Stay-at-home policies related to COVID-19 have restricted the movement of individuals, especially adolescents and young adults. At the start of the pandemic, we at Baylor Teen Health Clinics, a system of eight clinics that provide free preventive primary care, reproductive and mental health services, were concerned about how we would continue to provide health care. sexually to our customers? How do we ensure that our services are provided in a confidential and accessible manner? Like many other clinics, we quickly adopted a telehealth program to minimize care interruptions.
However, most of our patients are uninsured and underinsured young people who face many inequities limiting their ability to access health services remotely. A majority (97.9%) of our patients fall below the federal poverty level of 250% and 96% belong to racial and ethnic minority groups. Some teens and young adults have told us they don’t have a digital device or have poor Wi-Fi with limited cellular data availability for a video call. Others spoke of privacy issues such as thin walls in their homes that prevented them from talking to the clinic provider about their sexual health without being overheard.
We found that in the first few months of implementing telehealth services, less than 20% of our clinic visits were made via telehealth. As a result, we performed far fewer tests for sexually transmitted infections (despite the high rates of these infections nationwide). The alarming reduction in routine health care could lead to unrecognized and long-term complications from untreated infections. We therefore decided to implement an innovative pilot proposal that challenges and changes clinical practice by addressing technology as an essential component of the social determinants of health.
With a Health Disparities Research Grant from Baylor College of Medicine for a project titled “Technological Determinants of Health: Factors Associated with Equitable Use Among Minority Adolescents and Young Adults Receiving Sexual Health Services,” we explored telehealth acceptability and digital inequalities (access to devices, internet access). access and digital literacy) affecting the use of telehealth for sexual health services among adolescents and young adults.
In our survey of approximately 350 teens and young adults, while 99.6% of respondents had access to a telehealth-enabled device and 99.2% had internet access, over a third (37%) said that ‘they couldn’t trust their equipment to work. Some found it difficult to use the technology (12%) and others had privacy issues (8%). Most found the modality acceptable, agreeing that it could save them time (69%) and that they would be satisfied with a telehealth visit (59%).
Our respondents provided us with feedback such as suggestions for local resources such as internet access that we could provide to our patient population (for example, from the respondent, “There’s a Starbucks two miles away” or “Check out this resource for free Wi-Fi in Houston”), discussing privacy upfront and allowing the patient to scan the room by rotating the provider’s camera to allay any concerns that other people might be listening in on the conversation.
The results of our survey and qualitative interviews lay the groundwork for further research focusing on action-oriented steps to develop innovative interventions and clinical practice recommendations. The study has the potential to improve and innovate future clinical practice in public health by developing a clinical intervention to overcome barriers to telehealth based on feedback from adolescents and young adults.
By Allyssa Aguila Abacan MPH, PhD, Strategy and Business Development Associate, Baylor Population Program and Meghna Raphael, MD, Assistant Professor, Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics
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