Summary
Summary: Authors examined differences in telehealth access and experience between patients with limited English proficiency (LEP) and patients with English proficiency (EP) in California using 2021 adult data from California Health Interview Survey (CHIS), which is conducted in 6 languages. Study exposure was LEP, defined as speaking English not well or not at all. Study outcomes were telehealth use and visit experience. For telehealth use, CHIS participants were asked whether they had used video or telephone telehealth in the past 12 months. For visit experience, participants were asked to compare their experience with video or telephone visits to in-person visits.
The study included 24,453 participants (10,735 males, 13,718 females), representing a population of 29.6 million.
Findings: Patients with LEP accounted for 9% of participants and 7% of telehealth users. Telehealth users with LEP differed significantly from users with EP. Among telehealth users, patients with LEP accounted for 6.8% of video visit users (387, representing a population of 840,764) and 8.1% telephone visit users (484, representing a population of 1 million).
Patients with LEP were less likely to report either video or telephone telehealth use (37% vs 50%). Patients with LEP were less likely to report video or telephone telehealth use vs. patients with EP. For video visits, patients with LEP reported worse experience (32% vs 26%) vs. patients with EP. Patients with LEP were more likely to report worse experience with video visits than in-person visits. For telephone visits, there was no difference in visit experience between the two groups.
For patients with LEP, authors found not only telehealth access disparities but also worse video visit experience. Additionally, characteristics of video and telephone visit users differed by English proficiency. Worse video visit experience may be associated with challenges in integrating interpreters into telehealth visits or perceived effectiveness by both clinicians and patients. Patients, especially those with LEP, prefer in-person care due to anxiety with self-evaluation without a medical professional. Digital barriers (e.g., lack of affordable broadband/devices, unavailable translated portals, and limited digital literacy and support) may also play a role.
Study limitations include reliance on self-reported telehealth use, focus on California, and inability to control for clinician factors that may affect care experience. Future work may evaluate the potential of digital navigators in improving the video visit experience. These findings highlight access to telephone visits alongside needed improvements to video visits for patients with LEP.
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