JMIR Publications

ABSTRACT

Background:

Given the uncertain future of reimbursement for audio-only telehealth, it is important to investigate the disparities between audio-only and video telehealth usage. Video-enabled telehealth visits require patients to have the capability needed to operate video technology. The intersection of digital and health literacy, or eHealth literacy (eHL), may be particularly relevant in understanding the disparities within telehealth use. To date, no one has explored the role of eHL in the disparity between audio-only and video telehealth usage.

Objective:

This study examines video capability and telehealth usage in a hospitalized, urban population, stratified by eHL.

Methods:

The study design is a cross-sectional observational study of adult inpatients at the University of Chicago Medical Center. We assessed rates of video-enabled telehealth usage and willingness to utilize telehealth. We used a multivariable logistic regression to determine the odds ratio for being unwilling to use video telehealth, adjusted for age, sex, race/ethnicity, educational level, eHL (eHEALS Literacy Scale), health literacy (Brief Health Literacy Screen), technology access, internet access, and technology capability.

Results:

Of 297 enrolled participants, median age was 58 years, most (62%) identified as Black, half (50%) were female, one-quarter (22%) lacked home internet access, and one-third (34%) had inadequate eHL. Participants with low versus adequate eHL were less likely to report using video telehealth appointments during the pandemic (34% vs. 61%; p = .007). Participants with low eHL also needed more help with using video technology (52% vs. 6%; p < .001). In contrast to video visits, phone visits during the pandemic did not differ significantly between sub-populations. Unwillingness to use video visits was more likely among participants who had low eHL (p = .003), were older (p = .03), needed help using video (p = .04), and lacked home internet access (p = .03).

Conclusions:

Low eHL is associated with lower rates of video telehealth usage and lower willingness to use video technology. Furthermore, patients with inadequate eHL reported significant preferences for audio-only over video technology, the latter of which is needed to perform visual assessment through telehealth. The study results raise the question of how to improve video capability among patients who, despite having access to smart phones and laptops, face challenges in using telehealth optimally. Clinical Trial: This study does not meet the qualifications to be registered on ClinicalTrials.gov; thus, no trial registration is required.