1 Introduction

The Nordic eHealth Research Network (NeRN) was established on 15.02.2012 as a subgroup of the NCM and the eHealth group. NeRN comprises researchers from universities and health institutions in Denmark, Finland, Iceland, Norway, and Sweden.

NeRN's objective is to develop common Nordic indicators for eHealth functionalities and services, which can be utilized by national, Nordic, and international policymakers, decision-makers, scientific communities, associations, and interest groups. These indicators aim to support Nordic welfare systems and the ongoing development of sustainable digital healthcare systems. This report discloses citizens' experiences with digital healthcare.

The citizen survey presented in this report is the result of several years of research in the field. Over the past decade, NeRN researchers have conducted national surveys on citizens' use and experiences with digital healthcare services and eHealth in the Nordic countries.

In Denmark, researchers from Aalborg University conducted biannual national citizen surveys from 2013 to 2021, involving more than 1.000 respondents each time. The questionnaire used in these surveys comprised 34 questions related to citizens' experiences and attitudes toward health information technology [1,2].

Sweden conducted citizen surveys in 2019 and 2021 regarding citizens' use of eHealth. These surveys, developed by researchers from Karolinska Institutet and Linköping University, involved approximately 5.000 respondents and were distributed by the Swedish eHealth Agency [3-6].

In Finland, three surveys were conducted in 2014, 2017, and 2020 as part of the "Monitoring and Assessment of Social Welfare and Health Care Information System Services" project. The questionnaires, examining citizens' use of welfare, digitalization, and healthcare e-services, involved 4.000 to 6.000 citizens over the years [7-12].

In Norway, an annual citizen survey on the use, attitudes, and satisfaction towards digital health services, has been conducted since 2019. The questionnaire was developed in collaboration with NeRN and other stakeholders and involved approximately 1.500 respondents each year [13].

Hence, NeRN has formerly engaged in research activities based on citizen surveys. However, the unique aspect of the study outlined in this report is that it is the first time the same citizen survey regarding digital healthcare services has been conducted simultaneously across the five Nordic countries.

This study specifically examines citizens' access, use, and attitudes toward digital healthcare and personal health data across Sweden, Norway, Denmark, Finland, and Iceland. It adopts a cross-sectional study design to provide policymakers and decision-makers with quantitative data for evidence-informed policies in digital healthcare. Hence, the study's results allow for comparisons among the Nordic countries, facilitating targeted policies and interventions. Various stakeholders, including patient associations, professional associations, interest groups, healthcare professionals, and citizens, can utilize these research-based insights.

The survey and subsequent analysis were funded by the NCM. Since the study's findings are relevant to organizations developing healthcare systems and data exchange, the publication fee was covered by the NCM project, "World's Smoothest Cross-Border Mobility and Daily Life through Digitalization - Promoting Cross-Border Data Exchanges between Authorities." This collaboration aims to reach target audiences and explore opportunities for enhanced cross-border data exchange in the digital healthcare sector. Consequently, the citizen survey results, representing citizens' voices, can inform and support the work of developers and authority organizations in the field of digital health.

This study examines citizens' access, use of digital healthcare services and data, and their attitudes towards sharing health data and the digitalization of healthcare. It aligns with the strategies and visions formulated by the NCM, which include a focus on creating more sustainable welfare states, improving the health and well-being of Nordic citizens, ensuring the inclusion of vulnerable groups, and promoting preventive healthcare interventions to address lifestyle diseases. The survey results can serve as potential indicators to address these Nordic challenges. Specifically, the study provides decision-makers, researchers, and other stakeholders with an improved understanding of citizens' access to digital healthcare, their use of health data, and their attitudes toward the digitalization of Nordic healthcare systems.