Predictors of Digital Health Use for Rural and Urban Medicare Beneficiaries

Background. Telehealth delivery of Medicare Part B visits increased 63-fold in 2020 during the Covid-19 pandemic. Rapid expansion of digital health care delivery could contribute to a growing “digital divide,” exacerbating existing health disparities for older adults. While research has identified different barriers to accessing health care for rural and urban populations, there is a gap in knowledge on the unique predictors of digital health use by one’s residence. This study aimed to understand the factors that contribute to digital health use by comparing rural and urban aging Medicare beneficiaries.

Methods. This secondary analysis employed the 2021 National Health and Aging Trends Study with a sample of 1,741 Medicare beneficiaries aged 70 years or older. Separate linear regressions were conducted to examine unique predictors of digital health use, stratified by urban (N=1452) or rural living (N=289). Digital health use, a composite measure of health-related technology activities, included using the internet to (1) have a telehealth visit with a provider, (2) search about health conditions, (3) obtain health insurance information, (4) message a health care provider, or (5) refill a prescription. Independent variables, informed by existing research, consisted of demographic, social support, and technology readiness factors.

Results. The participants in this study were predominantly White, female, and in their seventies. The urban sample was primarily southern, while the rural sample was heavily midwestern. Among the urban participants, the significant demographic factors of digital health use included being male and non-Hispanic Black, both of which were not significant in the rural sample. There were significant differences in the technology readiness factors between samples. While using the internet to grocery shop and bank were significant predictors for both urban and rural participants, the use of personal video calls and social network sites only predicted digital health use for the urban dwellers. Technology access to a working tablet predicted digital health use for both samples, whereas having a computer or cell phone was not significant. The models explained 27.1% of the variance in the urban sample’s digital health use and 29.9% in that of the rural sample.

Conclusions. This study highlights different factors influencing digital health use based on an older adult’s residential environment. These findings extend current knowledge of the impact of technology experience on digital health uptake by specifying what type of online experience is predictive for urban and rural Medicare beneficiaries. Rural residents’ use of online grocery shopping and banking was significantly predictive of digital health use, which can inform research on how to design and implement digital interventions for rural older adults. This is important since interventions tend to be designed and tested in urban communities. Covid-19 caused a sudden increase in digital health use, and now policy must adjust as high telehealth rates continue. Future policy should consider how digital health use differs by urbanicity and should involve aging stakeholders from rural and urban communities to inform changes. Research must explore technology uptake for older adults to ensure they are not disadvantaged by the “digital divide.”