Demographic differences between patients selecting video or telephone for contraceptive counseling via telehealth

Abstract

Objective: To explore differences in demographic characteristics and telehealth usability between patients who chose video versus telephone for telehealth contraceptive counseling.

Study design: This was a secondary analysis of a prospective cohort comparing the interpersonal quality of contraceptive counseling between in-person and telehealth visits at a single Title X-funded clinic. Before the clinical visit, a non-clinician counselor provided structured contraceptive counseling based on patients' preferred modality. After counseling, respondents completed an electronic survey which included the Telehealth Usability Questionnaire (TUQ). Post-visit, the counselor evaluated perceived patient engagement. We calculated Area Deprivation Index (ADI) percentiles to characterize neighborhood environment. We compared characteristics between patients choosing video and telephone using Poisson regression and performed analyses stratified by ADI to test for effect modification.

Results: Between March 2021 and June 2022, we enrolled 149 patients in the telehealth group: 146 (98%) were included in the analysis. Seventy percent of respondents chose telephone. Higher ADI, Black race, and lower educational level (<4 years college) were associated with choosing telephone in the unadjusted analysis. However, after stratifying by ADI, only lower educational level remained associated with choice of telephone among respondents from more deprived neighborhoods (aRR 1.46, 95% CI 1.01-2.11). We observed no differences in TUQ scores between respondents choosing telephone and video.

Conclusion: When given the option, more patients selected telephone than video for telehealth contraceptive counseling. No demographic characteristics were associated with choice of telephone among patients with a higher ADI. Offering telephone-based telehealth may improve access for people seeking contraceptive services.

Implications: We found that telephone-based telehealth is preferable for some patients, which may reflect differences in access to or comfort with video technology. We observed that higher ADI, Black race, and lower education level were associated with choice of telephone, although not after stratifying by ADI. Utilization of telephone-based telehealth may improve access for some patients and lead to more equitable-based health care.

Keywords: Contraceptive; Counseling; Disparities; Telehealth.