The Impact of the COVID-19 Pandemic on Internet Use and the Use of Digital Health Tools: Secondary Analysis of the 2020 Health Information National Trends Survey

Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022

BACKGROUND

The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease's emergence.

OBJECTIVE

We aim to comprehensively assess telehealth use and its associated factors in the United States.

METHODS

This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (≥18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model.

RESULTS

Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers' recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ≥75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth.

CONCLUSIONS

To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research.

eHealth tools use and mental health: a cross-sectional network analysis in a representative sample

eHealth tools usage is vital for health care systems and increased significantly after the COVID-19 pandemic, which aggravated mental health issues. This cross-sectional study explored whether sociodemographic characteristics and mental health indices (stress and symptoms of anxiety and depression) were linked to the behavioral intention to use eHealth tools and eHealth tools usage in a representative sample from Poland using a network approach. Measurements were conducted in March 2023 among 1000 participants with a mean age of 42.98 (18-87) years, with 51.50% women. The measures included the behavioral intention to use eHealth tools (BI) based on the UTUAT2; eHealth tool use frequency (use behavior) including ePrescription, eSick leave, eReferral, electronic medical documentation (EMD), Internet Patient Account (IKP), telephone consultation, video consultation, mobile health applications, and private and public health care use; and the PSS-4, GAD-2, and PHQ-2. Furthermore, sociodemographic factors (sex, age, children, relationship status, education, and employment) were included in the research model. Network analysis revealed that mental health indices were weakly related to eHealth tools use. Higher stress was positively linked with mobile health application use but negatively linked to video consultation use. Use of various eHealth tools was intercorrelated. Sociodemographic factors were differentially related to the use of the eight specific eHealth tools. Although mental health indices did not have strong associations in the eHealth tools use network, attention should be given to anxiety levels as the factor with the high expected influence.

Healthcare Utilization Differences Among Primary Care Patients Using Telemedicine in the Veterans Health Administration: a Retrospective Cohort Study

BACKGROUND

The COVID-19 pandemic encouraged telemedicine expansion. Research regarding follow-up healthcare utilization and primary care (PC) telemedicine is lacking.

OBJECTIVE

To evaluate whether healthcare utilization differed across PC populations using telemedicine.

DESIGN

Retrospective observational cohort study using administrative data from veterans with minimally one PC visit before the COVID-19 pandemic (March 1, 2019-February 28, 2020) and after in-person restrictions were lifted (October 1, 2020-September 30, 2021).

PARTICIPANTS

All veterans receiving VHA PC services during study period.

MAIN MEASURES

Veterans' exposure to telemedicine was categorized as (1) in-person only, (2) telephone telemedicine (≥ 1 telephone visit with or without in-person visits), or (3) video telemedicine (≥ 1 video visit with or without telephone and/or in-person visits). Healthcare utilization 7 days after index PC visit were compared. Generalized estimating equations estimated odds ratios for telephone or video telemedicine versus in-person only use adjusted for patient characteristics (e.g., age, gender, race, residential rurality, ethnicity), area deprivation index, comorbidity risk, and intermediate PC visits within the follow-up window.

KEY RESULTS

Over the 2-year study, 3.4 million veterans had 12.9 million PC visits, where 1.7 million (50.7%), 1.0 million (30.3%), and 649,936 (19.0%) veterans were categorized as in-person only, telephone telemedicine, or video telemedicine. Compared to in-person only users, video telemedicine users experienced higher rates per 1000 patients of emergent care (15.1 vs 11.2; p < 0.001) and inpatient admissions (4.2 vs 3.3; p < 0.001). In adjusted analyses, video versus in-person only users experienced greater odds of emergent care (OR [95% CI]:1.18 [1.16, 1.19]) inpatient (OR [95% CI]: 1.29 [1.25, 1.32]), and ambulatory care sensitive condition admission (OR [95% CI]: 1.30 [1.27, 1.34]).

CONCLUSIONS

Telemedicine potentially in combination with in-person care was associated with higher follow-up healthcare utilization rates compared to in-person only PC. Factors contributing to utilization differences between groups need further evaluation.

Evaluating the impact of work from home policies on Google search Trends related to ankle surgery during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic caused notable shifts in healthcare behavior, influenced by remote work policies. This study examines the impact of Work from Home (WFH) policies on public interest in ankle-related orthopaedic surgeries, utilizing Google search trends. Understanding these trends is crucial for healthcare providers, enabling them to adapt services and communication to evolving patient needs during challenging times.

OBJECTIVE

To comprehend variations in search volume and trends for ankle-related queries due to WFH policies during the COVID-19 pandemic.

