Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults.

BACKGROUND: To reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored. OBJECTIVE: The 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs. METHODS: This study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis. RESULTS: Overall, 501 (373, 74.4% female; age range 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over one-half (279/501, 55.7%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants' perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options. CONCLUSIONS: The increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents.

Internet access is a necessity: a latent class analysis of COVID-19 related challenges and the role of technology use among rural community residents.

BACKGROUND: Rural and remote communities faced unique access challenges to essential services such as healthcare and highspeed infrastructure pre-COVID, which have been amplified by the pandemic. This study examined patterns of COVID-related challenges and the use of technology among rural-living individuals during the first wave of the COVID-19 pandemic. METHODS: A sample of 279 rural residents completed an online survey about the impact of COVID-related challenges and the role of technology use. Latent class analysis was used to generate subgroups reflecting the patterns of COVID-related challenges. Differences in group membership were examined based on age, gender, education, race/ethnicity, and living situation. Finally, thematic analysis of open-ended qualitative responses was conducted to further contextualize the challenges experienced by rural-living residents. RESULTS: Four distinct COVID challenge impact subgroups were identified: 1) Social challenges (35%), 2) Social and Health challenges (31%), 3) Social and Financial challenges (14%), and 4) Social, Health, Financial, and Daily Living challenges (19%). Older adults were more likely to be in the Social challenges or Social and Health challenges groups as compared to young adults who were more likely to be in the Social, Health, Financial, and Daily Living challenges group. Additionally, although participants were using technology more frequently during the COVID-19 pandemic to address challenges, they were also reporting issues with quality and connectivity as a significant barrier. CONCLUSIONS: These analyses found four different patterns of impact related to social, health, financial, and daily living challenges in the context of COVID. Social needs were evident across the four groups; however, we also found nearly 1 in 5 rural-living individuals were impacted by an array of challenges. Access to reliable internet and devices has the potential to support individuals to manage these challenges.

School responsiveness to adoption among lesbian mothers.

A sample of adoptive parents, including an oversampling of lesbian mothers (n = 125), was surveyed regarding their family's school experiences related to adoption, satisfaction with how the school handled adoption-related issues, and their child's experiences with teasing at school. Linear and logistic regression analyses showed that lesbian mothers were more likely than heterosexual parents and gay fathers to disclose their child's adoption status in the school record and to ensure that the school was aware of the child's adoption. Lesbian mothers were also more likely than heterosexual parents and gay fathers to report talking to teachers about adoption issues. There were no differences as a function of parent sexual orientation regarding rates of children being teased about adoption status. However, rates of teasing regarding child race/ethnicity were higher for children of lesbian mothers and gay fathers than for children of heterosexual parents. The implications of the findings for future research and the provision of services for lesbian mothers are considered.

Lesbian, Gay, and Heterosexual Adoptive Parents' Attitudes Towards Racial Socialization Practices.

We tested the validity and measurement invariance of the Transracial Adoptive Parenting scale (TAPS) across sexual orientation with a nationwide sample of adoptive parents. Our study sample consisted of 737 heterosexual, 102 lesbian, and 64 gay adoptive parents from the Modern Adoptive Families (MAF) study, a cross-sectional survey. We conducted reliability analyses, as well as exploratory and confirmatory factor analyses for the 29-item TAPs. We then tested for measurement invariance based on sexual orientation. Findings show the TAPS is a reliable scale with a two-factor model measuring racial socialization and managing bias related to racial socialization practices. However, there was measurement invariance based on parent sexual orientation. Our study informs practitioners that the TAPS measure is a useful tool for assessment and intervention that can be used with sexual minority transracial adoptive parents. However, cautions against comparing TAPs scores across parental sexual orientation.