Addressing the Digital Divide with Annual Mammography Exams

Could the increased development of telehealth options and online patient portals expand access to preventive care services and possibly exacerbate disparities with access at the same time?

Obtaining data from the 2018 National Health Interview Survey (NHIS), researchers performed a retrospective analysis involving 7,255 women (ranging between 40 and 74 years of age) with no history of breast cancer to assess the association between computer use and annual mammography exams.

The researchers found that patients who used computers to look up health-care information were 1.4 times more likely to get annual mammograms. Similarly, women who used the Internet to fill a prescription, schedule a health-care appointment or communicate with a clinician via e-mail were 1.6, 1.4 and 1.6 times more likely, respectively, to have annual mammography screenings.

However, only 18 percent of the 7,255 survey respondents scheduled health-care appointments online, according to the study. The study authors found that these women were more likely to be White, married, insured, and employed with higher income and higher education.

(Editor's note: For a related article, see "Study Finds Disparities with Follow-Up After Incomplete Mammography Exams.")

Specifically, those who did not schedule clinician appointments online made more than $40,000 less in mean household income in comparison to those who did online scheduling of health-care appointments. The researchers noted that among patients who didn’t do online scheduling, 38.5 percent did not have a college degree. For those who used online scheduling, 15.3 percent did not have a college degree.

“The results suggest that the expansion of digital health outreach and online portals may exacerbate breast cancer screening disparities,” wrote Peter Abraham, M.D., MAS, who is affiliated with the Department of Radiology at the University of California, and colleagues. “Radiology practices and health care leaders must collaborate better with underserved communities to cocreate feasible and scalable digital interventions.”

In addition to identifying potential gaps in broadband coverage, ensuring telehealth access in convenient locations, and modifying websites to be more linguistically and culturally appropriate are key measures, according to the authors. Dr. Abraham and colleagues also emphasized maintaining non-digital measures such as community outreach and traditional scheduling methods.