Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study

Abstract

Background The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+ years) were 1 of the highest user groups of in-person health care services prior to the pandemic. Social distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those at high risk of contracting the COVID-19 coronavirus, including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for and use of virtual care technologies among older adults. Objective The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visits during the COVID-19 pandemic among older adults in Canada. Methods A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16 years, selected from Leger’s Léger Opinion panel from July 14 to August 6, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using χ2 tests and logistic regression models for telephone visits, video visits, and secure messaging. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. Results A total of 2303 older adults were surveyed. Older adults expressed the highest demand for and use of telephone visits, following by video visits and secure messaging. eHealth literacy was positively associated with the use of all 3 virtual care modalities. Higher income was negatively associated with the use of video visits (odds ratio [OR] 0.65, 95% CI 0.428-0.974, P=.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, 95% CI 0.539-0.983, P=.04), but living in a rural community (OR 0.172, 95% CI 1.12-2.645, P=.01) and being born outside of Canada (OR 0.150, 95% CI 1.041-2.173, P=.03) were positively associated with the use of secure messaging. Higher education (OR 0.078, 95% CI 0.633-0.97, P=.02) and being non-White (OR=0.054, 95% CI 0.312-0.92, P=.02) were negatively associated with the use of the telephone. Conclusions This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies.

Desperately Seeking Intersectionality in Digital Health Disparity Research: Narrative Review to Inform a Richer Theorization of Multiple Disadvantage

“…Similarly, a mixed methods study based in the United Kingdom by Fu et al [ 5 ] found that there was a reduction in video consultations in older users, undocumented migrants, and individuals with poor health, which could mean that those in the greatest need were being excluded, perhaps because of the digital divide evidenced in some groups of migrants before the pandemic. Yu and Hagens [ 58 ] echoed similar findings in older adults in Canada, with results highlighting socioeconomic disparities among older adults that could potentially explain this trend, including lower income and education levels that may act as barriers for older adults to acquiring the skills and technologies necessary to use more complex solutions such as video. As Fu et al [ 5 ] stated, “those in the greatest need of health care appeared to be less able to access remote services.”…”

“…The second finding is that, despite the limitations of the literature, substantial digital disparities were reported [ 5 , 22 , 50 - 53 , 56 , 57 , 59 ]. Low household income, older age, and ethnic minority background (especially limited-English speakers) were all independently associated with lower uptake of video consultations [ 5 , 50 , 52 , 53 , 58 , 60 , 61 ]. Proposed explanations include lack of digital devices and infrastructure, low health and digital literacy, and inability to understand written resource materials [ 11 , 65 , 66 , 68 ].…”

“…The 17 peer-reviewed research papers (summarized in Table 1) comprised 1 (6%) systematic review [48], 1 (6%) narrative synthesis [49], 7 (41%) retrospective audits of medical records [56,57,[59][60][61][62]70], 3 (18%) quantitative surveys [5,50,58], and 5 (29%) qualitative studies based on semistructured interviews [5,51,52,54,55]. A further 37% (10/27) of the articles (Table 2) commented on others' research, reflected on findings from clinical practice, or proposed measures to reduce digital health disparities [11,21,22,[63][64][65][66][67][68][69].…”

Acceptance of Social Networking Sites by Older People before and after COVID-19 Confinement: A Repeated Cross-Sectional Study in Chile, Using the Theory of Planned Behaviour (TPB)

“…Due to the above, we found a modification in the strength of the variables that determine the intention to use social networks. Investigations in other countries coincide in reporting that the epidemic forced the elderly population to use more information technologies, including those related to health care services and applications for physical training and messaging [ 29 , 30 ]. Other researchers agree that older adults embraced digital technology and had sufficient knowledge and support, but felt apprehensive and faced financial barriers to technology adoption [ 31 ].…”

“…In addition to socioeconomic barriers, other variables that influenced the use of these technologies in older people during confinement were access to the Internet and previous use of video calls [ 29 ], level of education, digital literacy, and attitudes toward oneself aging [ 30 , 32 , 33 ]. According to international research, the benefits obtained were related to improvements in mental health, decreased loneliness, strengthening of physical capacity, mood, and memory enhancements [ 34 , 35 ].…”