Telehealth uptake among middle-aged and older Americans during COVID-19: chronic conditions, social media communication, and race/ethnicity

Abstract

Objectives

This study investigated whether and to what extent constructs of the protection motivation theory of health (PMT)—threat appraisal (perceived vulnerability/severity) and coping appraisal (response efficacy and self-efficacy)—are related to telehealth engagement during the COVID-19 pandemic, and how these associations differ by race/ethnicity among middle-aged and older Americans.

Methods

Data were from the 2020 Health and Retirement Study. Multivariable ordinary least-squares regression analyses were computed adjusting for health and sociodemographic factors.

Results

Some PMT constructs are useful in understanding telehealth uptake. Perceived vulnerability/severity, particularly comorbidity (b = 0.13, 95% confidence interval (CI) [0.11, 0.15], p < 0.001), and response efficacy, particularly participation in communication via social media (b = 0.24, 95% CI [0.21, 0.27], p < 0.001), were significantly and positively associated with higher telehealth uptake during the COVID-19 pandemic among middle-aged and older Americans. Non-Hispanic Black adults were more likely to engage in telehealth during the pandemic than their non-Hispanic White counterparts (b = 0.20, 95% CI [0.12, 0.28], p < 0.001). Multiple moderation analyses revealed the significant association between comorbidity and telehealth uptake was similar across racial/ethnic groups, whereas the significant association between social media communication and telehealth uptake varied by race/ethnicity. Specifically, the association was significantly less pronounced for Hispanic adults (b = −0.11, 95% CI [−0.19, −0.04], p < 0.01) and non-Hispanic Asian/other races adults (b = −0.13, 95% CI [−0.26, −0.01], p < 0.05) than it was for their non-Hispanic White counterparts.

Conclusion

Results suggest the potential of using social media and telehealth to narrow health disparities, particularly serving as a bridge for members of underserved communities to telehealth uptake.

Keywords:

• Comorbidity
• COVID-19
• midlife
• older adults
• race/ethnicity
• social media communication
• telehealth

Disclosure statement

No potential conflict of interest was reported by the author(s).

Statement on ethical approval

We used the public data of the Health and Retirement Study (HRS) which was approved by the Institutional Review Board (IRB) at the University of Michigan and all respondents provided informed consent; the project using the HRS was exempt from IRB review at The University of Alabama.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study used data from the Health and Retirement Study (HRS), a public use dataset produced and distributed by the University of Michigan with funding from the National Institute on Aging [grant number NIA U01AG009740].