The impact of digital competence on telehealth utilization

Abstract

ObjectivesTelehealth use has increased steadily since the mid-2000′s when technology shifted from voice-only systems to live video-conferencing and other technologies supported by broadband Internet. More recently, the COVID-19 pandemic has resulted in exponential growth in telehealth use. As telehealth systems become increasingly complex and gain widespread adoption, this study explores how users’ digital competences affect telehealth use. MethodsWe apply a series of multivariate logit models to a representative sample of California adults with Internet access surveyed in early 2021. We estimate the impact of self-reported digital competence–using items from the digital skills assessment scale–on a participant's likelihood of telehealth use during the COVID-19 pandemic as well as the likelihood to continue using telehealth beyond the pandemic. ResultsThe findings show that a one-unit increase in digital competence is associated with 72.8% greater odds of telehealth use (p <0.001) and 71.6% greater odds of willingness to continue using telehealth services beyond the pandemic (p<.01). We also found that greater social and economic capital generally were associated with increased odds of telehealth use. ConclusionsImproving access to telehealth will require solutions addressing both the first level (i.e., access to broadband and devices) and the second level (i.e., skills and attitudes towards the internet) of digital inequality. Policies and programs seeking to expand internet access must be coupled with investments in digital upskilling and training. Those with limited digital competence will face continued barriers in navigating telehealth systems, further exacerbating disparities in healthcare access and outcomes. Public Interest SummaryDigital competence is the ability and confidence to apply one's knowledge and skills to perform tasks through information technology, including computing devices and the internet. This study explores the relationship between digital competence and telehealth use among those with broadband internet access at home. Telehealth has become increasingly common due to its cost-effectiveness and accessibility for patients unable to visit healthcare facilities. Though the COVID-19 pandemic has contributed to a significant increase in telehealth use, it is expected that telehealth services will continue to expand after the pandemic subsides. In our analysis of California adults, a year into the pandemic, we find those with greater digital competence are more likely to have used telehealth during the pandemic. Further, among telehealth users, those with greater digital competence are more likely to continue using telehealth beyond the pandemic. Addressing disparities in healthcare access and outcomes will require improving potential users’ digital competence.