JMIR Publications

ABSTRACT

Background:

Telehealth has become a routine component of US healthcare delivery, but equity research often focuses on use versus nonuse or video versus audio-only modalities. Less is known about heterogeneity among people who have already used telehealth, including how modality, motivations, and perceived care experience overlap

Objective:

This study aimed to identify probabilistic profiles of US telehealth users based on modality, motivations, and care experience. We further examined sociodemographic correlates of class membership and class-specific differences in digital access, health numeracy, health status, and healthcare utilization.

Methods:

We conducted a cross-sectional secondary analysis of HINTS-6, a nationally representative 2022 survey of US adults. Our analysis was restricted to adults reporting at least one telehealth visit in the previous 12 months (n=2517). To identify distinct subgroups of telehealth users, we performed survey weighted latent class analysis (LCA) on nine binary indicators of modality, motivation, and experience with complex survey design adjustment. Sociodemographic correlates were examined using the bias-adjusted three-step regression (R3STEP; n=2256). We examined distal outcomes using the Bolck-Croon-Hagenaars (BCH) procedure in unadjusted analyses accounting for classification uncertainty.

Results:

We identified four latent class profiles: Convenience-oriented (44%), Broadly motivated (27%), Barrier-concerned (17%), and Provider-directed (12%). The Barrier-concerned profile had the highest probabilities of technical difficulties (0.41) and privacy concerns (0.56), and the lowest probability of perceiving telehealth care as equivalent to in-person care (0.42). In R3STEP analyses, Asian/other respondents had higher odds of Barrier-concerned membership (OR 4.60, 95% CI 1.50-14.12; P=.008) and Broadly motivated membership (3.94, 1.24-12.52; P=.02) compared with Convenience-oriented membership (reference). Female respondents had lower odds of Provider-directed membership (0.42, 0.19-0.93; P=.03), higher education was associated with lower odds of Broadly motivated membership (0.56, 0.33-0.97; P=.04) and disabled/other employment status was associated with Provider-directed membership (7.32, 1.42-37.71; P=.02). BCH analyses showed significant differences between latent classes in internet use, device access, health numeracy, online health information seeking, self-rated health, insurance coverage, and in-person visit frequency (all P<.05). The Barrier-concerned profile had lower internet use than all other profiles, more limited device access than the Convenience-oriented and Broadly motivated profiles, and greater health numeracy difficulty than the Convenience-oriented profile.

Conclusions:

Telehealth users are heterogeneous in modality, motivations, and care experience. Digital inequity was observed within the telehealth-user population, particularly for the Barrier-concerned profile. Equity-focused strategies may need to look beyond adoption alone and address technical support, privacy communication, device access, health numeracy, perceived care quality, and modality flexibility.