Date of Award

Winter 2023

Project Type

Dissertation

Program or Major

Sociology

Degree Name

Doctor of Philosophy

First Advisor

Heather A Turner

Second Advisor

Rebecca Glauber

Third Advisor

Karen Van Gundy

Abstract

The COVID-19 pandemic brought unprecedented change to the healthcare industry, including a large and rapid shift to providing care through telehealth technologies. Though the expansion of telehealth services was successful in continuing to provide patients with care while preventing the spread of disease, it is less clear how patient sociodemographic characteristics influenced telehealth use during this time. Similarly, less is known about how or if state-level parity laws influenced rates of individual-level telehealth utilization. To address these areas of research, this dissertation does three things. First, I conducted a systematic review of the literature on demographic disparities in telehealth access, utilization, and potential health outcomes published between March 2020 and October 2022. Litcovid, PubMed, Web of Science, and MEDLINE databases were searched, resulting in a final sample of n=32 studies. Results found that studies could be categorized as addressing at least one of eight different areas of inquiry: sociodemographic differences in telehealth use (1) during and (2) before the pandemic, telehealth use vs. non-use (3) during and (4) before the pandemic, (5) telehealth modality, (6) satisfaction with telehealth, (7) health outcomes associated with telehealth use, and (8) perceived or actual access to telehealth services. Findings were robust across included studies on racial differences in telehealth utilization and associated health outcomes. Other findings across studies were summarized and areas for future research were discussed. Next, using data from the U.S. Census Bureau’s nationally representative Household Pulse Survey (HPS), I used a sociological and intersectional lens to quantitatively examine sociodemographic disparities in telehealth utilization by modality (i.e. any, audio-only, video-enabled, both audio and video) and assess how sociodemographic predictors may interact to influence rates of telehealth utilization. Results from this second study found demographic disparities by telehealth modality, with lower proportions of racial and ethnic minorities and low-socioeconomic individuals utilizing video-enabled telehealth visits. Additionally, the relationship between gender and telehealth use was moderated by demographic factors including race/ethnicity, education, disability, and insurance status. Notably, though transgender adults had a higher odds of telehealth utilization when compared to males, the effect of gender was significantly moderated by race. Non-Hispanic Black and Hispanic transgender adults had similar predicted probabilities of telehealth use to males of the same race. These findings support earlier research that shows that at the intersection of multiple social identities, there are unique mechanisms that influence utilization of healthcare services. It is important that future research not treat demographic categories as homogenous risk factors but rather incorporate an intersectional perspective to examine how individuals occupying more than one social status experience access to and utilization of healthcare. In the third chapter, I again used HPS data in conjunction with the Center for Connected Health Policy (CCHP) Fall 2021 and Spring 2022 “State Telehealth Laws and Reimbursement Policies” data on state-level parity laws to examine whether and how parity laws influence telehealth utilization during 2021 and 2022 time periods. Findings did not offer robust evidence that state-level parity status affected the odds of telehealth utilization during this study period. However, sociodemographic factors persisted as strong predictors of utilization. Taken together, these findings add to the rapidly growing body of literature on sociodemographic disparities in telehealth access, utilization, and associated health outcomes following the expansion of telehealth services during the COVID-19 pandemic.

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