Digital health use growing in underserved counties

Though digital healthcare disparities persist, new research shows a promising increase in digital healthcare use among traditionally underserved participants.

Published in JAMA Network Open, the study aimed to assess the link between individual-level characteristics and digital healthcare use, and whether these associations differ by county-level social vulnerability. Researchers from the National Institutes of Health and Information Management Services conducted an online survey of US adults residing in 871 counties. These counties spanned the highest and lowest vulnerable quartiles of the Minority Health Social Vulnerability Index (MHSVI). The MHVSI is an index of county-level social vulnerability based on 34 indicators.

Of 5,444 survey participants, 53.77% were female, 14.66% were Black, 15.39% were Hispanic or Latino and 65.06% were White. About half of the survey participants (50.59%) used telehealth, which was defined as having an appointment with a clinician by video or phone; 29.56% used telemedicine, defined as receiving remote counseling or remotely supervised training or therapy from a clinician online or by telephone; and 15.69% used telemonitoring, defined as being remotely monitored by a clinician via a device.  

The study shows that telehealth, telemedicine and telemonitoring use was higher in the most vulnerable counties than in the least vulnerable counties.

However, individual-level characteristics also played a role in determining digital health use. For instance, educational attainment was associated with higher odds of digital healthcare use in the most socially vulnerable counties, whereas individuals self-identified as not heterosexual and those who self-reported fair or poor mental health had higher odds of digital health use in the least vulnerable counties. 

Additionally, identifying as Black or Hispanic was associated with higher odds of using telehealth, telemedicine and telemonitoring overall. However, these associations varied across MHVSI levels. For instance, the odds of telehealth use rose with being Hispanic in the most vulnerable counties, whereas self-identifying as Black was associated with higher odds of telehealth use in the least vulnerable counties.

The study also highlights digital health literacy as an important factor influencing digital health use. In general, individuals with higher scores on digital health literacy domains had increased odds of digital health use, even among those residing in the most vulnerable counties.

"While disparities in digital health care use were observed in association with traditional individual-level indicators of disadvantage, increased digital health care use among traditionally underserved participants found in this study is promising… Efforts are needed to ensure universal access to digital health care and to mitigate county-level vulnerability to future public health emergencies," the researchers concluded.

The study adds to our understanding of how demographic factors impact the use of digital healthcare. Another study, which focused on older adults' digital health use, also showed variations across demographic lines.

For the study, researchers assessed data from a survey conducted in August 2021 as part of the National Poll on Healthy Aging. Of the 2,110 survey respondents aged 50–80, 95.6% reported using a digital health tool.

However, younger, female and White respondents were more likely to report using a digital health tool compared to their peers.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.