Associations Between Digital Attitudes, Digital Inequalities, and Health Care Use Among Recipients of a Community-Based Laptop Distribution Program: Cross-Sectional Study

Abstract Background Telehealth use expanded rapidly during the COVID-19 pandemic, yet persistent digital inequities continue to shape who benefits from virtual and preventive health services. Although community-based digital inclusion programs aim to reduce barriers to access, less is known about how device reliability, broadband conditions, and perceptions of online health information influence health care use after access is provided. Objective The objective of this study was to investigate associations between digital attitudes and access and health care use, including telehealth use and preventive health care visits, among participants in a community-based laptop distribution program. Methods This study analyzed cross-sectional survey data from 1019 participants in a community-based laptop distribution program. Refurbished laptops were distributed between October 2020 and July 2023, after which approximately 20,000 program recipients were invited by email to complete an online survey in English or Spanish. Ordered logistic regression models assessed predictors of telehealth use and preventive health care use. Models were adjusted for sociodemographic characteristics, digital access conditions, and attitudes toward online health information. Results Among respondents, 26.95% (218/809) reported increased preventive health care visits since receiving a laptop, and 62% (502/810) reported using telehealth sometimes or often. Having a functioning program laptop was associated with higher odds of increased preventive health care use (odds ratio [OR] 2.13, 95% CI 1.07‐4.27; P =.03), whereas living with a partner was associated with lower odds (OR 0.47, 95% CI 0.23‐0.99; P =.048). Participants with both fast internet and affordable broadband had greater odds of increased preventive health care use (OR 8.29, 95% CI 1.03‐66.50; P =.046). Participants who strongly agreed that online information helped them make better health decisions were more likely to report increased preventive health care use (OR 15.03, 95% CI 4.53‐49.82; P <.001). More frequent telehealth use was associated with reporting that online health information often improved health (OR 17.77, 95% CI 6.78‐46.56; P <.001) and with speaking a language other than English as a primary language (OR 5.95, 95% CI 1.73‐20.41; P =.005). Respondents reporting decreased physician visits had lower odds of telehealth use (OR 0.21, 95% CI 0.10‐0.46; P <.001). Race, ethnicity, gender, race-by-gender, and ethnicity-by-gender interaction terms were not substantial in adjusted models. Conclusions Digital inclusion efforts may support engagement with preventive and virtual health services, but access alone appears insufficient. Device functionality, broadband quality and affordability, and perceptions of the value of online health information were important predictors of health care use. Digital inclusion initiatives should address both technological infrastructure and digital health engagement to promote equitable access to care.