COVID-19 stay-at-home policies restricted the movement of individuals, especially adolescents and young adults. At the onset of the pandemic, we at the Baylor Teen Health Clinics, a system of eight clinics that provides free preventive primary care, reproductive and mental health services, were concerned about how we would continue to provide sexual health care to our clients? How to we ensure our services are provided in a confidential and accessible manner? Like many other clinics, we rapidly adopted a telehealth program to minimize interruption in care.
However, most of our patients are uninsured and underinsured young people who face many inequities limiting their ability to access healthcare services remotely. A majority (97.9%) of our patients fall below the 250% federal poverty level threshold, and 96% belong to racial and ethnic minority groups. Some adolescents and young adults told us they didn’t have a digital device or had poor Wi-Fi access with limited cellular data availability for a video call. Others talked about privacy concerns such as thin walls in their home 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 conducted via telehealth. As a result, we conducted far fewer tests for sexually transmitted infections (despite the high nationwide rates of these infections). The alarming reduction in routine healthcare could lead to unrecognized and long-term complications from untreated infections. So, we decided to implement an innovative pilot proposal that challenges and shifts clinical practice by addressing technology as a critical component of social determinants of health.
Through a Health Disparities Research grant from Baylor College of Medicine for a project titled “Technological Determinants of Health: Factors Associated with Equitable Utilization among Minority Adolescents and Young Adults Receiving Sexual Health Services,” we explored telehealth acceptability and digital inequities (device access, internet access and digital literacy) affecting utilization of telehealth for sexual health services among adolescents and young adults.
In our survey of approximately 350 adolescents and young adults, while 99.6% of respondents had access to a telehealth compatible device and 99.2% had internet access, over one-third (37%) stated that they could not trust their equipment to work. Some found it difficult to use technology (12%), and others had privacy concerns (8%). Most found the modality acceptable, agreeing that it could save them time (69%) and that they could be satisfied with a telehealth visit (59%).
Our respondents provided us with feedback such as offering suggestions for local resources like internet access that we could provide to our patient population (e.g. from respondent, “There’s a Starbucks that’s two miles away” or “Check out this resource of free Wi-Fi’s in Houston”), discussing privacy upfront and allowing the patient to scan the room by rotating the provider’s camera to allay any fear that other people maybe listening into the conversation.
The findings from our survey and qualitative interviews are laying the groundwork for subsequent research focused on action-oriented steps to develop innovative interventions and clinical practice recommendations. The study has the potential to improve and innovate future public health clinical practice by developing a clinical intervention to address barriers to telehealth based on adolescents and young adults’ feedback.
By Allyssa Aguila Abacan MPH, PhD, Business Strategy and Development Associate, Baylor Population Program and Meghna Raphael, M.D., Assistant Professor, Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics