Gap in Willingness and Access to Video-visit Use Among High-Risk Veterans: A Cross-sectional Study (Preprint)

2021 ◽  
Author(s):  
Stuti Dang ◽  
Kiranmayee Muralidhar ◽  
Shirley Li ◽  
Fei Tang ◽  
Michael Mintzer ◽  
...  
Keyword(s):  
African American ◽  
High Risk ◽  
Physical Health ◽  
Digital Divide ◽  
Associate Degree ◽  
Daily Living ◽  
Healthcare Access ◽  
The Internet ◽  
Black African ◽  
Virtual Care

BACKGROUND The recent shift to virtual care has exacerbated disparities in healthcare access especially among High-Need High-Risk (HNHR) adults. Developing data-driven approaches to achieve appropriate virtual care scale-up necessitate a deeper understanding of HNHR adults’ attitudes toward video-visits and access to technology. OBJECTIVE This study aimed to identify the willingness, access, and ability of HNHR Veterans to use video-visits for healthcare. METHODS We designed a questionnaire that was conducted via mail or in-person. Among HNHR Veterans identified using predictive modeling with national Veterans Affairs (VA) data, we assessed willingness to use video-visits for healthcare, access to necessary equipment, and comfort with using technology. We evaluated physical health including frailty status, physical function, performance of Activities of Daily Living (ADL’s) and Instrumental Activities of Daily Living (IADL’s); mental health; and social needs including area deprivation index, transportation, social support and social isolation. RESULTS Average age of the 602 HNHR Veterans respondents was 70.6±9.2 (39-100); 367 (61.0%) White, 217 (36.0%) Black/African American; 104 (17.3%) Hispanic/Latino; 188 (31.2%) held at least an associate degree and 290 (48.2%) were confident filling medical forms. Of the 602, 327 (54.3%) reported willingness for video-visits with the VA, while 275 (45.7%) were unwilling. Willing Veterans were younger (P<0.001), more likely to have an associate degree (P=0.002), be health literate (P<0.001), live in better neighborhoods (P<0.048), be independent in IADLs (P=0.02), and in better physical health (P=0.04) than unwilling. A higher number of those willing were able to use the Internet and email, and were enrolled in the VA’s patient portal, My HealtheVet (p<0.001). Of the willing Veterans, 248 (75.8%) had a video-capable device. Those with video-capable technology were younger (P=0.004), had higher health literacy (P=0.01), less likely to be African American (P=0.007), more independent in their ADLs (P=0.005) and IADLs (P=0.04), less likely to have transportation issues (P<0.001), more likely to live in better neighborhoods (P<0.049), more adept at using the Internet and more likely to use email, than those without the needed technology (P<0.001). CONCLUSIONS Only about half of our HNHR respondents were willing for video-visits, and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, Black/African American Veterans, those in worse physical health, and those living in worse neighborhoods. Our study highlights that HNHR Veterans have complex needs, which risk being exacerbated by the digital divide. Our findings underscore, yet again, that while technology holds vast potential to improve healthcare access, those most in need are also those least likely to engage with, or have access to, technology. Therefore, targeted interventions are needed to address this digital divide, especially among HNHR adults. CLINICALTRIAL NCT04846049

scholarly journals The Digital Divide Amongst High-Need High-Risk Veterans

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 635-636
Author(s):  
Shirley Li ◽  
Kiranmayee Muralidhar ◽  
Fei Tang ◽  
Willy Marcos Valencia ◽  
Stuti Dang
Keyword(s):  
African American ◽  
High Risk ◽  
Digital Divide ◽  
Vulnerable Population ◽  
The Internet ◽  
Patient Portal ◽  
Higher Educational ◽  
Willingness To Use

Abstract High-need high-risk (HNHR) veterans are medically complex and at the highest risk of hospitalization and long-term institutionalization. Technology can mitigate challenges these veterans have in accessing healthcare. Willingness to use technology as well as access and ability to use technology were assessed in this study. At the time of the survey, 2543 Miami VAHS veterans were listed as HNHR. 634 veterans ultimately completed the questionnaire, and 602 answered the “willingness to use video-visits” question. Of the 602 respondents, 327 (54.3%) reported they were willing for video-visits with the VA, while 275 (45.6%) were not. Those who were willing were significantly younger (P&lt;0.001), with higher educational qualifications (P=0.002), and more health literate than those not willing (P&lt;0.001). They were more also capable of using the Internet, more likely to use email and be enrolled in the VA’s patient portal, My HealtheVet (P&lt;0.001). However, of the veterans who were willing, 248 (75.8%) had a device with video-capable technology. Those with video-capable technology were younger (P=0.004), more health literate (P=0.01), and less likely to be Black or African American (P=0.007). They were more capable of using the Internet, more likely to use email, and be enrolled in My HealtheVet than those without (P&lt;0.001). Half of the respondents were willing for video-visits but a quarter of those willing lacked requisite technology, thereby making only about 41.2% of the respondents willing and video-capable. To minimize the digital divide, especially during the ongoing COVID-19 pandemic, targeted measures need to address these disparities in this vulnerable population.

scholarly journals Eliciting Willingness and Beliefs towards Participation in Genetic Psychiatric Testing in Black/African American Mothers at Risk for Depression

