Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 10, 2019
Date Accepted: Jan 28, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Use of Technology for Communicating with Clinicians or Seeking Health Information in a Multilingual Urban Cohort: Findings from a Cross-Sectional Survey
ABSTRACT
Background:
Technology is being increasingly used to communicate health information, but there is limited knowledge on whether these strategies are effective for vulnerable populations, including non-English speaking or low-income individuals.
Objective:
To assess how language preference (English, Spanish, or Chinese), smartphone ownership, and type of clinic for usual source of care (no usual source of care, non-integrated safety net, integrated safety net, private/community clinic, academic tertiary medical center, integrated payer-provider) affect technology use for health-related communication.
Methods:
From May to September 2017, we administered a non-random, targeted survey to 1027 English, Spanish, and Chinese-speaking San Francisco residents and used weighted multivariable logistic regression analyses to assess predictors of five technology use outcomes. The three primary predictors of interest (language preference, smartphone ownership, and type of clinic for usual care) were adjusted for age, gender, race/ethnicity, limited English proficiency, educational attainment, health literacy, and health status. Three outcomes focused on respondents’ use of email, text message, or phone applications to communicate with clinicians. The two other outcomes were use of online educational health videos or online health support groups.
Results:
Nearly one-third of the surveyed population watched online health videos (367, 36%) or used email to communicate with their clinician (318, 31%). After adjusting for previously known predictors of technology use, individuals without smartphone owners had significantly lower odds of texting their clinician (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.13, 0.56), using online health support groups (OR: 0.14; 95% CI: 0.04, 0.55), or watching online health videos (OR: 0.31; 95% CI: 0.15, 0.64). Relative to English survey respondents, individuals that preferred Chinese had lower odds of texting their clinician (OR: 0.25; 95% CI: 0.08, 0.79) while Spanish-survey respondents had lower odds of using an app to communicate with clinicians (OR: 0.34; 95% CI: 0.16, 0.75) or joining an online support group (OR: 0.30; 0.10, 0.92). Respondents who received care from a clinic affiliated with the integrated safety-net, academic tertiary medical center, or integrated payer-provider systems had higher odds than individuals without a usual source of care at using email, text message, or apps to communicate with clinicians.
Conclusions:
In vulnerable populations, technology is frequently used for health purposes. Smartphone ownership is not sufficient to increase use of all forms of technology for communicating with clinicians. Language preference impacts use of technology for health purposes even after considering English proficiency. Health system factors impact patient’s use of mobile technology-enabled approaches for communicating with clinicians. No single factor was associated with higher odds of using technology for all health purposes. Healthcare systems that use technology to engage or educate their patients will need a multipronged approach to address the existing inequities in use of digital health among diverse, vulnerable populations.
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