Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 5, 2025
Open Peer Review Period: Aug 6, 2025 - Oct 1, 2025
Date Accepted: Jan 30, 2026
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited.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.
Determinants of Telehealth Use in the United States: A Decomposition Analysis of the HINTS 2022
ABSTRACT
Using 2022 Health Information National Trends Survey (HINTS; N=6,252) data, we estimated survey-weighted probability models of any phone or video visit in the prior year and apportioned the model's explanatory power with a Shorrocks-Shapley decomposition. Thirty-nine percent of adults used telehealth in~2022. Geography was the largest contributor to explained variation (20.1%): adults in the West North Central and East South Central divisions were significantly less likely to use telehealth than peers in the Northeast. Health literacy (14.3%) and health status/needs (11.3%) outranked traditional socioeconomic indicators (6.3%) and demographic traits (8.2%). Disability was strongly and negatively associated with use, suggesting design barriers. Telehealth uptake hinges more on where people live and their capacity to navigate digital care than on income or education alone. Policies that pair broadband investments with region-specific service integration and digital health literacy programs and that mandate platforms accessible to people with disabilities are needed to narrow the persistent digital divide in the U.S.
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.