Examining Disparities in Ownership and Use of Digital Health Technology Between Rural and Urban Adults in the US: An Analysis of the 2019 Health Information National Trends Survey

Abstract

Background: Although research shows that digital health tools (DHT) are increasingly integrated with healthcare in the United States, very few studies have investigated the rural-urban differences in DHT adoption at the national level. Individuals in rural communities experience disproportionately greater rates of chronic diseases and face unique challenges in accessing health care. Studies have shown that digital technology can improve access and support rural health by overcoming geographic barriers to care. Objective: To evaluate the rates of ownership and preferences for utilization of DHT as a measure of interest among rural adults compared to their urban counterparts in the United States using a National Inpatient Survey. Methods: Data was drawn from the 2019 (n= 5438) iteration of the Health Information National Trends Survey (HINTS 5 cycle 3). Chi-square tests and weighted multivariable logistic regressions were conducted to examine rural-urban differences regarding ownership, usage, and use of digital health tools to interact with health care systems while adjusting for health-related characteristics and sociodemographic factors. Results: The ownership rates of digital health technology (DHT) devices, including tablets, smart phones, health apps, and wearable devices, were comparable between rural and urban residents. For tablets, the ownership rates were 54.52% among rural residents and 60.24% among urban residents, with an adjusted odds ratio (OR) of 0.87 (95% confidence interval {CI}: 0.61, 1.24). The ownership rates of health apps were 51.41% and 53.35% among rural and urban residents, respectively, with an adjusted OR of 0.93 (95% CI: 0.62, 1.42). For smartphones, the ownership rates were 81.64% among rural residents and 84.10% among urban residents, with an adjusted OR of 0.81 (95% CI: 0.59, 1.11). Additionally, rural residents were equally likely to use DHT in managing their healthcare needs. Both groups were equally likely to have reported their smart device as helpful in discussions with their healthcare providers (OR 0.90; 95% CI 63 - 1.30; p = 0.572). Similarly, there were similar odds of reporting that DHT had helped them to track progress on a health-related goal (e.g., quitting smoking, losing weight, or increasing physical activity) (OR 1.17; 95% CI 0.75 - 1.83; p = 0.491), and to make medical decisions (OR 1.05; 95% CI 0.70 - 1.59; p = 0.797). However, they had lower rates of internet access and were less likely to use DHT for communicating with their healthcare providers. Conclusion: We found that rural residents are equally likely as urban residents to own and use DHT to manage their health. However, they were less likely to communicate with their health providers using DHT. With increasing use of DHT in healthcare, future research that targets reasons for geographical digital access disparities is warranted.

Exploring the Prevalence and Factors Influencing Clinical Trial Awareness in US Adults with Self-Reported Depression and Anxiety

“…Technology, efforts to improve trial awareness by the government, and the heightened healthcare discussions during the pandemic and with the specific population may be reasons for our findings to be similar to earlier data. Our results provide early evidence that awareness may be improving, and more efforts should shift towards improving participation and outcomes, given that studies still show racial and ethnic disparities in participation among a unique population of people with mental illness [11,[22][23][24][25][26][27]37].…”

An Analysis of the Effect of Stroke on Health-Related Quality of Life of Older Adults With Coronary Heart Disease Who Take Aspirin

“…Despite these differences in HRQoL evaluation tools, the poor mental aspect of HRQoL of patients with CHD has been linked to poor perception of illness with regards to control of the symptoms of CHD, consistency of information on CHD status, and timeline of progression or management of the disease [25]. Furthermore, the degree of associated comorbidities has also been implicated in the observed poor mental HRQoL in patients with CHD [26][27][28][29], and as such, despite the consideration of stroke in this analysis, a cumulative effect of other comorbidities such as older age, kidney disease, diabetes mellitus, and hypertension may be contributory to the high proportion of poor mental HRQoL reported by respondents.…”

“…For instance, weight loss programs to address associated comorbidities may be a priority, as these individuals would be more active with a lower BMI, which may improve their physical HRQoL. Other measures such as consistent education on the nature and etiology of their disease, the timeline of interventions, clear expectations of the management of symptoms, improved social support, and mitigating stressful life events may improve the mental aspects of HRQoL in CHD patients [27][28][29].…”

Editorial: Equitable digital medicine and home health care

“…Thanks to DHT, patients can be monitored, diagnosed and treated remotely, eliminating the need to physically travel to the hospital. This is especially relevant for people who live in remote areas or who have mobility difficulties, enabling them to receive appropriate care without having to make long and expensive journeys ( 19 ).…”