+ adults actively negotiate digital environments in ways shaped by cumulative experience, community history and collective resilience (Dannefer Reference Dannefer2003; Stinchcombe and Hammond Reference Stinchcombe and Hammond2022). Thus, while some participants encountered structural, social and personal barriers that restricted their willingness or ability to engage with technology, this cohort of ageing 2SLGBTQ+ adults overall demonstrated capacity, flexibility and intentionality in their use of technology.
The findings further show that mid-life and older 2SLGBTQ+ adults actively engaged with technology when it supported their social needs. This aligns with broader research on digital ageing, including Zhang’s (Reference Zhang2023) systematic review of 83 studies conducted across multiple countries, which demonstrates that older adults’ willingness to adopt and engage with emerging technologies is strongly shaped by perceived usefulness, meaningfulness and relevance to their everyday lives. Building on this argument that ‘meaningful use’ of technology is contingent upon the social, economic and cultural capital of the user (Selwyn Reference Selwyn2004), this article shows how ‘successful’ digital engagement for these ageing 2SLGBTQ+ participants was deeply embedded in historical and socio-cultural contexts, rather than being dependent on technological competence or ability alone (Betlej Reference Betlej2023; Yeh et al. Reference Yeh, Chang, Yang and Yang2025). During the Covid-19 pandemic, these contexts intersected with public health restrictions and physical distancing measures, as well as participants’ motivations for digital engagement, concerns about visibility and desires for community connection. By examining these socio-cultural, public health and technological dimensions, which are often overlooked in gerontology research on ageing populations, this article demonstrates that mid-life and older 2SLGBTQ+ adults’ agency with digital platforms is relational and historically situated, shaped by collective experiences of marginalization, resilience and community belonging.
While participants recognized the value of technology, they emphasized that virtual interactions could not fully replicate in-person interactions. This finding is consistent with research from the United Kingdom which shows that many mid-life and older 2SLGBTQ+ adults do not view online communication as a replacement for face-to-face interactions (Westwood et al. Reference Westwood, Hafford-Letchfield and Toze2021). Although technology can create new opportunities for engagement (Cotten Reference Cotten2017), in-person interactions remain important for the social health and wellbeing of ageing populations in North America and Europe (Hawkley et al. Reference Hawkley, Finch, Kotwal and Waite2021; Litwin and Levinsky Reference Litwin and Levinsky2022). Taken together, these findings suggest that gerontological understandings of 2SLGBTQ+ ageing must continue to recognize the value of in-person interactions, even as digital technologies expand opportunities for online connections.
Participants’ experiences also show that historical and socio-cultural conditions affected their agency. Notably, several participants reported drawing on resilience developed through previous experiences of marginalization, including during the AIDS epidemic, to navigate pandemic-related social and technological challenges. This finding aligns with research suggesting that long-term exposure to stigma and social barriers can equip ageing 2SLGBTQ+ adults in North America and Europe with unique adaptive skills relevant to managing social, physical and mental health issues across the lifecourse (Higgins et al. Reference Higgins, Sharek and Glacken2016; Quinn et al. Reference Quinn, Walsh, John and Nyitray2021). In this sense, participants’ engagement with technology during the pandemic was not simply a response to their social needs but also informed by previous experience, historical events and 2SLGBTQ+ identity development.
Digital visibility and community
Beyond individual agency, participants called attention to the broader social and political dimensions of digital engagement, particularly in relation to 2SLGBTQ+ community wellbeing. Several expressed concern about the lack of interpersonal exchange and the decreased visibility of 2SLGBTQ+ communities as social gatherings shifted online because of the pandemic. These concerns were closely linked to fears about potential social, political and legal consequences, and they reflect an understanding of the critical role that visibility has played in promoting 2SLGBTQ+ rights, recognition, safety and health in North America (Bernstein Reference Bernstein2002; Brotman et al. Reference Brotman, Ferrer, Sussman, Ryan and Richard2015; Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Shiu, Bryan, Goldsen and Kim2017).
For these ageing 2SLGBTQ+ participants, concerns about visibility were also tied to fears about losing historical knowledge, a sense of community and solidarity with younger generations of queer and trans people. Participants viewed intergenerational exchange as a way to maintain 2SLGBTQ+ visibility and relationships, even as their reliance on technology increased. This finding highlights the value of community-based, intergenerational interactions for supporting the social health of mid-life and older 2SLGBTQ+ adults and for preserving 2SLGBTQ+ histories, which aligns with research from Canada, the United States and the United Kingdom about the value of intergenerational programmes (Freeman et al. Reference Freeman, Marston, Musselwhite, Olynick, Genoe, Kulczycki and Xiong2020; Powell et al. Reference Powell, Lavallee, Bajwa, Ilac and Meuser2025), including for ageing 2SLGBTQ+ populations (McGovern and Vinjamuri Reference McGovern and Vinjamuri2016; Bietsch Reference Bietsch2025). In Canada, intergenerational exchanges have been found to be especially beneficial for those who identify as Two-Spirit or Indigenous, since they support individuals’ social health and facilitate the sharing of cultural practices, traditions, stories, language and other forms of knowledge (Viscogliosi et al. Reference Viscogliosi, Asselin, Basile, Borwick, Couturier, Drolet, Gagnon, Obradovic, Torrie, Zhau and Levasseur2020; Hausknecht et al. Reference Hausknecht, Freeman, Martin, Nash and Skinner2021).
