JMIR Publications

ABSTRACT

Background:

The COVID-19 pandemic increased use of digital health tools. Studies have shown that older individuals, racial/ethnic minorities, or populations with lower educational attainment or income have lower rates of accessing digital health compared to more advantaged populations. Patient advocates have expressed concerns that the recent growth of digital health tools may increase access barriers in these populations.

Objective:

This study evaluated how use of digital tools for healthcare changed after the pandemic, particularly in older adults, populations of color, and individuals with lower educational attainment or income.

Methods:

Using 2019 and 2020 Health Information National Trends Survey (HINTS) data, we examined internet use and seven digital health outcomes (electronic communication with provider, electronic appointment scheduling, electronic test result viewing, patient portal access, portal use to download health records, portal use for patient-provider communication, and portal use to view test results). Using weighted logistic regression, we investigated the impact of the pandemic after adjusting for sociodemographic traits (age, race/ethnicity, income, education, gender), digital access (internet use, smartphone/tablet ownership), and health-related factors (insurance coverage, caregiver status, having a regular provider, chronic diseases).

Results:

A total of 9,303 survey respondents were included in the analysis, of which 6,875 were in the pre-pandemic group and 2,428 were in the post-pandemic group. The impact of the pandemic on several outcomes varied across age, income, and race/ethnicity. Older individuals had growth in odds of internet use post-pandemic, but the youngest age group (18-34 years old) had a decrease in odds of internet use. Meanwhile, the lowest income group (<$20k), had decrease in odds of internet use which was significantly different from the growth in the odds of using the Internet among highest income group (>$75k). In contrast, the two lower income groups had increased odds of using electronic communication with a provider, while the remaining income groups had relatively stable odds of using electronic communication with a provider post-pandemic. Lastly, Asian respondents had an increased odds of using patient portal messaging post-pandemic while the remaining race/ethnicity groups had relatively stable usage of patient portal messages post-pandemic

Conclusions:

This analysis of HINTS collected from the 2019 and 2020 shows promising results for closing the disparities in internet usage for older adults 50 – 64 and seniors 75+ as well as electronic communication with physicians for individuals with low income. However, barriers exist even when respondents could complete certain technical tasks. Our results showed that the relative increase in internet use for seniors did not translate to increased use of digital tools to complete healthcare tasks. Healthcare systems must note that equitable and accessible implementation of digital health tools requires close attention to the specific skills needed for successful use.