Limited English proficiency patients have worse video visit experiences

Patients with limited English proficiency (LEP) not only face telehealth access challenges but also have worse video visit experiences than their peers who are proficient in English, new research reveals.

Published in JAMA Network Open, the study examined differences in telehealth access and virtual care experience between patients with LEP and patients with English proficiency in California.

Researchers examined adult data from the 2021 California Health Interview Survey, conducted in six languages. They defined LEP as speaking English not well or not at all. They evaluated telehealth use by asking survey participants whether they had used video or audio-only telehealth in the past 12 months. They assessed the video visit experience by asking participants to compare their video or audio-only telehealth visits to in-person visits.

The study included 24,453 survey participants, representing a population of 29 million. Of the participants, 9 percent were patients with LEP. Among the 7 percent of patients with LEP who used telehealth, 6.8 percent had a video visit, and 8.1 percent had a telephone visit.

Unadjusted data analyses reveal that only 37 percent of patients with LEP reported using either video or audio-only telehealth, compared to 50 percent of patients with English proficiency.

In adjusted analyses, patients with LEP were less likely to report video or audio-only telehealth use versus patients with English proficiency. Patients with LEP were also 40 percent more likely than their counterparts to rate video visit experience as worse than in-person appointments. They were 20 percent more likely to describe their audio-only telehealth experience as worse than in-person visits, though this finding was not statistically significant.

“Setting up a video visit can require high-speed internet and a device. It may require creating a login for a new platform,” said study lead author Jorge Rodriguez, MD, a clinician-investigator in the Division of General Internal Medicine and Primary Care at Brigham and Women’s Hospital, in a press release. “If you’re someone with limited English proficiency, you might need an interpreter to be involved. There are a lot of different pieces to navigate. If you're a patient who doesn't speak the language that the technology is built in, just getting onto the platform is challenging.”

The researchers concluded that future research should evaluate whether digital navigators can improve the video-visit experience for patients with LEP.

Prior research has highlighted strategies to enhance telehealth access and use among patients with LEP. A paper published in January 2024 detailed how clinicians at Massachusetts General Hospital addressed virtual care disparities for these patients by increasing access to telehealth platforms, ensuring privacy for immigrant patients, and including language interpreters in virtual visits.

The paper described the clinicians’ efforts, including performing targeted outreach to provide patients with information on accessing the portal and its benefits and launching a marketing and education campaign that included resources in multiple languages to help patients navigate the telehealth platform. Additionally, they added more language options to the portal to increase accessibility for patients with LEP.

Further, the United States Department of Health and Human Services and the Department of Justice have published guidance to eliminate telehealth access and use disparities. The guidance, released on the anniversary of the Americans with Disabilities Act in 2022, included actions to curb potential discrimination against people with LEP. These include providing access to interpreters and offering information about telehealth services in non-English languages.