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2023 HSR&D/QUERI National Conference Abstract

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1141 — Racial, Ethnic, and Predominant Language Spoken at Home Differences in Secure Messaging Communication with Providers

Lead/Presenter: Carolyn Turvey,  COIN - Iowa City
All Authors: Turvey CL (Veterans Rural Health Resource Center-Iowa City, Virtual Specialty Care QUERI, CADRE), McKoy K (Veterans Rural Health Resource Center-Iowa City; Center for Access and Delivery Research and Evaluation. Klein D (JP Systems) Nazi K (Trilogy Federal)

Objectives:
This study explores patient use of My HealtheVet and secure messaging across different races, ethnicities, and predominant languages spoken at home. The use of patient portals and eHealth has grown in light of COVID-19 social distancing requirements and reduced provider availability. Though eHealth aims to increase patient access to care, there are concerns about a digital divide for patients with constrained resources for internet-based technology.

Methods:
We obtained SHEP data between October 2018 and December 2020 to explore the association of 1) race (American Indian/Alaskan Native (N = 2239), Asian (N = 1144), Black/African American (N = 8173), Native Hawaiian or Pacific Islander (N = 1029), or White (N = 95036)), 2) ethnicity (Hispanic Latino (N = 6461), non-Hispanic Latino (N = 102,579)), and 3) predominant language spoken at home (Chinese or Vietnamese (N = 297), English (N = 109,457), Spanish (N = 1148)) with use of My HealtheVet and secure messaging. Data was collected from a random sample of all Veterans who had a primary care visit in VHA. The total sample was 107,621 with some variability related survey non-response to some items. Univariate logistic regression models were constructed followed by multiple regression analyses that controlled for potential confounding, including: age, gender, and self-rated health.

Results:
All minority groups endorsed using secure messaging at proportions higher than Whites -American Indian/Alaskan Natives (35%), Asians (39%), Blacks (34%), Native Hawaiians or Pacific Islanders (42.3%), Whites (30%) (p < 0.001). Comparable patterns emerged when comparing Hispanic-Latinos to non-Hispanic Latinos (36% vs 30%) (p < 0.001). More marked differences in secure messaging use emerged when comparing English speaking households (30%) as compared with Chinese/Vietnamese speaking households (45%) and Spanish speaking households (38%) (p < 0.001). Predominant language differences remained significant after controlling for age, gender, and self-rated health. Similarly, all minority groups endorsed the use of secure messaging instead of seeking an in-person visit with their provider at higher proportions than Whites (14%): American Indian/Alaskan Natives (20%), Asians (24%), Blacks (16%), Native Hawaiians or Pacific Islanders (19%), (p < 0.001). Veterans living in Chinese or Vietnamese-speaking households were twice as likely as Veterans from English-speaking households to endorse using secure messaging instead of an in-person visit (28% vs. 14%). Of Whites, 42% indicated having never used My HealtheVet as compared with 37% of American Indian/Alaskan Natives, 26% of Asians, 32% of Blacks/African Americans, 23% Native Hawaiian/Pacific Islanders (p < 0.001).

Implications:
Veterans of minoritized racial or ethnic groups and those for whom English was not the predominant language spoken at home, reported greater, not lesser, use of My HealtheVet and secure messaging when compared with White, non-Latino, English speakers. This counters concerns about poor access and a digital divide, yet the broader implications of these results need exploration. Though non-English speaking households rely on secure messaging, we need to ensure these Veterans are receiving the same quality of care as Veterans relying primarily on in-person contact.

Impacts:
These results indicate an opportunity for VA to harness eHealth to support minoritized Veteran groups, particularly those in non-English-speaking households. However, VA must ensure equitable quality of care across eHealth and direct care so eHealth adoption does not create a new unanticipated inequity.