HumanInsight The Impact of the COVID-19 Pandemic on Internet Use and Use of Digital Health Tools: A Secondary Analysis of the 2020 Health Information National Trends Survey
J Med Internet Res. 2022 Aug 26. doi: 10.2196/35828. Online ahead of print.
BACKGROUND: The COVID-19 pandemic increased use of digital tools in healthcare (e.g., patient portal, telemedicine, online scheduling). Studies have shown that older individuals, racial/ethnic minorities, or populations with lower educational attainment or income have lower rates of using many digital health tools. Patient advocates have expressed concerns that the increasing digitalization of healthcare may exacerbate access barriers in these populations.
OBJECTIVE: This study evaluated how use of the Internet or digital tools to asynchronously communicate with clinicians, schedule appointments, and/or view medical records changed near the beginning of the pandemic.
METHODS: Using 2020 Health Information National Trends Survey (HINTS) data, we examined internet use and seven digital health technology use outcomes (electronic communication with a provider, electronic appointment scheduling, electronic test result viewing, patient portal access, portal use to download health records, portal use for patient-provider communication, and portal use to view test results). The HINTS surveyors designated surveys received after 3/11/2020 as post-pandemic responses. Using weighted logistic regression, we investigated the impact of the pandemic after adjusting for sociodemographic traits (age, race/ethnicity, income, education, gender), digital access (ever used internet, smartphone/tablet ownership), and health-related factors (insurance coverage, caregiver status, having a regular provider, chronic diseases). To explore changes in differences in usage among key sociodemographic groups, we tested for significant interaction terms between the pandemic variable and race/ethnicity, age, income, and educational attainment.
RESULTS: There were 3,865 survey respondents (1,437 pre-pandemic; 2,428 post-pandemic). Of the eight outcomes investigated, the pandemic was only significantly associated with higher odds (aOR 1.99, 95% CI: 1.18-3.35) of using electronic communication with a provider. There was a significant interaction between the pandemic variable and key sociodemographic traits for two outcomes. Relative to the lowest income group (<$20k), the highest income group (>$75k) had increased growth in odds of ever having used the internet in post-pandemic responses. Compared to the most educated group (post-baccalaureates), groups with lower educational attainment (high school graduates and bachelor's) had lower growth in odds of using electronic communication with a provider post-pandemic. However, individuals with less than a high school degree had similar growth to the post-baccalaureate group in using electronic communication with a provider.
CONCLUSIONS: This analysis of HINTS collected from the 2020 did not show widespread increase of use of digital health tools or increase in disparities in using these tools among less advantaged populations in the early months after declaration of the public health emergency. While some advantaged populations reported a greater increase in adoption of some digital tools, there were also signs that some less advantaged populations also adapted to an increasingly digital healthcare ecosystem. Future studies are needed to see if these differences remain beyond the initial months of the pandemic.
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