Telehealth Digital Divide: Bridging the Gap or Leaving Some Behind?

STRIDE is committed to understanding how its patients utilize telehealth options and ensuring these services are accessible to all. As healthcare increasingly shifts to digital platforms, STRIDE recognizes the importance of bridging the gap for those who may be left behind. Their efforts are focused on identifying barriers and enhancing telehealth access, ensuring every patient can benefit from these convenient and vital services. With STRIDE's numbers of patients who self-identify as Hispanic/Latino/a steadily increases, reaching as high as 58% in some clinics, STRIDE takes a serious look at ways to improve telehealth services in such a way that no one is left behind.

Telehealth Services for Latinx Patients

Healthcare is constantly evolving as medical providers learn about advances in research, best practices, medication, and especially technology. Technology has provided many developments in healthcare including the rise of a relatively new form of healthcare delivery– telehealth. Telehealth has given patients the ability to access healthcare without having to make an in-person appointments with their medical providers through the use of secure phone calls, text messages, and video calls (1). Telehealth especially became a common solution for patients who needed access to regular medical appointments, but were required to follow stay at home orders during the Covid-19 pandemic (7). The potential benefits for using telehealth have included: increased flexibility in location (patients and providers can attend an appointment at home or at their place of work if necessary), increased availability of time (patients do not need to completely reschedule their work hours or worry about who will look after children/older family members as often), and decreased need of transportation to attend medical appointments (1).

Who Uses Telehealth?

In 2021, 37.0% of adults in the United States used telemedicine (2). In addition, the percentage of adults who used telemedicine increased with age, from 29.4% among adults aged 18–29 to 43.3% among adults aged 65 and over in 2021 (2). Among patients of different insurance types in the US, the highest rates of telehealth visits were from those covered by Medicaid (28.3%) and Medicare (26.8%), while those with private insurance and no insurance were the least likely to use telehealth services during 2021 (3). In terms of telehealth use between patients of different income earnings in 2021, telehealth use was used more frequently by patients of lower incomes (the highest rate of usage where those earning less than $25,000) and declined as income increased (3).

Telehealth Impact for Latinx Patients

There has been successful implementation of telehealth services aimed towards Latinx patients including the ACTIVATE program which focuses on providing equitable diabetic management services through telehealth services to rural, low income, Latinx farming communities who would typically not have access to diabetic management counseling (4). Also, the potential benefits of telehealth services apply for Latinx patients including being able to receive immediate healthcare despite potential barriers to accessing transportation and finding time among important work and family obligations. While telehealth can serve as a potential solution to certain barriers experienced by the Latinx community, there are still barriers that exist in telehealth services that affect Latinx patients.

Telehealth Barriers for Latinx Patients

Socioeconomic status and race/ethnicity affect a patient’s ability to use digital platforms which can lead to inequitable healthcare access through telehealth (5). In fact, Non-Hispanic White (39.2%) and non-Hispanic American Indian or Alaska Native (40.6%) patients were more likely to use telemedicine compared to Hispanic (32.8%), non-Hispanic Black (33.1%), and non-Hispanic Asian (33.0%) patients during 2021 (2). Some specific factors that can affect Latinx patients from utilizing telehealth services include language barriers, digital literacy, and quality of services.

According to the UCLA Latino Policy and Politics Institute, when evaluating telehealth services for Latinx patients during the Covid-19 pandemic, the institute found that patients with Limited English Proficiency (LEP) were less likely to use telehealth services (5). Additionally, Latinx patients had more challenges with telehealth use compared to white patients due to limited availably of non-English sources and technical assistance (5).

Digital literacy and access to available devices such as computers, data, broadband connectivity, limited smartphone platforms for telehealth also affects utilization of telehealth services (5,6). In 2021, Latinx patients were significantly less likely to use video telehealth but instead used audio-only telehealth (3). Video telehealth rates increased among patients who were younger, white, and had a higher income and education level (bachelor’s degree or higher) while audio-only telehealth was highest among those with less than a high school education (64.2%) and adults ages 65+ (56.5%) (3). In addition, older Latinx patients tended to have increased difficulty with navigating telehealth services due to limited access to technology, limited digital literacy and language barriers, especially if no family support was present (5).

Finally, the quality of the telehealth services affects how likely Latinx patients are to engage with it. Latinx patients often prefer to be seen by providers who understand them linguistically and culturally which is not always feasible due to existing provider staffing and shortages (5). In addition, Latinx patients might be more reluctant to engage in telehealth since they might desire a more personal connection with their provider in person (5). Telehealth might also be more challenging to use for Latinx patients if their health concerns relate to sensitive issues including trauma and they would rather want in-person support (6.) Also, lack of privacy can affect the quality of telehealth services such as if a patient is busy at home taking care of family members, at their place of work, running errands, or especially if they are discussing issues of domestic violence at home (6).

