The Impact of Telehealth Use Experience on Recruitment of Underserved Populations Into a Telehealth-Delivered Mindfulness-Based Trial for Patients With Chronic Low Back Pain: Cross-Sectional Survey.

Abstract

Background: Mindfulness-based stress reduction (MBSR) is recommended as a noninvasive, evidence-based treatment for chronic low back pain (CLBP); however, access and uptake are often constrained among medically underserved populations. Telehealth-delivered MBSR may scale access, yet little is known about the characteristics of underserved patients who have experience using telehealth and are willing to enroll in pragmatic trials evaluating MBSR.

Objective: This study examined individual- and county-level social vulnerability characteristics associated with telehealth use experience among people living with CLBP who enrolled in OPTIMUM (Optimizing Pain Treatment in Medical Settings Using Mindfulness), a pragmatic randomized clinical trial of telehealth-delivered MBSR.

Methods: We conducted a cross-sectional analysis of baseline measures from the OPTIMUM trial, focusing on participants from a safety-net health institution and a federally qualified health center. The primary outcome was telehealth use experience (having had a prior telehealth visit at or before enrollment). Guided by Andersen's Behavioral Model of Health Services Use, we evaluated predisposing, enabling, and need factors. Prespecified measures included the following: demographics; employment and education; internet access and comfort using Zoom; neighborhood indices (Area Deprivation Index [ADI], Social Vulnerability Index [SVI]); rurality; back-pain duration; and validated patient-reported outcomes. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% CIs.

Results: Of 244 enrolled participants (mean age 50.6, SD 13.5 y; n=162, 66.7% female; n=124, 50.8% non-Hispanic Black), 174 (71.3%) reported previous telehealth use. Predisposing factors associated with lower telehealth use included race or ethnicity (non-Hispanic Black: AOR 0.38, 95% CI 0.2-0.8; Hispanic: AOR 0.21, 95% CI 0.06-0.7) and part-time employment (AOR 0.33, 95% CI 0.1-0.9) vs full-time employment, whereas educational attainment above or below a high school degree was associated with higher odds of telehealth use (AORs 2.7-3.2). Enabling factors showed that lower comfort with Zoom was associated with lower telehealth use (AOR 0.5, 95% CI 0.2-0.9), whereas home internet access was common and not independently significant in adjusted models. Neighborhood socioeconomic disadvantages, social vulnerability, and rurality did not demonstrate significant associations. Needs factors indicated that longer CLBP duration was positively associated with telehealth experience (>5 y: AOR 3.5, 95% CI 1.4-8.8). Other patient-reported outcomes, comorbidity burden, and surgical history were not significantly associated.

Conclusions: In a safety-net and federally qualified health center context, prior telehealth experience was common among patients with CLBP willing to enroll in a telehealth-delivered MBSR trial. Although certain predisposing factors (race or ethnicity, employment status) were associated with lower odds of telehealth experience, these factors did not prevent trial enrollment. Targeted outreach to improve digital comfort and inclusive engagement strategies may further reduce disparities and support broader implementation of telehealth for CLBP.