Relationship of Rurality and Confidence in Video Skills With Persistent Nonuse of Video Appointments for Health Care.

INTRODUCTION: Limited research has examined how technology and digital literacy may affect patients' use of video visits. This study explored the relationship of demographic factors and patient-reported confidence in digital literacy skills to access to video visits among patients who never used them during the COVID-19 pandemic. METHODS: Using existing survey data, the current study examined data from respondents who did not engage in video appointments but instead attended face-to-face appointments between April and December 2020 for nonemergent health concerns. A multivariable logistic regression model was used to investigate whether demographic and social determinants of health factors, context of care (primary care or psychiatry/psychology), and digital literacy confidence were associated with video visit engagement. Collinearity was assessed using the variance inflation factor. RESULTS: This study found that living in rural areas and having a self-reported lack of confidence in logging video appointments using the Mayo Clinic patient portal were associated with persistent nonuse of video appointments in a cohort of patients who did not use video visits at this institution during the early part of the COVID-19 pandemic. DISCUSSION: The research findings reported herein reveal that individuals living in rural areas and those who lack confidence in logging into patient portals to access video visits tend to persistently avoid using video appointments. More investment is needed at the federal and corporate levels to improve digital connectivity. Digital navigators and community involvement can promote digital adoption. CONCLUSION: To encourage digital competency in rural communities, it is important to implement support strategies through community stakeholders and other resources.

Proximal Risk for Suicide: Protocol for an Ecological Momentary Assessment Study.

BACKGROUND: Suicide is a prevalent public health concern in the United States across all age groups. Research has emphasized the need to identify risk markers that prevent suicide along shorter timeframes, such as days to weeks. Furthermore, little has been done to explore the relative significance of factors that can predict short-term suicide risk or to evaluate how daily variability in these factors impacts suicidal ideation or behavior. This proposed project aims to identify risk factors that best predict near-time changes in suicidal ideation and examine potential interactions between these factors to predict transitions into suicidal thinking or behaviors. OBJECTIVE: The aim of this proposed study is threefold: (1) To identify which psychological risk factors are most strongly associated with proximal changes in suicide risk across days and weeks. (2) To evaluate theoretical assumptions of the Integrative-Motivational-Volitional Theory of Suicide. (3) To determine how disruptions in physiological arousal interact with theoretical mechanisms of risk to predict concurrent and short-term prospective increase in suicidal thoughts and behaviors. METHODS: A daily diary or ecological momentary assessment design will be utilized with 200 participants. Participants will complete 2 in-person visits separated by 3 weeks during which they will complete 3 brief daily assessments within their natural environments using the ilumivu research app on a smart device. Research will occur at the Mayo Clinic Health System (MCHS) Eau Claire site. Participants will be recruited through chart review and standard care delivery assessment. RESULTS: This manuscript outlines the protocol that will guide the conduct of the forthcoming study. CONCLUSIONS: The proposed project aims to lead efforts using technological advances to capture microchanges in suicidal thinking/behavior over shorter timeframes and thereby guide future clinical assessment and management of suicidal patients. Results of this study will generate robust evidence to evaluate which risk factors predict proximal changes in suicidal ideation and behaviors. They will also provide the ability to examine potential interactions with multiple theoretically derived risk factors to predict proximal transitions into worsening suicidal thinking or behaviors. Such information will provide new targets for intervention that could ultimately reduce suicide-related morbidity and mortality. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/37583.

Patient Telemedicine Perceptions During the COVID-19 Pandemic Within a Multi-State Medical Institution: Qualitative Study.

BACKGROUND: During the COVID-19 pandemic, to prevent the spread of the virus, federal regulatory barriers around telemedicine were lifted, and health care institutions encouraged patients to use telemedicine, including video appointments. Many patients, however, still chose face-2-face (f2f) appointments for nonemergent clinical care. OBJECTIVE: We explored patients' personal and environmental barriers to the use of video appointments from April 2020 to December 2020. METHODS: We conducted qualitative telephone interviews of Mayo Clinic patients who attended f2f appointments at the Mayo Clinic from April 2020 to December 2020 but did not utilize Mayo Clinic video appointment services during that time frame. RESULTS: We found that, although most patients were concerned about preventing COVID-19 transmission, they trusted Mayo Clinic to keep them safe when attending f2f appointments. Many expressed that a video appointment made it difficult to establish rapport with their providers. Other common barriers to video appointments were perceived therapeutic benefits of f2f appointments, low digital literacy, and concerns about privacy and security. CONCLUSIONS: Our study provides an in-depth investigation into barriers to engaging in video appointments for nonemergent clinical care in the context of the COVID-19 pandemic. Our findings corroborate many barriers prevalent in the prepandemic literature and suggest that rapport barriers need to be analyzed and problem-solved at a granular level.