Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Oct 3, 2023
Date Accepted: Oct 9, 2024
Warning: This is an author submission that is not peer-reviewed or edited.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.
Digital divide during COVID: Who had ever used telehealth by late 2020? A cross-sectional study of Nebraska adults
ABSTRACT
Background:
Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients' access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address healthcare access barriers and enhance health outcomes, there are still disparities in accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated.
Objective:
To identify factors associated with ever use of telehealth in Nebraska.
Methods:
In October 2020, a stratified random sample of Nebraska households (n=5,300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English, Spanish) with online response options about social determinants of health and healthcare access. Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes/no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence ratios (PR) with 95% confidence intervals (CI) of telehealth use after controlling for socioeconomic, demographic, and health conditions.
Results:
The overall response rate was 20.8% (n=1,101). An estimated 25.5% of Nebraska adults had ever used telehealth, and 97% had internet access. In univariate models, internet access, age, sex, ethnicity, education, and no chronic health condition were significant. When adjusted, education was not significant but internet access (PR 5.36; 1.60-17.88), age <45 (PR 4.60; 1.90-11.16) and age 45-64 (PR 7.78; 2.01-30.10), female (PR 1.55; 1.04-2.31), non-Hispanic (PR 6.96; 2.31-20.95), and no chronic condition (PR 1.97; 1.25-3.10) were significantly associated with having ever used telehealth.
Conclusions:
This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of digital divide in telehealth access and use. Older adults, people with chronic health condition, and Hispanic individuals were significantly less likely to use telehealth. Targeted interventions that address barriers to telehealth use and improve healthcare access are warranted. Clinical Trial: not applicable
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