Uncovering eHealth Engagement Patterns Through Latent Class Analysis and SHAP: A Data Mining Perspective on Telehealth Access

Understanding how patients engage with digital health technologies is critical for improving the reach and equity of telehealth services. While prior research has largely focused on demographic predictors of telehealth use, this study applies a hybrid data mining approach to uncover behavioral engagement patterns and evaluate their predictive power. Using data from the 2022 U.S. Health Information Trends Survey (HINTS; N = 3525), we identified four distinct eHealth engagement typologies through Latent Class Analysis (LCA): (1) Highly Digital Engagers, (2) Moderate Digital Users, (3) Social Media and App Enthusiasts, and (4) Wearable and Health App Enthusiasts. We then modeled telehealth utilization as the outcome using multivariable logistic regression and eXtreme Gradient Boosting (XGBoost) with Shapley Additive Explanations (SHAP). Compared to Highly Digital Engagers, Moderate Digital Users had significantly lower odds of telehealth use (OR = 0.52), while the other two classes had higher odds. SHAP analyses confirmed that depression status and geographic region interacted with engagement profiles to shape telehealth access, with a notably negative effect of depression within Class 2. These findings demonstrate the value of integrating behavioral segmentation with interpretable machine learning to characterize heterogeneity in digital health engagement and its association with telehealth utilization. Our study offers a scalable, population-level analytic framework that can inform targeted telehealth planning and outreach strategies aligned with real-world patterns of digital engagement.