Immigrant Adults' Use of Telehealth during the COVID-19 Pandemic: Findings from the 2020-2021 National Health Interview Survey

Background and Purpose:

During the COVID-19 pandemic, social distancing policies significantly restricted access to traditional, in-person medical care, highlighting the importance of telehealth as an alternative for remotely receiving medical services. Nonetheless, access to telehealth was not uniformly available across all populations. Notably, immigrants may have encountered substantial barriers to accessing telehealth services due to language barriers, lack of health insurance, and inadequate information about available services. This study aims to explore the impact of immigrant status on telehealth utilization and examine the role of health insurance coverage and social support in mitigating disparities in telehealth utilization among different groups. Andersen’s behavioral model of healthcare utilization provides the theoretical framework for this analysis.

Methods:

Data and Measures: The National Health Interview Survey was utilized for the analysis. Data from the years 2020 and 2021, a period marked by the widespread COVID-19 outbreak, were pooled. The analysis included a total of 61,050 samples, among which 84.37% were US natives, 9.62% were naturalized citizens, and 6.01% were immigrants. The usage of telehealth was designated as the dependent variable. Predisposing factors included immigrant status (US native/naturalized citizen/immigrant), race, gender, marital status, education level, and residence, along with financial hardship (having problems or worried about paying any medical bill). Need factors included self-rated health, number of chronic health conditions, levels of anxiety and depression, and disruption of medical care during COVID-19. Enabling factors were social support and health insurance coverage.

Analyses: The study initially compared the use of telehealth, as well as predisposing, need, and enabling factors among US natives, naturalized citizens, and immigrants. A stepwise hierarchical logistic regression was then conducted to examine the impact of immigrant status, along with predisposing, need, and enabling factors on the utilization of telehealth services.

Results: During COVID-19, the utilization of telehealth among US natives and naturalized citizens was observed at 38.82% and 38.24%, respectively, while immigrants’ utilization of telehealth was significantly lower at 26.06% (p<.001). In terms of need factors, immigrants were characterized by better self-rated health, fewer chronic medical conditions, lower levels of anxiety and depression, and less disruption in medical care during COVID-19. However, they also experienced significantly more problems and hardship in paying medical bills and recorded a higher rate of being uninsured compared to their counterparts. Logistic analyses revealed that, even after adjusting for other predisposing and need factors, immigrant status significantly impacted the use of telehealth. Specifically, compared to US natives, immigrants were 25% less likely to use telehealth services (OR=.75). However, when health insurance coverage was included in further analyses, immigrant status no longer had a significant impact. Social support did not show a significant influence on telehealth utilization.

Conclusions and Implications: The study results suggest that while immigrant status independently influences telehealth usage, the disparities observed may be largely mediated by differences in health insurance coverage. Addressing insurance gaps could potentially mitigate the lower rates of telehealth utilization among immigrants, highlighting the importance of inclusive health insurance policies to ensure equitable access to telehealth services.