JMIR Publications

ABSTRACT

Background:

During the COVID-19 outbreak, video appointments became a popular method for healthcare delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (f2f) appointments to prevent the spread of the virus, some patients continued seeing their healthcare providers in person. As social distancing measures were relaxed in the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, there remained a subset of patients who continued to avoid video appointments. It is not yet clear what socio-demographic factors may be associated with this group of patients.

Objective:

This cross-sectional study aimed to examine demographic and social determinants of health (SDoH) factors associated with persistent non-users of video appointments among a sample of patients within a multistate healthcare organization. We also explored patient beliefs about the use of video for healthcare appointments.

Methods:

We conducted a one-time cross-sectional paper survey, mailed between July-December 2022, of patients with the study eligibility of (1) aged ≥18 years as of April 2020, (2) Mayo Clinic Midwest, Florida or Arizona patient, (3) did not utilize video appointment services during the time April-December 2020 but attended f2f appointments in the Departments of Primary Care and Psychiatry/Psychology. The survey asked patients, “Have you ever had a video appointment with a healthcare provider?” “Yes” were defined as “ever-users” (adapted to video appointments), and "No" were defined as “persistent non-users” of video appointments. We analyzed demographics, SDoH, and patient beliefs towards video appointments in two groups: persistent non-user of video appointments and ever-users groups. We used Chi-Square and t-tests for analysis.

Results:

Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent non-users of video appointments. Only one SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent non-use of video appointments. Persistent non-users of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting non-verbal cues, and personal preference for f2f appointments over video.

Conclusions:

Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients' decisions to choose between video vs. f2f appointments for healthcare delivery. Healthcare institutions should assess patients' negative attitudes toward technology prior to introducing them to digital healthcare services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a "digital health coordinator" could be assigned to assist with various digital health solutions.