METHODS

Ankle-related terms accessible to laypersons were analyzed using Google Trends data from March 2018 to March 2022 in the United States. Data were divided into pre-pandemic (March 2018-March 2020) and post-pandemic (March 2020-March 2022) periods. Weekly search interest data for 20 terms were analyzed using a Mann-Whitney U test. The study aimed to identify significant changes in search interest, providing insights into public information-seeking behavior concerning ankle surgeries.

RESULTS

Among the 20 terms analyzed, 11 exhibited significant changes. Ankle arthritis and ankle bursitis showed increased interest, suggesting heightened concern during the pandemic. Conversely, post-pandemic interest decreased for terms 9 terms, including ankle pain and ankle tendonitis, indicating reduced worry. Moderate declines were noted for ankle gout, Achilles tendonitis, and heel bursitis, reflecting shifting patient priorities. Some terms, including ankle fracture and ankle arthroplasty, showed stable information-seeking behavior despite the pandemic.

CONCLUSIONS

The study underscores the nuanced impact of WFH policies on public interest in ankle-related orthopaedic surgeries. Varied search trends highlight changing patient concerns. Healthcare providers can use these insights to tailor services effectively, meeting evolving patient needs and enhancing communication strategies.

Prevalence of computer vision syndrome: A systematic review and meta-analysis

PURPOSE

This review aimed to estimate the prevalence of computer vision syndrome (CVS) in the general population and subgroups.

METHODS

A search was conducted in the following the databases: PubMed, SCOPUS, EMBASE, and Web of Science until February 13, 2023. We included studies that assessed the prevalence of CVS in any population. The Joanna Briggs Institute's critical appraisal tool was used to evaluate the methodological quality. A meta-analysis of the prevalence of CVS was done using a random-effects model, assessing the sources of heterogeneity using subgroup and meta-regression analyses.

RESULTS

A total of 103 cross-sectional studies with 66 577 participants were included. The prevalence of CVS was 69.0% (95% CI: 62.3 to 75.3; I2: 99.7%), ranging from 12.1 to 97.3% across studies. Point prevalence was higher in women than in men (71.4 vs. 61.8%), university students (76.1%), Africa (71.2%), Asia (69.9%), contact lens wearers (73.1% vs. 63.8%) in studies conducted before the COVID-19 pandemic (72.8%), and in those that did not use the CVS-Q questionnaire (75.4%). In meta-regression, using the CVS-Q scale was associated with a lower prevalence of CVS.

CONCLUSION

Seven out of ten people suffer from CVS. Preventive strategies and interventions are needed to decrease the prevalence of this condition which can affect productivity and quality of life. Future studies should standardize a definition of CVS.

Online Videos Regarding Relevant Postoperative Patient Information and Postoperative Rehabilitation After Arthroscopic Rotator Cuff Repair Provide Poor Information Quality, Accuracy, and Reliability

PURPOSE

To evaluate the information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair.

METHODS

By use of The Onion Router (TOR) software and predefined search terms, 102 videos were assessed. Four scoring systems were used to evaluate included videos: (1) Journal of the American Medical Association (JAMA) benchmark criteria score; (2) Global Quality Score (GQS); (3) DISCERN score; and (4) a newly developed score, the Rotator Cuff Score (RCS). The RCS (0-30 points) was built based on the latest published evidence and guidelines from the American Academy of Orthopaedic Surgeons. Videos that scored up to 9 points were regarded as poor-quality videos.

RESULTS

Most of the included videos provided poor information quality, accuracy, and reliability. Videos that were uploaded by medically trained professionals showed significantly better results for all scores compared with commercial or personal-testimony videos (JAMA benchmark criteria score, P < .001; GQS, P < .001; DISCERN score, P = .001; and RCS, P = .001). Multivariate linear regression showed that the involvement of medically trained professionals was a significant predictor of better results for all scores (JAMA benchmark criteria score, β = 1.496 [P < .001]; GQS, β = 1.105 [P < .001]; DISCERN score, β = 11.234 [P < .001]; and RCS, β = 5.017 [P < .001]). Surprisingly, the like ratio was significantly higher for videos that were uploaded by non-medically trained individuals (P = .041).

CONCLUSIONS

The average information quality, accuracy, and reliability of YouTube videos regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are poor. Videos from medically trained professionals provide significantly higher information quality; however, even these videos lack important information for a better understanding of arthroscopic rotator cuff repair.

CLINICAL RELEVANCE

Because of the lack of a peer-review process, available videos on YouTube regarding relevant postoperative patient information and postoperative rehabilitation after arthroscopic rotator cuff repair are of low quality, accuracy, and reliability. However, patients increasingly visit YouTube to gather medical knowledge. Physicians should enlighten patients about these findings and should be able to provide alternative sources of high-quality information.

