JMIR Publications

ABSTRACT

Background:

The recent shift to virtual care has exacerbated disparities in healthcare access especially among High-Need High-Risk (HNHR) adults. Developing data-driven approaches to achieve appropriate virtual care scale-up necessitate a deeper understanding of HNHR adults’ attitudes toward video-visits and access to technology.

Objective:

This study aimed to identify the willingness, access, and ability of HNHR Veterans to use video-visits for healthcare.

Methods:

We designed a questionnaire that was conducted via mail or in-person. Among HNHR Veterans identified using predictive modeling with national Veterans Affairs (VA) data, we assessed willingness to use video-visits for healthcare, access to necessary equipment, and comfort with using technology. We evaluated physical health including frailty status, physical function, performance of Activities of Daily Living (ADL’s) and Instrumental Activities of Daily Living (IADL’s); mental health; and social needs including area deprivation index, transportation, social support and social isolation.

Results:

Average age of the 602 HNHR Veterans respondents was 70.6±9.2 (39-100); 367 (61.0%) White, 217 (36.0%) Black/African American; 104 (17.3%) Hispanic/Latino; 188 (31.2%) held at least an associate degree and 290 (48.2%) were confident filling medical forms. Of the 602, 327 (54.3%) reported willingness for video-visits with the VA, while 275 (45.7%) were unwilling. Willing Veterans were younger (P<0.001), more likely to have an associate degree (P=0.002), be health literate (P<0.001), live in better neighborhoods (P<0.048), be independent in IADLs (P=0.02), and in better physical health (P=0.04) than unwilling. A higher number of those willing were able to use the Internet and email, and were enrolled in the VA’s patient portal, My HealtheVet (p<0.001). Of the willing Veterans, 248 (75.8%) had a video-capable device. Those with video-capable technology were younger (P=0.004), had higher health literacy (P=0.01), less likely to be African American (P=0.007), more independent in their ADLs (P=0.005) and IADLs (P=0.04), less likely to have transportation issues (P<0.001), more likely to live in better neighborhoods (P<0.049), more adept at using the Internet and more likely to use email, than those without the needed technology (P<0.001).

Conclusions:

Only about half of our HNHR respondents were willing for video-visits, and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, Black/African American Veterans, those in worse physical health, and those living in worse neighborhoods. Our study highlights that HNHR Veterans have complex needs, which risk being exacerbated by the digital divide. Our findings underscore, yet again, that while technology holds vast potential to improve healthcare access, those most in need are also those least likely to engage with, or have access to, technology. Therefore, targeted interventions are needed to address this digital divide, especially among HNHR adults. Clinical Trial: NCT04846049