Non-English speakers face multiple barriers to video visits

Patients who prefer to speak languages other than English noted various barriers to accessing video visits, including communication difficulties and technical issues, underscoring the need to increase telehealth equity, according to new research.

Published in JAMA Network Open, the study aimed to understand the factors influencing video visit utilization among patients with non–English language preference (NELP). The researchers wrote that since patients with NELP participate in video visits less often than their English-speaking counterparts, understanding these factors is critical to closing digital health equity gaps.

The researchers conducted a qualitative study, interviewing patients who preferred Spanish or Cantonese in the ambulatory clinic network of an academic health system in California. They conducted the interviews from November 2022 to September 2023, using EHR data to identify the patients with NELP and at least one clinic visit but no video visits in the prior 12 months.

Of the 27 patients who participated in the interviews, 16 spoke Spanish and 11 Cantonese. Most participants reported having a phone, computer or tablet with internet or cellular data access, but they reported a wide range of digital literacy levels. For instance, some participants used their phones only for phone calls, while others could answer video calls but could not start them.

Four themes emerged from the interviews:

• Video visits create additional communication challenges: Many participants felt that communication quality during video visits was poor, noting that it was harder for them to ask questions or explain their symptoms over video and that the communication felt less natural and comfortable than in-person visits.
• Medical evaluations are more challenging via video visits: Participants reported concerns that video visits may not provide as comprehensive or appropriate medical evaluations as in-person visits. The lack of physical examinations, in-person vital sign measurements and testing were some reasons participants believed video visits were less comprehensive.
• Digital literacy and technical hurdles: Participants described anxiety around video visits because they did not know what to expect or how to troubleshoot. Many stated that video visits were not user-friendly and required too many steps. Some further noted that digital access was especially "difficult, confusing or troublesome" for older adults who lack basic technology skills.
• In-person teaching, troubleshooting support and language-concordant instructions could help: Participants detailed the assistance and resources that would help them increase their utilization of video visits. These included in-person assistance, simpler processes, repeated demonstrations, opportunities to practice and instructions in patients' preferred language.

Thus, the researchers found that while challenges associated with language barriers hinder video visit access and use, some interventions could help close telehealth equity gaps.

"Our study adds to the literature by highlighting patient perspectives on the relationship between technical accessibility and motivation to use video visits," researchers concluded. "Simple video visit processes and strategies for supporting patients with NELP are needed."

Research has repeatedly shown that not speaking English is a significant telehealth access barrier, specifically for synchronous video telehealth.

According to a study published last May, patients with limited English proficiency (LEP) face telehealth access challenges and have worse video visit experiences than their English-speaking peers. The study examined adult data from the 2021 California Health Interview Survey, finding that patients with LEP were less likely to report telehealth use and more likely to rate video visit experience as worse than in-person appointments compared to patients with English proficiency.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.