Promoting Health Equity Among Sexual and Gender Minority Older Adults through Digital Health Technologies

Background and Purpose: Sexual and gender minority (SGM) older adults face distinct challenges to accessing healthcare. Digital health technologies have been increasingly recognized as viable solutions to overcome barriers that restrict marginalized populations’ access to health resources. The internet is an essential source of information and connection among SGM populations, especially community members who report isolation and discrimination. Some SGM older adults, however, may face challenges with electronic literacy that constrain use. The current study examined: 1) the relationship between healthcare discrimination and use of digital health technologies for communication and health-information seeking, and; 2) if this relationship varied among SGM subgroups.

Methods: Data were analyzed from the 2015 health care access module of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) (N=2,322). Multivariate logistic regression models tested the relationship between healthcare discrimination and use of digital technologies in the past 12 months to: 1) communicate with providers, and; 2) find health information. Models also examined moderating effects of SGM identity to identify differences in extent to which SGM subgroups turn to digital health technologies in response to healthcare discrimination. Gender, race/ethnicity, and age were included as covariates.

Results: Of the 2,322 participants, majority were gay or lesbian (n=1,996; 85%) and about 8% were transgender (n=180). Close to 7% of the sample reported past 12-month experiences of healthcare discrimination, including that they had been denied or provided inferior care. Many participants used digital health technologies, including 62% (n=1,451) to communicate with a provider and 48% (n=1,113) to find health information. Results indicated use of digital health technologies varied across SGM older adult subgroups and healthcare discrimination. Transgender participants who experienced healthcare discrimination more likely communicated with providers online than cisgender participants who had similarly experienced healthcare discrimination (contrast=1.30, p=0.002) and transgender (contrast=0.84, p=0.03) and cisgender (contrast=1.25, p<0.001) participants who did not report healthcare discrimination. Meanwhile, bisexual participants with past experiences of healthcare discrimination more likely turned to the internet to find health information than lesbian and gay counterparts (contrast=1.58, p=0.016), and bisexual and lesbian and gay participant who did not report healthcare discrimination. Across models, older cohorts (65-79; 80+) and Black and Hispanic participants less likely used digital health technologies to access health care and information.

Conclusions and Implications: Digital health technologies may enhance access for some SGM older adults who may otherwise avoid healthcare. For example, these resources may bridge gaps in availability of affirmative care. This is particularly evident for certain SGM subgroups, such as transgender and bisexual older adults with histories of healthcare discrimination. It remains imperative to create community-based, translational programs that promote digital access and electronic literacy needs among older cohorts and SGM communities with multiple marginalized identities. The translation of research findings, such as these, supported the development and evaluation of Tech Connect, a program designed to promote digital access for both services providers and SGM older adults.