Telehealth Use and Modality Choice Among US Adults: Shorrocks-Shapley Decomposition of a 2022 Cross-Sectional National Survey.

Background: Telehealth use surged during the COVID-19 pandemic and has stabilized at levels substantially above prepandemic baselines. However, concerns persist that the digital divide may reproduce or widen disparities in access. Understanding the determinants of telehealth use-and particularly modality choice between video and audio-is essential for designing policies that promote equitable access in the post-public health emergency era. Objective: This study aims to identify determinants of telehealth use and modality among US adults in 2022 and quantify the relative contributions of digital, geographic, clinical, and socioeconomic domains. Methods: We conducted a cross-sectional secondary analysis of the sixth cycle of the Health Information National Trends Survey, administered in 2022 by the National Cancer Institute, a nationally representative, 2-stage stratified random probability survey of civilian, noninstitutionalized US adults aged 18 years or older. Sampled households were recruited via mailed invitations, and 1 adult per household was randomly selected using the next birthday method and invited to complete a self-administered questionnaire between February 2022 and November 2022 (N=6252). The primary analytic sample included respondents with nonmissing telehealth modality responses (n=6046, 59.4% female; mean age of 55.1 y). Individual-level data were linked to county-level American Community Survey socioeconomic indicators and broadband availability measures. The primary outcome was telehealth use, categorized as video (n=1641, 27.2%; 95% CI 25.5%-29.1%), audio-only (n=876, 12.1%; 95% CI 10.9%-13.4%), or none (n=3529, 60.7%; 95% CI 58.6%-62.7%). We estimated 4 binary contrasts using survey-weighted linear probability models with jackknife variance estimation, reporting absolute risk differences in percentage points (pp) with 95% CIs. We applied Shorrocks-Shapley decomposition to quantify each predictor domain's contribution to explained variance. Results: Nationally, 39.3% (n=2517; 95% CI 37.3%-41.4%) reported any telehealth use in the past 12 months. In survey-weighted linear probability models (α=.05), significant predictors of any telehealth vs none included: male sex (-9.7 pp, 95% CI -14.0 to -5.4), disability status (+22.5 pp, 95% CI 16.1-28.8), and health app use (+18.4 pp, 95% CI 12.0-24.8). For video vs audio-only telehealth, insurance coverage increased video use (+21.2 pp, 95% CI 13.0-29.3), while basic cell phone only (vs smartphone) decreased video use (-20.1 pp, 95% CI -33.5 to -6.8). Shorrocks-Shapley decomposition revealed that digital access and eHealth behaviors explained 40.4% of variance in video vs audio choice and 33.4% of video vs none; geography explained 40.5% of audio vs none; digital factors (25.7%), geography (19.7%), and health status and needs (15.5%) all contributed substantially to any vs none. Conclusions: Digital access and eHealth behaviors collectively explain more variance in modality choice than traditional sociodemographic factors. Telehealth uptake reflects a combination of digital factors, geography, and clinical need, whereas video modality specifically hinges on digital readiness. Interventions pairing sustained insurance coverage with targeted investments in device access, affordable high-speed connectivity, and digital literacy training are most likely to narrow persistent telehealth gaps.