Recognizing the value of intergenerational exchange and the agency of mid-life and older 2SLGBTQ+ adults, health promotion efforts aimed at ageing populations should explore opportunities to integrate technology in ways that meaningfully connect generations. More broadly, these findings demonstrate that digital environments are not peripheral to 2SLGBTQ+ communities but central to how 2SLGBTQ+ visibility, history, solidarity and social health are sustained in later life. In this sense, technology functions as a socio-structural context that influences the conditions through which the health and wellbeing of ageing 2SLGBTQ+ adults are negotiated and experienced.
Digital health equity and health promotion
Rather than position technology as inherently beneficial or automatically harmful, this article demonstrates that the value, risks and impacts of technology on 2SLGBTQ+ people’s health are contextual and vary. Digital technologies shape access to information, services and social connection in ways that can either mitigate or exacerbate existing health inequities (Richardson et al. Reference Richardson, Lawrence, Schoenthaler and Mann2022; Chidambaram et al. Reference Chidambaram, Jain, Jain, Mwavu, Baru, Thomas, Greaves, Jayakumar, Jain, Rojo, Ridao Battaglino, Meara, Sounderajah, Celi and Darzi2024). During the pandemic, digital platforms provided critical social support to mid-life and older 2SLGBTQ+ adults, while also raising concerns about access, inclusion and equity (Crawford and Serhal Reference Crawford and Serhal2020). Recognizing technology as a determinant of health within the HEPM (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014) enables a more nuanced understanding of digital ageing and highlights how technological contexts impact 2SLGBTQ+ health outcomes.
Participants’ experiences showed how inequitable access to digital platforms, devices and other technologies can restrict opportunities for social connection and health promotion. Structural barriers that exacerbate the digital divide, such as limited internet access and affordability, can also hinder digital engagement and exacerbate social isolation in ageing populations (Scheerder et al. Reference Scheerder, Van Deursen and Van Dijk2017; Lythreatis et al. Reference Lythreatis, Singh and El-Kassar2022; Raihan et al. Reference Raihan, Subroto, Chowdhury, Koch, Ruttan and Turin2025). In the context of the HEPM, such inequities are understood as structural and environmental conditions that intersect with individual identities to affect 2SLGBTQ+ health outcomes across the lifecourse (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014). Addressing digital inequities therefore requires attention not only to individual circumstances but also to the development of upstream interventions, such as policy development, investment in digital infrastructure and community-led initiatives that promote equitable access to technology and health promotion resources.
Participants also described physical and mental consequences associated with increased reliance on technology. While digital platforms facilitated social interactions during the pandemic, they also contributed to prolonged screen time and sedentary practices and resulted in participants experiencing pain, fatigue, insomnia and addiction, among other issues. These findings illustrate the need for holistic approaches to health promotion that recognize how digital engagement can promote social health outcomes while simultaneously creating physical and mental health risks. From a health promotion perspective, attending to the dual nature of technology is essential to mitigate and prevent the accumulation of health concerns while still preserving the social benefits of digital connection.
Together, these findings have important implications for the gerontology of 2SLGBTQ+ ageing. Rather than simply challenging the assumption that ageing brings declining agency, including technological agency, they demonstrate how ageing 2SLGBTQ+ adults actively negotiate digital environments in ways that are shaped by their life experiences, community histories and broader structural conditions in society. This suggests that gerontological and health promotion frameworks must account for technology as a structural and relational context that impacts ageing, health and equity. By expanding the HEPM (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014) to include a technological dimension, this article offers a framework for future research that explores the intersections of technology, ageing, health and equity across diverse international contexts. As digital platforms increasingly mediate access to social engagement, health information and health care services, research in the gerontology of 2SLGBTQ+ ageing must consider technology’s health-promoting potential as well as its capacity for exclusion, invisibility and harm among ageing 2SLGBTQ+ populations.
Limitations and future research
This study has several limitations that should be considered when interpreting the findings. First, the participant sample lacked racial diversity and did not include known representation from Indigenous peoples. Future research should prioritize the participation of Black, Indigenous and other people of colour through culturally responsive recruitment strategies and partnerships with relevant community organizations.
The sample was also limited in terms of gender and sexual diversity, with only two participants identifying as bisexual or queer and no participants openly identifying as trans. Additionally, the average participant age was 68, which may limit the applicability of findings to older generations. Future studies should engage with a wider range of ages and ensure stronger representation across gender identities and sexual orientations, particularly among ageing trans adults.
