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.

Keywords: COVID-19; low-income disparities; racial/ethnic disparities; rural disparities; telehealth.

Figure 1.

A) Rural vs. non-rural and B) low-income vs. non-low-income perceived access to telehealth services and willingness to use telehealth services, weighted to be nationally representative within racial/ethnic groups.

Figure 2.

Adjusted prevalence of perceived access to and willingness to use telehealth services among rural vs. non-rural, and low-income vs. non-low-income adults, weighted to be nationally representative within racial/ethnic groups. Bold text indicated statistically significant results (p<0.05).

Figure 3.

Prevalence of barriers to using telehealth services among rural and low-income adults, weighted to be nationally representative within racial/ethnic groups. 57.4% of rural adults and 56.9% of low-income adults reported having no barriers to telehealth use (data not shown).