TY - JOUR AU - Smith, Lisa C AU - Johnson, George AU - Jadhav, Snehal AU - Kabayundo, Josiane AU - Ahuja, Muskan AU - Wang, Hongmei AU - Ratnapradipa, Kendra L PY - 2024 DA - 2024/11/28 TI - Ever Use of Telehealth in Nebraska by March 2021: Cross-Sectional Analysis JO - J Med Internet Res SP - e53320 VL - 26 KW - COVID-19 KW - digital divide KW - health care access KW - telehealth KW - cross-sectional study KW - Nevada KW - United States KW - adult KW - medical care KW - geographical area KW - disparity KW - accessibility KW - utilization KW - survey KW - chi-square test KW - regression model KW - socioeconomic KW - demographic KW - health condition KW - digital health AB - Background: Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients’ access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated. Objective: This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas. Methods: A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions. Results: The overall response rate was 20.8% (1101/5300). About 25.5% of Nebraska adults had ever used telehealth (urban 26.4%, rural 20.8%), despite 97% of respondents reporting internet access (98.3% urban, 90.5% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4%), female (30.7%), and non-Hispanic (25.9%); with at least a bachelor’s degree (32.6%); who had a routine checkup (30.2%) or health care visit other than a routine checkup (34.2%); and with any chronic health conditions (29.6%) but did not differ (P≥.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth. Conclusions: This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted. SN - 1438-8871 UR - https://www.jmir.org/2024/1/e53320 UR - https://doi.org/10.2196/53320 DO - 10.2196/53320 ID - info:doi/10.2196/53320 ER -