Exploring Multiple Dimensions of Access to and Preferences for Telehealth Use.

Introduction: During the pandemic, telehealth became critically important in care provision. Yet, research exposed the inequities facing various groups of people in terms of accessing telehealth. The purpose of this analysis was to examine the various dimensions of access that impact a person's ability to use and preference for telehealth.

Methods: We used a mixed-methods approach framed by Levesque's Access to Health care model. In August, 2021, a stratified random sample of 500 patients of an integrated rural health care network was invited to participate in a survey designed to capture familiarity with, use of, and preference for digital technologies in general as well as with telehealth. In addition, key informant interviews were conducted between January 2022 and June 2022.

Results: Patients' willingness to use telehealth was influenced by multiple dimensions of access, including approachability of the resource, acceptability, availability, affordability, and appropriateness. Clinician beliefs and attitudes as well as health care system policies affected how a patient perceived, sought, reached, and engaged with telehealth.

Conclusions: Access is a dynamic, multifaceted concept that is influenced by individual-, organization-, and systemic-level factors. Looking beyond patient determinants and examining different dimensions of access is important to better facilitate implementation and sustainment of telehealth.