Work

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

Year: 2022

Type: article

Abstract: Objective To examine the preferred response mode (internet, phone, paper)to a Medicaid enrollee survey. Data Source Data was obtained from survey responses for a sub-sample of Flint Water Crisis Medicaid Expansion Waiver enrollees (N=2584). Study Design Enrollees were offered the choice of utilizing the internet, telephone, or mail to respond to a survey evaluating health services. Analyses were stratified by age, residency, race, and income. Chi-square was utilized to detect categorical differences. Principal Findings The majority (p<0.01) of participants responded by internet (55.46%), followed by mail (39.36%), and telephone (5.19%). Of those responding by internet, 75% used smart phones for connectivity. Weighted participation estimates for available survey modes showed variation by age, residence, race/ethnicity and poverty status. A smaller proportion (p<0.01) of ethnicities classified as Hispanic and Other used telephone participation compared to White or Black respondents. Respondents at 200% Federal Poverty Level (FPL) or higher used internet at greater rates than those below 200% FPL (p<0.01). Conclusions Overall, this low-income population preferred the web-based response mode compared to paper or telephone, the variation by race and FPL suggests the continued presence of a digital divide in the population. Nevertheless, our findings revealed greater utilization of web-based tools for survey administration in vulnerable populations than was expected. This is a valuable finding that may inform future health programming and telehealth efforts particularly in the advent of COVID-19. What this study adds Active health care participation using internet connectivity is increasing and may be associated with improved quality and costs of health care services yet access and usage vary among populations. Research suggests that persons of low income and resources are unable to participate with internet based activities due to access and literacy issues that may further exacerbate health disparities. This study revealed enrollees of the Flint Michigan Section 1115 Demonstration utilized the internet for survey participation at a greater rate than responding by mail or phone. Finding that vulnerable populations have greater access to the internet via digital technology than assumed may expand opportunities to participate in their health care through health information portals and telehealth.

Source: Journal of Health Care for the Poor and Underserved

DOI: 10.1353/hpu.2022.0080