The effect of broadband access on electronic patient engagement activities: Assessment of urban-rural differences

Lack of access to high-speed internet may explain disparities in the use of technologies that support electronic patient engagement (EPE). This study describes trends in how people with and without fixed broadband connectivity in urban and rural communities used EPE tools to interact with health care providers between 2014 and 2018.

We linked Federal Communications Commission fixed broadband data with the Association of American Medical Colleges Consumer Survey of Health Care Access data for years 2014-2018 (n = 23,131). ZIP Codes with a 25Mbps download speed and 3Mbps upload speed were determined to have broadband connectivity access. We evaluated 6 activities involving the use of 4 EPE tools (email, text, website, chat, video, and mobile app) and the intensity of use (0 = none, 1-3 = low, 4-6 = high). Multivariate logistic and multinomial regression models were used to determine factors associated with EPE.

More than half (57.1%) of those without broadband access lived in rural areas. Overall, the intensity in the use of EPE tools increased from 2014 to 2016, then declined steadily with higher increases in use observed in urban and suburban than in rural areas. Lack of broadband access was associated with increased odds of zero intensity versus low-intensity use of EPE tools in rural areas (OR = 1.72, 95% CI: 1.42-2.09).

Inequality in broadband connectivity access may explain why rural communities lag in using various electronic tools for interacting with health care providers. Continued efforts to increase broadband connectivity in rural communities could improve their engagement with care providers.