Lucille Standaar ^1,2,3* Adriana Israel ⁴ Rosalie van der Vaart ⁵ Brigitta Keij ¹ Roland Friele ^2,3 Mariëlle Beenackers ⁴ Lilian van Tuyl ²

• ¹ Department of Population Health and Health Services Research, National Institute for Public Health and the Environment (Netherlands), Bilthoven, Utrecht, Netherlands
• ² Netherlands Institute for Health Services Research, Utrecht, Netherlands, Netherlands
• ³ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
• ⁴ Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
• ⁵ Centre of Expertise Health Innovation, The Hague University of Applied Sciences, The Hague, Netherlands

Introduction: The digitalization of healthcare poses a risk of exacerbating health inequalities. Dutch public libraries offer freely accessible e-health courses given by trainers. However, there is limited knowledge on whether these libraries successfully reach and support those in need. This study aimed to explore trainers' perspectives on the challenges, successes, and potential improvements in digital health skill education in a library setting. Materials and Methods: Trainers of the e-health course were interviewed. Topics included: the role of the library in digital health skills education, the successes and challenges in reaching groups with a low socioeconomic position, the perceived impact of the digital health skills education, and strategies for future improvements. A deductive analysis based upon the interview guide topics was performed. A second inductive analysis was applied to identify underlying patterns. Coding was done independently and cross-checked. Codebooks and themes were determined in discussion with authors. Results: Three themes emerged. 1) Trainers' services, skills and expertise: Trainers identified older adults, youth, people with low (digital) literacy, the unemployed, and people from non-native cultural backgrounds as the groups most in need of support. Trainers felt equipped to address these groups' needs. 2) The libraries' reach: improving engagement, perceived accessibility, and clients' barriers: Despite trainers' efforts to adjust the course to the target groups' level of commitment, (digital) literacy levels, and logistics, the digital health course predominantly engages older adults. Experienced barriers in reach: limited perceived accessibility of the public library and clients' personal barriers. 3) Collaborations with healthcare, welfare and community organizations: Trainers emphasized that collaborations could enhance the diversity and number of participants. Current partnerships provided: reach to target groups, teaching locations, and referral of clients. Discussion: Trainers in public libraries recognize diverse target groups that need support in digital health skill development. The study identified three challenges: accessibility of the digital health course, reach of the public library, and clients' personal barriers. Public libraries have potential to support their target groups but need strategies to improve engagement and reach. Collaborations with healthcare, welfare, and community organizations are essential to improve the reach of the e-health course.