JMIR Publications

ABSTRACT

Background:

Telehealth is becoming an increasingly important component of healthcare delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies such as smartphones and the internet.

Objective:

This study aimed to describe smartphone and internet use within a diverse, targeted sample; to assess the association between smartphone and internet use with several measures of health literacy and access to care; and to identify mediating factors in those relationships.

Methods:

Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April-December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with select outcomes for the total cohort and after stratifying the cohort by personal history of cancer.

Results:

Of the 2149 total participants, 61.4% were female, 30.5% were non-Hispanic White, and 31% were non-Hispanic Black. The median age was 51 (IQR, 38-65). The majority of respondents reported using the internet (89.4%) and owning a smartphone (83.8%). Respondents without smartphones or internet access were more likely to report that a doctor was their most recent source of health information (33.2% vs 19.1% and 35.1% vs 19.8%, respectively, both P < 0.001). Internet use was associated with having looked for information about health topics from any source (OR 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34). Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95). Respondents who use the internet had higher odds of a personal history of cancer (OR 1.91, 95% CI 1.21 – 3.01). Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of being confident in the ability to obtain needed health information (OR 5.63, 95% CI 1.05 – 30.23) and lower odds of being unable to obtain needed medical care (OR 0.17, 95% CI 0.06 – 0.47), while these associations were not significant among participants without a prior history of cancer.

Conclusions:

We found widespread use of digital technologies to access health information in a community cohort, though disparities persist. Non-smartphone and internet users represent a particularly vulnerable patient population already underserved within the healthcare community. Lack of smartphone ownership was significantly associated with needing medical care but not being able to get it, even when controlling for potential sociodemographic confounders. Major medical illnesses such as cancer have the potential to amplify health engagement and empowerment and may motivate greater digital access. Special emphasis must be placed on reaching patient populations with limited access to digital technology, so these patients are not left behind in the new age of telehealth. Clinical Trial: N/A