Irene Loureiro-Álvarez

Contemporary welfare states face an unresolved challenge regarding the social organisation of care, particularly in Mediterranean societies such as Spain. This study aims to analyse the distribution of informal care in Spain from a gender and age perspective. A quantitative approach is adopted, based on the analysis of secondary data from Study No. 3506 of the Centre for Sociological Research (CIS) on living conditions, work, family and gender in Spain. Using descriptive and inferential analyses (Student’s t-test, ANOVA and Chi-square), the study examines the time devoted to informal care, the distribution of household activities within cohabiting couples, and the repercussions on work performance. The results reveal the persistence of statistically significant gender inequalities. Women devote more hours per week to both domestic tasks and caring for family members. Furthermore, tasks such as cleaning, laundry and meal preparation remain highly feminised. Although there are signs of a more balanced distribution of certain activities among younger generations, gender gaps persist structurally. The mass entry of women into the labour market has not been accompanied by an equivalent redistribution of care responsibilities. In this context, there is a growing need to rethink the model of caregiving between the family, the market and the state, incorporating a perspective aimed at reducing social and gender inequalities.

Background/Objectives: The advent of the pandemic catalysed the global adoption of digital health services. In Spain, this transition has markedly influenced eHealth accessibility, particularly through mobile-based technologies. This study compares reported real-access experiences of users of digital health at two key moments—2018 (pre-pandemic) and 2025 (post-pandemic)—to identify how access determinants have evolved. Methods: The evolution of users who have accessed digital health resources and their characterization, including the specification of who uses websites and mobile applications, was analyzed using binary logistic regression models for each year. These models incorporated sociodemographic characteristics and patterns of device usage as predictors. Results: Access to digital health services increased significantly between 2018 and 2025. The proportion of the population using such services increased from 50.2% to 85.4%. The use of mobile applications grew from 24.4% to 80.2%. In 2018, access was linked to a wider range of factors, including age, education, municipality size, self-rated health, and computer or tablet use. In contrast, the 2025 model revealed a more concentrated set of determinants. Age emerged as the primary barrier, especially >65 years, reducing the likelihood of eHealth access. Meanwhile, frequent use of digital devices (e.g., computers, smartwatches) was positively correlated with accessing eHealth. Conclusions: The study reveals an increase in access to digital health services in Spain, accompanied by shifts in the factors influencing this access. Notwithstanding technological advances, the digital divide could persist as a major impediment to access for the groups mentioned earlier. This analysis suggests the need for targeted digital inclusion measures, especially as mobile platforms are becoming the main entry point to healthcare services.

Objective: This study analyses access to and use of eHealth services in Spain from a multidimensional perspective, considering how sociodemographic factors such as age, gender, educational level, income, nationality and place of residence influence digital divide in health. The digitalisation of public services has generated new opportunities, but it has also accentuated structural inequalities in access to key eHealth tools. Specifically, this study focuses on three components: the Digital Health Record (DHR), electronic prescriptions and digital certificate. Methods: This research is based on a quantitative approach, using data from the three waves of the Health Barometer 2024 of the Centro de Investigaciones Sociológicas—CIS—with a total sample of 7.623 cases. Binary logistic regression models were applied to identify which variables predict the accessibility and usability of these services. Results: The results show that variables such as age, gender, educational level, income, employment status, nationality, place of residence and health status have a significant impact on the probability of using eHealth tools. Especially older people, people with less education or low economic resources present greater barriers, which would evidence a structural and multidimensional digital divide. Conclusion: This study suggests that the digitalisation of the healthcare system may reinforce existing inequalities. Particularly those associated with the factors that showed the greatest influence on access to and use of digital health services in the analysis, such as age, income and educational level. These findings highlight the need for inclusive digital health policies that address the multidimensional nature of digital divide.

The Delphi method is widely employed in social and health research to explore complex problems, structure expert knowledge, and support collective processes of knowledge development. However, its qualitative and mixed-method applications sometimes display methodological ambiguity and limited standardization. In particular, the early stages of open-ended question design and narrative data analysis remain insufficiently defined, hindering comparability, transparency, and theoretical depth. This article proposes a systematic methodological framework for the design, analysis, validation and reporting of qualitative and mixed Delphi. Its aim is to contribute to the methodological development of these approaches by synthesizing existing debates and operationalizing procedures for transforming expert narratives into analytically grounded categories through iterative feedback and validation processes. Drawing on selected principles from Grounded Theory, the proposed approach emphasizes the systematic exploration and refinement of meanings, interpretations and expert perspectives. The framework is illustrated through a Delphi study on eHealth conducted in Spain. The case demonstrates how reflexive question formulation, transparent feedback mechanisms, and explicit validation criteria can support the Delphi as a robust strategy for the collective generation of situated, theoretically grounded knowledge. Ultimately, the qualitative Delphi emerges as a deliberative and structured methodology, capable of bridging empirical complexity and theoretical construction while providing a rigorous foundation for evidence-informed public policy. In conclusion, this study presents a methodological framework that highlights the independence and usefulness of the technique in exploratory or emerging contexts.

Resumen La digitalización sanitaria ha transformado la relación entre la ciudadanía y los servicios de salud, generando nuevas oportunidades de acceso, pero también el riesgo de reproducir desigualdades derivadas de la brecha digital. Este estudio analiza cómo distintos factores sociodemográficos influyen en la exclusión digital en el ámbito sanitario español. Para ello, se emplean los datos de los Barómetros Sanitarios de 2024 del Centro de Investigaciones Sociológicas (CIS). En primer lugar, se elabora un perfil descriptivo del uso y conocimiento de la eSalud según variables sociodemográficas. Posteriormente, mediante los estadísticos Chi-cuadrado y V de Cramer, se analizan las relaciones de asociación y su intensidad. Los resultados muestran que la digitalización del sistema sanitario excluye especialmente a las personas mayores y con bajo nivel educativo. Además, otras variables que acentúan la desigualdad son el bajo nivel de ingresos, el trabajo doméstico no remunerado y la autopercepción negativa sobre el estado de salud.