The impact of COVID-19 on PRO development, collection and implementation: views of UK and Ireland professionals

BACKGROUND

PROs are valuable tools in clinical care to capture patients' perspectives of their health, symptoms and quality of life. However the COVID-19 pandemic has had profound impacts on all aspects of life, in particular healthcare and research. This study explores the views of UK and Irish health professionals, third sector and pharmaceutical industry representatives and academic researchers on the impact of COVID-19 on PRO collection, use and development in clinical practice.

METHODS

A volunteer sample took part in a 10 question cross sectional qualitative survey, on the impact of COVID-19, administered online via Qualtrics. Demographic data was descriptively analysed, and the qualitative free text response data was subject to thematic analysis and summarised within the Strengths, Weaknesses, Opportunities and Threats (SWOT) framework.

RESULTS

Forty nine participants took part located in a range of UK settings and professions. Participants highlighted staff strengths during the pandemic including colleagues' flexibility and ability to work collaboratively and the adoption of novel communication tools. Weaknesses were a lack of staff capacity to continue or start PRO projects and insufficient digital infrastructure to continue studies online. Opportunities included the added interest in PROs as useful outcomes, the value of electronic PROs for staff and patients particularly in relation to integration into systems and the electronic patient records. However, these opportunities came with an understanding that digital exclusion may be an issue for patient groups. Threats identified included that the majority of PRO research was stopped or delayed and funding streams were cut.

CONCLUSIONS

Although most PRO research was on hold during the pandemic, the consensus from participants was that PROs as meaningful outcomes were valued more than ever. From the opportunities afforded by the pandemic the development of electronic PROs and their integration into electronic patient record systems and clinical practice could be a lasting legacy from the COVID-19 pandemic.

Factors Associated with Online Patient-Provider Communications Among Cancer Survivors in the United States during COVID: A Cross-Sectional Study

BACKGROUND

Online Patient-Provider Communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS/COVID-19 (COVID), yet investigations in vulnerable subgroups have been limited.

OBJECTIVE

Thus, this study aimed to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID vs. pre-COVID.

METHODS

Nationally representative cross-sectional survey data (Health Information National Trends Survey, HINTS 5 2017-2020) was used among cancer survivors (n= 1,900) and adults without a history of cancer (n= 13, 292). COVID included data from February to June 2020. We calculated the prevalence of three types of OPPC, defined as using email/internet, tablet/smartphone, or Electronic Health Records (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (OR) and 95% confidence intervals (95% CI).

RESULTS

The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs. 49.7%, email/internet; 32.2% vs. 37.9%, tablet/smartphone; 19.0% vs. 30.0%, EHR). Cancer survivors (OR=1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID. Among cancer survivors, email/internet (OR=1.61, 1.08-2.40) and EHR (OR=1.92, 1.22-3.02) were more likely to be used during COVID than pre-COVID. During COVID, subgroups of cancer survivors, including Hispanics (OR=0.26, 0.09-0.71 vs. non-Hispanic Whites), or those with the lowest income (OR=6.14, 1.99-18.92 $50,000 to <$75,000; OR=0.42, 1.56-11.28 ≥ $75,000 vs. <$20,000), with no usual source of care (OR=6.17, 2.12-17.99), or reporting depression (OR=0.33, 0.14-0.78) were less likely to use email/internet and those who were the oldest (OR=9.33, 2.18-40.01 age 35-49; OR=3.58, 1.20-10.70 age 50-64; OR=3.09, 1.09-8.76 age 65-74 vs. ≥75), unmarried (OR=2.26, 1.06-4.86) or had public/no health insurance (ORs=0.19-0.21 Medicare, Medicaid, or Other, vs. private) were less likely to use tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR=6.23, 1.66-23.39) or healthcare office visits within a year (ORs=7.55-8.25) were significantly more likely to use EHR to communicate. While not observed in cancer survivors, lower education level was associated with lower OPPC among adults without a history of cancer during COVID.

CONCLUSIONS

Our findings identified vulnerable subgroups of cancer survivors who were left behind in online patient-provider communications which are becoming an increasing part of healthcare. Those vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities.

CLINICALTRIAL

Not applicable.

Racial/ethnic and income disparities in neighborhood-level broadband access in 905 US cities, 2017-2021

OBJECTIVES

Broadband access is an essential social determinant of health, the importance of which was made apparent during the COVID-19 pandemic. We sought to understand disparities in broadband access within cities and identify potential solutions to increase urban access.

STUDY DESIGN

This was a descriptive secondary analysis using multi-year cross-sectional survey data.

METHODS

Data were obtained from the City Health Dashboard and American Community Survey. We studied broadband access in 905 large US cities, stratifying neighborhood broadband access by neighborhood median household income and racial/ethnic composition.