2020 ◽  
Vol 10 (12) ◽  
pp. 181
Author(s):  
Rahshida Atkins ◽  
Terri-Ann Kelly ◽  
Shanda Johnson ◽  
Wanda Williams ◽  
Yolanda Nelson ◽  
...  
Keyword(s):  
African American ◽  
Genetic Testing ◽  
High Risk ◽  
African American Women ◽  
Genetic Research ◽  
Willingness To Participate ◽  
African American Mothers ◽  
Black African ◽  
Testing Procedures ◽  
Psychiatric Genetic

Black/African American women are at high risk for depression, yet are underrepresented in psychiatric genetic research for depression prevention and treatment. Little is known about the factors that influence participation in genetic testing for Black/African American women at risk. The purpose of this study was to elicit the beliefs that underlie participation in genetic testing for depression in Black/African American mothers, a subgroup at high risk. Willingness to participate in genetic testing procedures was also determined. A qualitative, descriptive design was employed. Exactly 19 mothers aged 21–42 completed open-ended questionnaires. Directed content and descriptive analyses of the text were conducted based on the Theory of Planned Behavior. Salient beliefs included: behavioral advantages—diagnosing/detecting depression (31.6%), finding cure/treatment (21.1%); disadvantages—not finding follow-up treatment/help (21.1%); salient referents, who approves—family members (47.4%), agencies/organizations (26.3%); who disapproves—church associates (21.1%). Control beliefs included: barriers—unpleasant/difficult testing procedures (42.1%), limited knowledge about the purpose of testing (26.3%); facilitator—a convenient location (21.1%). Most mothers (89.5%) indicated willingness to participate in testing. Interventions can target families, address barriers, emphasize future benefits, and use convenient locations and community-based participatory research methods. Policies can address social determinants of participation to increase inclusion of these mothers in psychiatric genetic research.

scholarly journals Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study

10.2196/24716 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e24716
Author(s):  
Shruthi Mahalingaiah ◽  
J Jojo Cheng ◽  
Michael R Winter ◽  
Erika Rodriguez ◽  
Victoria Fruh ◽  
...  
Keyword(s):  
African American ◽  
Pilot Study ◽  
Polycystic Ovary Syndrome ◽  
Polycystic Ovary ◽  
Clinical Population ◽  
The Internet ◽  
Completion Rates ◽  
Ovary Syndrome ◽  
Web Based ◽  
Black African

Background Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. Objective The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. Methods We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. Results We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7% (216/271) had a college degree or higher, and 14.6% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7% (176/272) White, 11.8% (32/272) Black/African American, 7.7% (21/272) Latina/Hispanic, and 5.9% (16/272) Asian individuals; 9.9% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5%) compared to 1.6% (1/61) in the community fair and 8.3% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4%) and community fairs (60/61, 98.4%) compared to those recruited in clinic (28/43, 65.1%). Conclusions Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair.

Toward Identifying Mild Cognitive Impairment in Hispanic and African American Adults

2017 ◽  
Vol 2 (2) ◽  
pp. 110-116
Author(s):  
Valarie B. Fleming ◽  
Joyce L. Harris
Keyword(s):  
Older Adults ◽  
African American ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Healthcare Access ◽  
Communication Disorders ◽  
Healthcare Systems ◽  
Prevention Education ◽  
Education Management ◽  
African American Adults

Across the breadth of acquired neurogenic communication disorders, mild cognitive impairment (MCI) may go undetected, underreported, and untreated. In addition to stigma and distrust of healthcare systems, other barriers contribute to decreased identification, healthcare access, and service utilization for Hispanic and African American adults with MCI. Speech-language pathologists (SLPs) have significant roles in prevention, education, management, and support of older adults, the population must susceptible to MCI.

Multisystemic Therapy Improves Asthma Management in High- Risk African American Teens

2014 ◽  
Author(s):  
S. Naar-King ◽  
D. Ellis ◽  
P.S. King ◽  
P. Lam ◽  
P. Cunningham ◽  
...  
Keyword(s):  
African American ◽  
High Risk ◽  
Asthma Management ◽  
Multisystemic Therapy

HIV and STD Prevention for High-Risk, Inner-City, African American Youth

2008 ◽  
Author(s):  
Daniel Romer ◽  
Ralph DiClemente ◽  
Lawrence Brown ◽  
Peter Vanable ◽  
Robert Valois
Keyword(s):  
African American ◽  
High Risk ◽  
Inner City ◽  
African American Youth ◽  
Std Prevention

The Digital Divide and K-12 Student Computer Use

10.28945/2926 ◽  
2005 ◽  
Author(s):  
James N. Morgan ◽  
Craig A. VanLengen
Keyword(s):  
Digital Divide ◽  
Computer Use ◽  
Census Data ◽  
Internet Access ◽  
Demographic Characteristics ◽  
The Internet ◽  
Substantial Impact ◽  
Limited Basis ◽  
K 12 ◽  
The Impact

The divide between those who have computer and Internet access and those who do not appears to be narrowing, however overall statistics may be misleading. Measures of computer availability in schools often include cases where computers are only available for administration or are available only on a very limited basis (Gootman, 2004). Access to a computer and the Internet outside of school helps to reinforce student learning and emphasize the importance of using technology. Recent U.S. statistics indicate that ethnic background and other demographic characteristics still have substantial impact on the availability and use of computers by students outside of the classroom. This paper examines recent census data to determine the impact of the household on student computer use outside of the classroom. Encouragingly, the findings of this study suggest that use of a computer at school substantially increases the chance that a student will use a computer outside of class. Additionally, this study suggests that computer use outside of the classroom is positively and significantly impacted by being in a household with adults who either use a computer at work or work in an industry where computers are extensively used.

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