Limited English Proficiency Hinders Access to Telehealth Video Visits

Patients with limited English proficiency were less likely to use telehealth video visits when accessing virtual services during the pandemic compared to adults comfortable speaking English, a JAMA Network Open study found.

Telehealth can help increase access to healthcare and offer convenience for patients who struggle with finding transportation or leaving their homes. But telehealth comes with barriers of its own that can make it difficult for certain populations to access this type of care. Limited access to technology and internet can hinder patient access, as can low digital literacy.

Twenty-five million individuals in the US have limited English proficiency, the study noted. Due to language barriers, these individuals may have low health literacy in addition to limited digital literacy, which can make accessing telehealth all the more difficult.

To understand how these disparities impact telehealth use among patients with limited English proficiency, researchers retrospectively analyzed primary care telehealth visits within Kaiser Permanente Northern California. The visits occurred between March 16 and October 31, 2020, and the patients scheduled the appointments themselves using a patient portal.

The data consisted of 955,352 telehealth visits among 642,370 patients. More than half (60.3 percent) of the visits were telephone appointments and 39.6 percent were conducted via video conferencing.

Nearly half of the patients were White (47.6 percent), 22.7 percent were Asian, 20.6 percent were Hispanic, and 7.4 percent were Black.

The researchers used EHR data to determine patient level of English proficiency. If a patient’s EHR documented the need for an interpreter, she was considered to have limited English proficiency. Out of the over 600,000 patients, 22,476 (2.4 percent) had limited English proficiency.

The analysis revealed that patients with limited English proficiency used video visits less frequently than patients who did not have limited English proficiency. Only 7,765 patients who had a documented need for an interpreter attended a telehealth visit via video, compared to 371,237 patients without limited English proficiency.

Prior experience with video visits also impacted patient likelihood to choose between a video and a telephone visit.

Among patients who had no history with video appointments, patients with limited English proficiency had 28.9 percent odds of using video visits, while patients without limited English proficiency had a higher likelihood of 35.9 percent.

But when the researchers compared patients in both groups who had past video visit experience, they found no difference in the likelihood of choosing a video visit over a telephone visit. Patients with limited English proficiency were 47.2 percent likely and patients without limited English proficiency were 49.1 percent likely to attend a video appointment.

These results suggest that once patients with limited English proficiency attend an initial video visit, there is a higher chance they will choose video visits for telehealth use in the future.

“Although our analyses cannot determine causality, it is reasonable to hypothesize that helping adults with LEP overcome initial barriers to using video visits will result in more frequent future video visit use,” the researchers wrote.

Audio-only telehealth visits certainly have benefits, especially for patients who do not have access to a computer or device with a camera. But some experts argue that a provider needs to see a patient in order to establish a good relationship with them. Opponents to audio-only visits also note that many diagnoses and treatments require and rely on visual observations and cues.

While it is largely dependent on the patient’s health concern, video visits and telephone visits can both typically yield positive patient outcomes. Nevertheless, all patients should feel comfortable and have the proper resources to access a video conferencing appointment for primary care services, regardless of their English proficiency.

If healthcare professionals work to identify the barriers that patients with limited English proficiency face when trying to access an initial video visit, providers can implement strategies that will help facilitate telehealth access for this population, the study concluded.