Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey

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Abstract

Certain sociodemographic factors are associated with low technology access and digital healthy literacy.

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Most cited references 6

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Technology Literacy as a Barrier to Telehealth During COVID-19

Austin J. Triana, Roman E. Gusdorf, Kaustav P. Shah … (2020)

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Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study

Cynthia Williams, Di Shang (2023)

Background Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. Objective This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. Methods A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. Results Among 2,850,831 unique patients, nearly 60% of them were female, 75% of them had a high school education or less, 49% of them were unemployed, and 62% of them identified as non-Hispanic White. Our results suggest that 9.84% of the patients had ≥1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15% (OR 1.148, 95% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12% (OR 0.875, 95% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5% (OR 0.953, 95% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor’s degree or higher. Patients in the 18-44–year age group were 32% (OR 1.324, 95% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ≥65-year age group. Conclusions Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally.

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Identifying and understanding the health and social care needs of Indigenous older adults with multiple chronic conditions and their caregivers: a scoping review

Sharlene Webkamigad, Robyn Rowe, Shanna Peltier … (2020)

Background Indigenous people continue to experience high rates of multiple chronic conditions (MCC) at younger ages than other populations, resulting in an increase in health and social care needs. Those who provide services designed to address MCC for Indigenous communities require synthesized information to develop interventions that meet the needs of their older adult population. This review seeks to answer the research question: What are the health and social care needs, priorities and preferences of Indigenous older adults (living outside of long-term care settings) with MCC and their caregivers? Methods A scoping review, guided by a refinement of the Arksey & O’Malley framework, was conducted. Articles were included if the authors reported on health and social care needs and priorities of older Indigenous adults. We also included articles that focused on Indigenous conceptions of wellness, resilience, well-being, and/or balance within the context of aging, and articles where authors drew from Indigenous specific worldviews, ways of knowing, cultural safety, cultural competence, cultural appropriateness, cultural relevance and community needs. Results This scoping review included 9 articles that were examined using an Indigenous determinants of health (IDH) theoretical framework to analyze the needs of older adults and CGs. Five areas of needs were identified: accessible health services; building community capacity; improved social support networks; preservation of cultural values in health care; and wellness-based approaches. Conclusion The review highlights key determinants of health that influenced older adults’ needs: education and literacy, ethnicity, and social support/network (proximal); health promotion and health care (intermediate); and a combination of historical and contemporary structures (distal). The findings highlight the importance of local Indigenous knowledge and perspectives to improve accessibility of culturally relevant health and social services.

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Author and article information

Contributors

Jennifer Huang:

ORCID: https://orcid.org/0000-0001-6191-7486

Dermatology SectionDivision of ImmunologyBoston Children's Hospital300 Longwood AvenueBoston, MA, 02115United States1 6173556117jennifer.huang@childrens.harvard.edu

Journal

Journal ID (nlm-ta): JMIR Dermatol

Journal ID (iso-abbrev): JMIR Dermatol

Journal ID (publisher-id): JDERM

Title: JMIR Dermatology

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2562-0959

Publication date Collection: 2024

Publication date (Electronic): 22 March 2024

Volume: 7

Electronic Location Identifier: e51511

Affiliations

[1 ] Dermatology Section Division of Immunology Boston Children's Hospital Boston, MA United States

[2 ] Harvard Medical School Boston, MA United States

[3 ] Biostatistics and Research Design Center ICCTR Boston Children's Hospital Boston, MA United States

[4 ] Department of Dermatology Harvard Medical School Boston, MA United States

Author notes

Corresponding Author: Jennifer Huang jennifer.huang@ 123456childrens.harvard.edu

Author information

Danny Linggonegoro https://orcid.org/0000-0001-7426-6205

Kathryn Williams https://orcid.org/0000-0002-4687-3961

Madeline Hlobik https://orcid.org/0009-0008-2302-348X

Jennifer Huang https://orcid.org/0000-0001-6191-7486

Article

Publisher ID: v7i1e51511

DOI: 10.2196/51511

PMC ID: 10998172

PubMed ID: 38517468

SO-VID: 62a3f648-904a-4915-b1ff-c8186ea73c19

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.

History

Date received : 3 August 2023

Date revision requested : 12 October 2023

Date revision received : 29 January 2024

Date accepted : 6 February 2024

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