Qu Jiajia
Computer Information Systems and Business Analytics, James Madison University, 800 South Main Street, Harrisonburg, VA, 22807, United States, 1 7164586270.
J Med Internet Res. 2025 Jul 10;27:e63295. doi: 10.2196/63295.
The increased integration of telehealth services into health care systems, especially during the COVID-19 pandemic, transformed patient-provider interactions. Despite numerous benefits that promote health equity and resource allocation, patients' acceptance and use of telehealth have declined post pandemic. To enhance health care delivery and patient satisfaction, we study the factors of this decline from the perspective of patient characteristics that influence the adoption and use of telehealth services.
This study examines the direct impact of patient trust, social determinants of health, and health self-efficacy on telehealth usage, the indirect effect of confidence in health information seeking, patient-centered communication, and health literacy barriers on telehealth usage through trust.
This paper uses secondary data from cycle 6 of the Health Information National Trends Survey, a nationally representative dataset collected by the National Cancer Institute. This dataset used a mixed-mode experimental design, with data collected between March and November 2022. The survey included 2 experimental conditions: concurrent (web and paper surveys offered simultaneously) and sequential (web survey offered first, followed by paper). A total of 6252 respondents participated, with a household response rate of 28.1% (6252/22,471). Respondents were randomly assigned to 1 of 3 web-based survey groups to address data quality issues such as speeding and straight lining. We use structural equation modeling to test our research questions, evaluating both direct and indirect pathways influencing telehealth usage. Common method bias is addressed through Harman's single-factor test, and robustness checks ensure the validity and reliability of our results.
Out of 5554 participants who had at least 1 doctor visit within the past 12 months, 44.89% used telehealth services in the past year. Trust has an inverted U-shaped relationship with confidence in health information seeking (β=-.031; P=.002); we find trust positively influenced by patient-centered communication (β=.156; P<.001) and negatively affected by health literacy barriers (β=-.063; P<.001). Trust enhances telehealth usage (β=.025; P<.001), with social determinants of health exerting a positive impact (β=.105; P<.001) and health self-efficacy having a negative impact (β=-.019; P=.007).
This study finds that trust, social determinants of health, and health self-efficacy directly impact telehealth usage. Additionally, telehealth usage is indirectly influenced by patient characteristics, such as confidence in health information seeking and health literacy barriers, as well as by a patient-centered communication environment. The findings emphasize the need for targeted interventions to improve patient health literacy and engagement, thereby promoting the telehealth services usage.
远程医疗服务越来越多地融入医疗保健系统，尤其是在新冠疫情期间，这改变了患者与医疗服务提供者之间的互动。尽管远程医疗有诸多促进健康公平和资源分配的益处，但疫情后患者对远程医疗的接受度和使用率有所下降。为了提高医疗服务质量和患者满意度，我们从影响远程医疗服务采用和使用的患者特征角度研究了这种下降的因素。
本研究考察患者信任、健康的社会决定因素和健康自我效能对远程医疗使用的直接影响，以及通过信任对健康信息寻求的信心、以患者为中心的沟通和健康素养障碍对远程医疗使用的间接影响。
本文使用了来自《健康信息国家趋势调查》第6轮的二手数据，这是美国国家癌症研究所收集的具有全国代表性的数据集。该数据集采用混合模式实验设计，数据收集于2022年3月至11月之间。调查包括2种实验条件：并行（同时提供网络和纸质调查问卷）和顺序（先提供网络调查问卷，随后是纸质问卷）。共有6252名受访者参与，家庭回应率为28.1%（6252/22471）。受访者被随机分配到3个基于网络的调查小组之一，以解决诸如快速答题和直线答题等数据质量问题。我们使用结构方程模型来检验我们的研究问题，评估影响远程医疗使用的直接和间接途径。通过哈曼单因素检验解决共同方法偏差问题，稳健性检验确保我们结果的有效性和可靠性。
在过去12个月内至少进行过1次就诊的5554名参与者中，44.89%在过去一年中使用过远程医疗服务。信任与对健康信息寻求的信心呈倒U形关系（β = -0.031；P = 0.002）；我们发现信任受到以患者为中心的沟通的正向影响（β = 0.156；P < 0.001），并受到健康素养障碍的负向影响（β = -0.063；P < 0.001）。信任提高了远程医疗的使用率（β = 0.025；P < 0.001），健康的社会决定因素产生了正向影响（β = 0.105；P < 0.001），而健康自我效能产生了负向影响（β = -0.019；P = 0.007）。
本研究发现，信任、健康的社会决定因素和健康自我效能直接影响远程医疗的使用。此外，远程医疗的使用还受到患者特征的间接影响，如对健康信息寻求的信心和健康素养障碍，以及以患者为中心的沟通环境的影响。研究结果强调需要有针对性的干预措施来提高患者的健康素养和参与度，从而促进远程医疗服务的使用。
