JMIR Publications

ABSTRACT

Background:

Adoption of eHealth accelerated during the Coronavirus disease 2019 (COVID-19) pandemic. Inequalities in eHealth adoption during the COVID-19 pandemic have been reported, but there are few such studies among people with impairment.

Objective:

The aim of this study was to investigate use and difficulty in the use of eHealth before the COVID-19 pandemic compared to during late social distancing restrictions in Sweden, among people with and without impairment, as well as between different types of impairment.

Methods:

A cross-sectional survey was distributed twice by snowball-sampling to people with self-reported impairment and to a general population matched by age, gender and county. Use and difficulty in the use of six eHealth services were compared between groups using Chi2-test and logistic regression with year interaction terms, reported as odds ratio adjusted for gender and age (aOR) with 95% confidence interval (CI).

Results:

The surveys included 1,631 (in 2019) and 1,410 (in 2021) participants with impairment, and 1,084 (2019) and 1,223 (2021) without. Participants with impairment, compared to those without impairment, reported less use and more difficulty in booking healthcare appointments online, digital identification and the Swedish national web-portal for health information and eHealth services (1177.se), both before and during the pandemic (p=∙003 or lower). Video healthcare appointments was the exception to this disability digital divide in eHealth, as video appointment adoption had the highest odds ratio among participants with attention, executive and memory impairments (interaction term aOR 2·10, CI 1·30–3·39). Non-use and difficulty in the use of eHealth were consistently associated with language impairments and intellectual impairments (e.g. booking healthcare appointments online: use with language impairments aOR 0·64, CI 0·49–0·83 (in 2019) and aOR 0·70, CI 0·54–0·93 (in 2021); avoid use with language impairments aOR 1·64, CI 1·19–2·27 (in 2019) and aOR 1·31, CI 0·94–1·82 (in 2021); use with intellectual impairments aOR 0·28, CI 0·20–0·39 (in 2019) and aOR 0·25, CI 0·17–0·35 (in 2021); avoid use with intellectual impairments aOR 2·88, CI 1·86–4·45 (in 2019) and aOR 2·74, CI 1·74–4·33 (in 2021)).

Conclusions:

This repeated cross-sectional survey study, among participants with diverse types of impairment and a control group without impairment, reveal persistent disability digital divides, despite an accelerated adoption of eHealth across the pandemic. eHealth services were not accessible to all groups of people who were identified as being at risk of severe disease during the COVID-19 pandemic. Thus, people with impairment have been excluded from eHealth as measures of infection protection.