Language Barriers in Telehealth Could Leave Spanish-Speaking Patients Behind

Latinx populations are more than 10 percent less likely to use telehealth than their white counterparts. (Photo courtesy: Pexels.com)

When a medical provider asks a Spanish-speaking patient, “¿Cómo estás?” they will naturally respond, “Muy bien, estoy muy bien," said Yaira Oquendo-Figueroa, a Colorado-based clinical psychologist in a 2020 YouTube presentation about telehealth challenges faced by Spanish-speaking patients.

But their automatic response of “very good” may not tell the full story.

“Spanish-speaking people rely on visual cues to understand their underlying emotions,” Oquendo-Figueroa said. “We gesture with our hands; we talk with our bodies . . . It's difficult to understand over the phone or by video.”

The COVID-19 pandemic exposed gaps in telemedicine’s ability to reach all patients, from communication barriers and spotty internet to relatives peering over their shoulders, said Oquendo-Figueroa, a native Spanish speaker who works at Salud Family Health Centers. Those disparities could have widespread implications beyond the pandemic as providers increasingly embrace telehealth and usage stabilizes at levels 38 times higher than before the pandemic. Heightened patient demand coupled with better insurance reimbursement policies are fueling a shift that could leave many non-native English speakers behind. 

Telehealth’s Equity Issue

In its earliest days, telehealth’s goal was to increase access to health care, including to those in underserved populations who might otherwise go without proper care and consultation, such as people in rural areas or incarcerated individuals. But, after a once-in-a-century pandemic, telehealth is increasingly used as a medium to replace in-person visits, partly in response to patient demand for convenience and flexibility.

Telehealth can be a particularly useful tool for people who, because of work schedules, may not be able to make it into a doctor’s office during normal hours, said Dr. Nelsson Becerra, an urgent care physician on the Mid-Atlantic Permanente Medical Group’s Equity, Inclusivity, and Diversity Team. But this assumes they have access to the internet and can communicate effectively in English.

Infographic by Kylia Ahuna.

As the pandemic swept the country in April 2020, telemedicine visits spiked, making up more than 32 percent of office and outpatient visits. This year, those levels have stabilized between 13 to 17 percent across all specialties, according to a McKinsey & Co. report. But that increased access hasn’t reached all populations. A 2020 Penn Medicine study of 50,000 patients shows a connection between patients with limited English proficiency and fewer completed telemedicine visits—Latinx populations are more than 10 percent less likely to use telehealth than their white counterparts. The Penn Medicine researchers say these “troubling statistics” could lead to heightened health disparities. 

Patients and families with limited English proficiency live at the intersection of many social, economic, and cultural challenges that create a digital divide between marginalized populations and others. This is especially relevant to the D.C., Maryland, and Virginia (DMV) region. According to a 2019 Kaiser Permanente Community Health Analysis, nearly 43 percent of the population identify as either Black, Hispanic, or Asian/Pacific Islander; 9.7 percent of adults don’t have a high school diploma; and nearly 10 percent of people live under the poverty line. There are over 100,000 people in the DMV who identify themselves as having limited English proficiency.

Some providers, like the Mid-Atlantic Permanente Medical Group (MAPMG), want to address disparities in telemedicine. MAPMG treats patients in D.C., Maryland, and Northern Virginia. In 2020 alone, it held 500,000 telehealth visits with patients whose first language is not English. MAPMG’s Equity, Inclusivity, and Diversity Team created resources to improve virtual visits for patients with limited English.

Addressing Disparities

With these disparities in mind, Becerra joined MAPMG’s Spanish Virtual Team, a network of bilingual physicians who offer patients a direct line of communication between doctor and patient. Patients can directly message a Spanish-speaking physician and discuss their medical concerns right away. 

MAPMG also works with LanguageLine Solutions, a company providing on-demand language interpretation and document translation services worldwide for law enforcement, health care organizations, legal courts, schools, and businesses. The service connects patients with translators fluent in over 240 languages to mediate virtual visits.

Meanwhile, in Colorado, Salud Family Health Care is also creating resources and tools for its Spanish-speaking patients. Oquendo-Figueroa said the center is looking to increase community outreach so current members can introduce new members to the basics of telehealth. “This is especially helpful for people who are new to the area, or even new to the country,” she said.

She also hopes to develop brochures and infographics in Spanish to better communicate some of the services offered at Salud Family Health Care.

Artur Treyster, an MAPMG urgent care physician and leader of telehealth initiatives, stressed the importance of education and outreach. Along with its other initiatives, his group also hopes to diversify pamphlets and brochures to better serve Latinx patients. “We are forced to redesign our digital front door, so to speak, and we have to make sure that everyone is invited in,” Treyster said.

Looking Ahead

The COVID-19 pandemic revealed deep-seated inequities in health care for Latinx communities and amplified social, economic, and language barriers that contribute to poorer health outcomes. The pandemic disproportionately impacted communities of color, specifically the Latinx community, compounding long-standing racial disparities. Without significant changes, telehealth could follow the pattern of inequity, researchers from Mount Sinai Health Center in New York City reported. Their study on telehealth inequities in communities of color was recently published in the Journal of the American Medical Informatics Association.

"We include race as a predictor in our model because documenting racial/ethnic differences for public awareness is a necessary first step in reducing disparities,” wrote the researchers. "Our findings of racial differences in telehealth use should be interpreted within the context of persistent structural racism in the US.”