RESULTS

In 2017, 30% of urban households across 905 large US cities did not have access to high-speed broadband internet. After controlling for median household income, broadband access in majority Black and Hispanic neighborhoods was 10-15% lower than in majority White or Asian neighborhoods. Over time, lack of broadband access in urban households decreased from 30% in 2017 to 24% in 2021, but racial and income disparities persisted.

CONCLUSIONS

As an emerging social determinant, broadband access impacts health across the life course, affecting students' ability to learn and adults' ability to find and retain jobs. Resolving lack of broadband access remains an urban priority. City policymakers can harness recent infrastructure funding opportunities to reduce broadband access disparities.

Barriers to Telemedicine Adoption during the COVID-19 Pandemic in Taiwan: Comparison of Perceived Risks by Socioeconomic Status Correlates

Telemedicine is the use of technology to deliver healthcare services from a distance. In some countries, telemedicine became popular during the COVID-19 pandemic. Its increasing popularity provides new research opportunities to unveil users' perceptions toward its adoption and continued use. Existing studies have provided limited information and understanding of Taiwanese users and the various sociodemographic factors that influence their intention to use telemedicine services. Thus, the goals of this study were twofold: identifying the dimensions of perceived risks of telemedicine services in Taiwan and providing specific responses to those perceptions as well as determining strategies to promote telemedicine to local policymakers and influencers by providing a better understanding of the perceived risks in relation to socioeconomic status. We collected 1000 valid responses using an online survey and found performance risk to be the main barrier, which was followed by psychological, physical, and technology risks. Older adults with lower levels of education are less likely to use telemedicine services compared to other categories because of multiple perceived risks, including social and psychological concerns. Understanding the differences in perceived risks of telemedicine services by socioeconomic status may aid in identifying the actions required to overcome barriers and may consequently improve adoption of the technology and user satisfaction.

Changes in mental health of Korean adolescents before and during the COVID-19 pandemic: a special report using the Korea Youth Risk Behavior Survey

OBJECTIVES

We aimed to study the effects of the coronavirus disease 2019 (COVID-19) pandemic on adolescents' mental health in Korea.

METHODS

We used data from the Korea Youth Risk Behavior Survey 2018-2021 with 227,139 students aged 12-18 years. We estimated the differences in depressive symptoms, suicidal ideation, and stress perception before (2018-2019) and during (2020-2021) the pandemic, as well as before (2019), the first year (2020) of, and the second year (2021) of the pandemic. We also examined whether COVID-19 is statistically associated with mental health.

RESULTS

In both male and female adolescents, the prevalence of depressive symptoms, suicidal ideation, and stress perception was higher in the "not living with family," "low household economic status," and "self-rated unhealthy status" subgroups. The prevalence of depressive symptoms and stress perception was higher in middle school students. Adolescents were less likely to experience depressive symptoms (adjusted odds ratio [aOR], 0.86; 95% confidence interval [CI], 0.83 to 0.89), suicidal ideation (aOR, 0.80; 95% CI, 0.76 to 0.83), and stress perception (aOR, 0.76; 95% CI, 0.74 to 0.79) in 2020 than in 2019. However, there were more depressive symptoms (aOR, 1.06; 95% CI, 1.02 to 1.09), suicidal ideation (aOR, 1.15; 95% CI, 1.10 to 1.21), and stress perception (aOR, 1.19; 95% CI, 1.16 to 1.23) in 2021 than in 2020.

CONCLUSIONS

The COVID-19 pandemic had positive impacts on mental health of adolescents in its early stages but has had negative impacts as the pandemic continues. Attention should be paid to adolescents who are particularly vulnerable to the mental health effects of the pandemic.

Online health information seeking and the association with anxiety among older adults

Introduction

The Internet supplies users with endless access to a wealth of information and is generally the first source searched by U.S. adults (18 years and older) when seeking health information. Age and anxiety are associated with online health information seeking (OHIS). Older adults (65 years and older) are increasing their OHIS. Importantly, OHIS can potentially lead to improved health outcomes for older adults. The relationship between OHIS and anxiety is less clear. Studies report those with more symptoms of anxiety are more likely to be OHIS, while other studies find the reverse pattern or no association. Generalized anxiety disorder affects up to 11% of older adults and is oftentimes unrecognized and untreated.

Methods

To address the mixed findings in the literature, we analyzed six waves (2015-2020) of data from the National Health and Aging Trends Study to assess the causal relationship between anxiety and OHIS using a Random Intercept Cross-lagged Panel Model framework.

Results

We found that while anxiety symptoms lead to OHIS in the next wave, OHIS was not associated with anxiety symptoms in the next wave.

Discussion

This suggests that for this sample of older adults, OHIS does not reduce or exacerbate older adults' symptoms of anxiety.