Factors Affecting Patients' Use of Telehealth Services: Cross-Sectional Survey Study.

Background: The increased integration of telehealth services into health care systems, especially during the COVID-19 pandemic, transformed patient-provider interactions. Despite numerous benefits that promote health equity and resource allocation, patients' acceptance and use of telehealth have declined post pandemic. To enhance health care delivery and patient satisfaction, we study the factors of this decline from the perspective of patient characteristics that influence the adoption and use of telehealth services. Objective: This study examines the direct impact of patient trust, social determinants of health, and health self-efficacy on telehealth usage, the indirect effect of confidence in health information seeking, patient-centered communication, and health literacy barriers on telehealth usage through trust. Methods: This paper uses secondary data from cycle 6 of the Health Information National Trends Survey, a nationally representative dataset collected by the National Cancer Institute. This dataset used a mixed-mode experimental design, with data collected between March and November 2022. The survey included 2 experimental conditions: concurrent (web and paper surveys offered simultaneously) and sequential (web survey offered first, followed by paper). A total of 6252 respondents participated, with a household response rate of 28.1% (6252/22,471). Respondents were randomly assigned to 1 of 3 web-based survey groups to address data quality issues such as speeding and straight lining. We use structural equation modeling to test our research questions, evaluating both direct and indirect pathways influencing telehealth usage. Common method bias is addressed through Harman's single-factor test, and robustness checks ensure the validity and reliability of our results. Results: Out of 5554 participants who had at least 1 doctor visit within the past 12 months, 44.89% used telehealth services in the past year. Trust has an inverted U-shaped relationship with confidence in health information seeking (β=-.031; P=.002); we find trust positively influenced by patient-centered communication (β=.156; P<.001) and negatively affected by health literacy barriers (β=-.063; P<.001). Trust enhances telehealth usage (β=.025; P<.001), with social determinants of health exerting a positive impact (β=.105; P<.001) and health self-efficacy having a negative impact (β=-.019; P=.007). Conclusions: This study finds that trust, social determinants of health, and health self-efficacy directly impact telehealth usage. Additionally, telehealth usage is indirectly influenced by patient characteristics, such as confidence in health information seeking and health literacy barriers, as well as by a patient-centered communication environment. The findings emphasize the need for targeted interventions to improve patient health literacy and engagement, thereby promoting the telehealth services usage.