Evaluating the Effectiveness of Routine Screening for Digital Needs Among Rural Veterans

Context: To facilitate access to telehealth services among Veterans enrolled in Veterans Health Administration (VHA) care during the COVID-19 pandemic, in August 2020 VHA implemented a national Digital Divide (DD) Consult. Through this consult, Veterans without reliable internet access or video-capable devices can receive a loaned internet-connected device and/or assistance applying for federal internet subsidies. VHA lacks a way, however, to systematically identify Veterans who would benefit from a DD Consult.

Objective: To develop and integrate digital needs screening questions into an existing VHA social risk screening and referral program, “Assessing Circumstances & Offering Resources for Needs” (ACORN).

Study Design: Cross-sectional pilot.

Setting: Two rural VA primary care clinics.

Population Studied: Veterans seen by primary care social work between July-September 2021.

Intervention: Digital needs screening questions were developed with input from an interprofessional group of clinicians and subject matter experts, and refined through cognitive testing with Veterans. Questions assessed access to a phone, tablet, and/or computer; access to reliable and affordable internet; running out of phone minutes and/or data before the end of the month; interest in assistance setting up a telehealth visit; and need for help learning to use a device for a telehealth visit. Social workers routinely administered the expanded ACORN screening tool to Veterans as part of an intake assessment.

Outcome Measures: 1) prevalence of reported digital needs and 2) DD Consult placed in the prior 12 months (y/n).

Results: Of 156 Veterans screened, 45% reported >=1 digital need. Twenty-two percent reported not having access to a device, 13% lacked reliable and affordable internet, and 3% reported often or sometimes running out of phone minutes and/or data. Thirteen percent of Veterans were interested in help setting up a telehealth visit; of those, 55% needed help learning to use a device. Among Veterans with a digital need, only 4% had a DD Consult placed in the prior 12 months.

Conclusions: Nearly half of rural Veterans in our pilot screened positive for >=1 digital need. The vast majority of Veterans identified as having a digital need had not previously had a DD Consult placed. Routine screening for digital needs is a critical step towards connecting Veterans with needed technology resources and informing future resource allocation in VHA.