Telehealth and Reproductive Health Equity

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PROJECT SUMMARY Historically marginalized populations such as people of color, low-income people, and immigrant populations disproportionately face barriers to reproductive healthcare. Telehealth options for reproductive health care services are growing and may address some of the distance and cost barriers to access. Research on telehealth for primary care suggests that it may bridge geographic disparities, allow for easier language translations, feel safer and more private for immigrant populations, be less expensive, and require less time off work or school. Conversely, telehealth services could exacerbate inequities if patients lack technology, digital literacy, and reliable internet coverage. Our long-term goal is to reduce disparities in healthcare access and to optimize telehealth for groups historically marginalized from healthcare including people of color, low-income people, and immigrants. The goal of this research is to determine whether telehealth provides patients with more timely and affordable reproductive healthcare, whether telehealth reaches people in areas with greater health inequities, and which attributes of telehealth patients prefer. The Telehealth and Reproductive Health Equity study will enroll 2,000 patients seeking reproductive health care. One cohort will comprise 1,000 patients seeking telehealth or in-person services through the clinic sites. A second cohort of 1,000 patients searching for a reproductive healthcare provider online will be recruited using Google Ads. In Aim 1 we will determine the ways in which telehealth services affect timing, costs, and follow-up care relative to in-person care. We will also compare rates of unplanned in-person care between telehealth and in-person groups. The cohorts recruited from clinics and via Google Ads will be analyzed separately. In Aim 2 we will conduct a geospatial analysis of patient census block groups or tracts to determine whether compared to patients using in-person care for abortion care, patients using telehealth reside in areas with greater health inequities. We will compare the telehealth and in-person groups using four social vulnerability indices. In Aim 3 we will determine preferences in and barriers to telehealth for reproductive healthcare, focusing on historically marginalized populations. We will use two innovative methods traditionally used for market research, the discrete choice experiment and maximum difference analysis. This research addresses substantial and increasing disparities in access to healthcare in historically marginalized groups. The results of the proposed research will provide clear guidance on how health care providers can design telehealth services so that they are accessible and attractive to people of color, low-income people, and immigrants. Our results will contribute to digital inclusion and increased health access and will be applicable to all areas of healthcare.