JMIR Publications

ABSTRACT

Socially vulnerable populations have less access to quality gastrointestinal (GI) care. Digital telehealth services provided by GI-focused Registered Dietitian Nutritionists (RDNs) and Digestive Health Coaches (HCs) may improve digestive health outcomes by facilitating access to GI care and thereby reducing healthcare disparities among vulnerable populations. The objectives of this study were to 1) evaluate the impact of a digital digestive health program on reducing GI symptoms among socially vulnerable populations and 2) assess whether telehealth visits with digital application (app)-usage provide additional benefits in symptom reduction compared to digital app-usage alone among socially vulnerable populations. A comprehensive digital digestive care program with optional telehealth visits with RDNs and HCs was provided to US employees of participating companies via their employee benefits. We enrolled participants in the program between 2022-2023, and they tracked symptoms at least twice within 30-90 days. We measured changes in GI symptoms from baseline to up to 3 months, comparing those who opted for telehealth visits with those who used the app only. We stratified participants by the median Social Vulnerability Index (SVI) in our cohort to evaluate symptom improvement across socially vulnerable populations. Multivariable regressions adjusted for age, gender, race, BMI, and pre-existing GI conditions. 1656 participants met inclusion criteria, of which 1362 (82%) scheduled at least one telehealth visit and 18% used only app-based resources. The majority (86%) of participants saw GI symptom improvement, with an average reduction of 60% in symptom burden (p<0.001). Participants who used telehealth services and the app had a symptom reduction of 16% greater than that of app-only users (p=0.01). High SVI participants (>0.4, median), indicating greater social vulnerability, had a 22% greater reduction in a GI symptom severity score than app-only high SVI participants (p=0.04). Digital health solutions may be an important resource in advancing equitable access to quality GI care and addressing disparities among populations with high social vulnerability. Virtual telehealth visits with RDNs and HCs appear to be particularly beneficial in improving digestive symptoms in such populations.