Solutions to Improve Telehealth Services  

For possible language barriers, clinics and telehealth providers could increase language accessibility for Latinx patients by providing Spanish telehealth services, investing in bilingual providers, and creating numerous support materials in Spanish such as educational materials, consent forms, and telehealth onboarding instructions (7). Also, investing in bi-lingual telehealth scheduling and navigation support might help older Latinx patients who need support even when they are provided the necessary devices and instructions (5).

To address digital literacy and barriers to technology access, clinics and telehealth providers could invest in user friendly platforms and provide telephone consultations for those who do wish to use audio-only telehealth services (7). To increase connectivity, limited reliance on patient portal’s (which are often only in English) might be helpful for patients with LEP and using unique meeting ID hyperlinks sent to a patient through SMS text or email could allow for easy “one-click connection” without the need for patients to use accounts or special software (8). Another important topic that might be beneficial to explain to Latinx patients is explaining why telehealth providers cannot use non-HIPPA complaint platforms such as WhatsApp and Messenger for the patient’s confidentiality and privacy (6). Lastly, community engagement and education could help increase Latinx community member awareness and knowledge about potential telehealth services through bi-lingual marketing, outreach and toolkits (8).

To improve on the quality of telehealth services, provider development through education on the role of race/ethnicity in telehealth delivery and cultural competency could help a provider be more skilled in their telehealth services for Latinx patients (5). Additional training for providers unfamiliar with telehealth on how to conduct telehealth services including technology training, expectation setting, “webside” manner, tele-exam and tele-diagnosis could also help providers feel more prepared and confident in their telehealth services (8). In addition, continuous monitoring and evaluation of telehealth services through regularly collecting feedback from patients and providers could further improve these services (7). Finally, understanding if telehealth is covered under insurance policies Latinx patients commonly use at a clinic is important and offering flexible payment options including sliding fee scales or payment plans can make telehealth more accessible to those who are uninsured (7).

Sources

1.     Health Services and Resources Administration . (n.d.). Why use Telehealth?. telehealth.hhs.gov. https://telehealth.hhs.gov/patients/why-use-telehealth?gad_source=1&gclid=Cj0KCQjwvb-zBhCmARIsAAfUI2sOrCY54y5dj30SOs25WABmSIwHUGMbeNYG7MBTq17E8FnB0Esu3zkaArQGEALw_wcB

2.     Lucas, J. W., & Villarroel, M. A. (2022, October 12). Telemedicine Use Among Adults: United States, 2021. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db445.htm

3.     Lee, E. C., Grigorescu, V., Enogieru, I., Smith, S. R., Samson, L. W., Conmy, A. B., & Lew, N. D. (2023, April 19). Updated National Survey Trends in Telehealth Utilization and Modality (2021-2022). Washington, D.C; US Department of Health and Human Services. https://aspe.hhs.gov/sites/default/files/documents/7d6b4989431f4c70144f209622975116/household-pulse-survey-telehealth-covid-ib.pdf

4.     Disparities, C. for R. H. (n.d.). Accountability, coordination, and telehealth in the valley to achieve transformation and equity: Center for Reducing Health Disparities: UC Davis Health. Accountability, Coordination, and Telehealth in the Valley to Achieve Transformation and Equity | Center for Reducing Health Disparities | UC Davis Health. https://health.ucdavis.edu/crhd/projects/activate

5.     Bustamante, A. V., Silver, J., Martinez, L. E., Anaya, Y., Malagon, J. C. R., Santos, N. B., Beltran, L. F., Mota, A. B., & Rich, J. (2023, February 28). Equity gaps in telehealth use to manage chronic conditions during COVID-19. Latino Policy & Politics Institute. https://latino.ucla.edu/research/equity-gaps-telehealth-covid-19/#:~:text=Interviewees%20reported%20that%20older%20Latino,barriers%20and%20access%20to%20technology.

6.     Hodges, J., & Calvo, R. (2023). Telehealth for all? assessing remote service delivery for Latinx immigrants. Health & Social Work, 48(3), 170–178. https://doi.org/10.1093/hsw/hlad016

7.     Latino Behavioral Health Coalition. (n.d.). Best practices for Telehealth services in Latino communities. Best Practices for Telehealth Services in Latino Communities. https://lbhcphila.org/learning-center/best-practices-for-telehealth-services-in-latino-communities

8.     Jelinek, R., Pandita, D., Linzer, M., Engoang, J. B., & Rodin, H. (2022). An evidence-based roadmap for the provision of more equitable telemedicine. Applied Clinical Informatics, 13(03), 612–620. https://doi.org/10.1055/s-0042-1749597