Methodological design choices may have also impacted participation. Although the demographic questionnaire included options such as ‘other’ and ‘prefer not to respond’, which were intended to promote inclusion, comfort, flexibility and choice regarding disclosure (Slade et al. Reference Slade, Gross, Niwa, McKillop and Guptill2021), participants may have experienced these options as exclusion, erasure or other-ing (Vincent Reference Vincent2018; Slade et al. Reference Slade, Gross, Niwa, McKillop and Guptill2021). Moreover, the lack of trans participation may be indicative of greater issues with research design, since the absence of trans-specific findings often reflects broader barriers to participation, including marginalization, distrust and exclusionary practices (Namaste Reference Namaste2000; Spade Reference Spade2015; Pearce et al. Reference Pearce, Erikainen and Vincent2020). Scholars conducting research on ageing 2SLGBTQ+ populations should critically reflect on their methodological choices to ensure that their decisions are inclusive, equitable and do not risk erasing or excluding trans people (Reed Reference Reed2023).
Most participants lived in urban areas and were recruited through 2SLGBTQ+ community organizations, which may have excluded individuals who live in rural or remote regions or who are less involved or less connected to formal supports. Given the geographic inequities regarding access to health care, social services and support networks (Baernholdt et al. Reference Baernholdt, Yan, Hinton, Rose and Mattos2012; Carandang et al. Reference Carandang, Asis, Shibanuma, Kiriya, Murayama and Jimba2019), future research should examine digital ageing in diverse geographic contexts and among 2SLGBTQ+ people with differing levels of community engagement.
Lastly, while this article expands upon the HEPM by conceptualizing technology as a determinant of 2SLGBTQ+ health, further theoretical work is needed. Future research should empirically test and refine this framework across different countries, technological environments and ageing populations to better understand how digital determinants interact with the lifecourse, structural inequities and health outcomes over time.
Conclusion
This article, and the study on which it is based, examined how mid-life and older 2SLGBTQ+ adults in Canada used digital technologies to manage their social health during the Covid-19 pandemic. Although participants emphasized that technology could not replace in-person interactions, they demonstrated a clear willingness and capacity to engage with digital platforms. Growing up as 2SLGBTQ+ and living through the AIDS epidemic helped participants develop resilience, which they applied to overcome social, technological and pandemic-related obstacles. Digitally mediated social connections emerged as a meaningful component for facilitating social health in later life, emphasizing the need for inclusive and accessible digital environments within holistic health promotion strategies.
In addition to reporting empirical findings, this article advances a theoretical contribution to the gerontology of 2SLGBTQ+ ageing by expanding the HEPM (Fredriksen-Goldsen et al. Reference Fredriksen-Goldsen, Simoni, Kim, Lehavot, Walters, Yang, Hoy-Ellis and Muraco2014) to more explicitly account for digital and technological contexts. While the HEPM was originally developed in the United States, applying it to the Canadian context demonstrates its relevance across countries and highlights the importance of situating health equity frameworks within evolving socio-cultural and technological conditions. By conceptualizing technology as a structural and environmental determinant of health, this article shows how digital platforms and online interactions affect visibility, social connection, resilience and risk among ageing queer and trans populations.
For international studies conducted in the gerontology of 2SLGBTQ+ ageing and health promotion, these findings suggest that research should move beyond individual-level health experiences and attend to the historical, socio-cultural and technological contexts that structure and influence health in later life. As digital platforms continue to evolve – and as artificial intelligence becomes more common in interventions for healthy ageing (Lopez-Barreiro et al. Reference Lopez-Barreiro, Garcia-Soidan, Alvarez-Sabucedo and Santos-Gago2024; McDaniel et al. Reference McDaniel, Essien, Lefcourt, Zelleke, Sinha, Chellappa and Abadir2025) – scholars, practitioners and policy makers should consider how technology intersects with health promotion among seniors living in diverse national contexts. Integrating digital determinants into gerontological scholarship can strengthen international efforts to promote health equity, accessibility and community among ageing 2SLGBTQ+ populations.
These findings have implications for health care service providers, health promoters, policy makers and community organizations whose work touches the lives of ageing 2SLGBTQ+ populations. Policy and programming that recognize technology as embedded within broader systems of inequality can help reduce digital divides, advance health equity and foster valuable social engagement – provided that systemic barriers are meaningfully addressed. Overall, this article contributes to international scholarship in gerontology and health promotion by demonstrating that 2SLGBTQ+ ageing is shaped not only by socio-cultural and historical conditions but also by digital technologies through which community, health, agency and resilience are negotiated and experienced in later life.
Acknowledgements
The authors would like to thank the mid-life and older 2SLGBTQ+ adults who participated in this research, as well as the 2SLGBTQ+ community organizations who supported this project.
Author contributions
Project conceptualization: Christopher Dietzel and Matthew Numer. Data collection: Christopher Dietzel. Data analysis: Christopher Dietzel, Beatrice Devlin, Samantha McCready, Laura Colford and Brittany O’Shea. Initial paper writing: Christopher Dietzel, Beatrice Devlin, Samantha McCready, Laura Colford and Brittany O’Shea. Paper refinement, synthesis and revisions: led by Christopher Dietzel, with support from all co-authors.
Financial support
This research was supported by funding from the Social Sciences and Humanities Research Council of Canada (SSHRC), Insight Develop Grant Award #184600.
Competing interests
The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Ethical standards
This research project received ethics approval from the Social Sciences and Humanities Research Ethics Board at Dalhousie University (REB #2023-6758).
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