Rethinking the Digital Divide: Using an Internet Survey in a Flint Water Crisis Medicaid Population.

Area of Science:

• Public Health
• Health Services Research
• Health Communication

Background:

• Understanding preferred communication channels is crucial for effective health services research.
• The Flint Water Crisis impacted a vulnerable population, necessitating accessible health program outreach.
• Digital communication and telehealth are increasingly important in public health, especially post-COVID-19.

Purpose of the Study:

• To determine the preferred mode of response (internet, phone, mail) for a health services survey among Flint Water Crisis Medicaid Expansion Waiver enrollees.
• To analyze response preferences based on demographic factors like age, residency, race, and income.
• To assess the role of smartphones in internet-based survey participation within this population.

Main Methods:

• Survey data collected from 2,584 Flint Water Crisis Medicaid Expansion Waiver enrollees.
• Chi-square tests used for analyzing categorical differences in response modes.
• Stratified analyses conducted by age, residency, race, and income.

Main Results:

• The majority of participants (55.5%) preferred internet responses, followed by mail (39.4%) and phone (5.2%).
• Among internet responders, 75% utilized smartphones for connectivity.
• Black and White respondents showed higher internet usage rates than Hispanic respondents (p<0.01).
• Respondents at or above 200% federal poverty level (FPL) used the internet more frequently than those below 200% FPL (p<0.01).

Conclusions:

• Vulnerable populations demonstrate higher-than-expected internet usage for health surveys.
• Despite increased internet use, a digital divide persists within this demographic.
• Findings can inform the development of digital health programming and telehealth strategies, particularly in light of the COVID-19 pandemic.