Disparities in telehealth access, not willingness to use services, likely explain rural telehealth disparities

Abstract

Purpose Although telehealth access and utilization have increased during the pandemic, rural and low‐income disparities persist. We sought to assess whether access or willingness to use telehealth differed between rural and non‐rural and low‐income and non‐low‐income adults and measure the prevalence of perceived barriers. Methods We conducted a cross‐sectional study using COVID‐19's Unequal Racial Burden (CURB) online survey (December 17, 2020‐February 17, 2021), which included 2 nationally representative cohorts of rural and low‐income Black/African American, Latino, and White adults. Non‐rural and non‐low‐income participants from the main, nationally representative sample were matched for rural versus non‐rural and low‐income versus non‐low‐income comparisons. We measured perceived telehealth access, willingness to use telehealth, and perceived telehealth barriers. Findings Rural (38.6% vs 44.9%) and low‐income adults (42.0% vs 47.4%) were less likely to report telehealth access, compared to non‐rural and non‐low‐income counterparts. After adjustment, rural adults were still less likely to report telehealth access (adjusted prevalence ratio [aPR] = 0.89, 95% CI = 0.79‐0.99); no differences were seen between low‐income and non‐low‐income adults (aPR = 1.02, 95% CI = 0.88‐1.17). The majority of adults reported willingness to use telehealth (rural = 78.4%; low‐income = 79.0%), with no differences between rural and non‐rural (aPR = 0.99, 95% CI = 0.92‐1.08) or low‐income versus non‐low‐income (aPR = 1.01, 95% CI = 0.91‐1.13). No racial/ethnic differences were observed in willingness to use telehealth. The prevalence of perceived telehealth barriers was low, with the majority reporting no barriers (rural = 57.4%; low‐income = 56.9%). Conclusions Lack of access (and awareness of access) is likely a primary driver of disparities in rural telehealth use. Race/ethnicity was not associated with telehealth willingness, suggesting that equal utilization is possible once granted access.

Family engagement in a behavioral parenting intervention: A randomized comparison of telehealth versus office-based treatment formats.

“…While telehealth also holds promise for reducing logistical barriers specific to economically disadvantaged families, the present study did not actually show benefit of telehealth over office-based care for such individuals. This is consistent with research on telehealth indicating no difference in telehealth preference based on income (Ko et al, 2023). On the other hand, higher INR was associated with higher satisfaction for families who received office-based care.…”

Equitable access to evidence-based treatment for eating disorders for patients with low-income: identifying barriers and exploring solutions

“…For patients who opt for telehealth, taking time to determine what kinds of technology (internet access and devices) are available in the home, available space to have the session, as well as comfort level in using online technologies is important. In the US, individuals from historically marginalized racial/ethnic groups and those with low income are less likely than their white and higher-income counterparts to have internet access (Ko et al, 2023). Prevalence of households with no internet may be as high as 21-29% for Black and Hispanic youth with low-income nationally (Dolcini et al, 2021).…”