Jose J. Analyzing telehealth disparities in the Latinx community. HPHR. 2023;60. https://doi.org/10.54111/0001/HHH5
The COVID-19 pandemic has changed the world of healthcare. Because of pervasive lockdowns, people turned to online alternatives to access medical care. While much of the world has largely returned to normal, the impact of COVID-19 on our healthcare system persists. However, certain communities—namely the Latinx community—have been severely paralyzed by this shift, owing to several economic, cultural, and political factors. These issues have left this demographic reeling and, in many cases, lacking in critical medical care. Recent meta-analyses and experimental data on telehealth accessibility for Latinx communities versus other groups have been studied, and many contrasting viewpoints have been gathered to assess how the Latinx community has embraced this change. Evidence shows that the Latinx community, as a whole, has lagged behind other ethnic groups in the uptake of telehealth compared to other virtual medical options, including their willingness to accept it. This lack of access has spurred an urgent need for increased health equity for this population, and undergoing these changes and policy efforts will allow for increased equality and social justice within the telehealth and overall healthcare field. Fundamental societal values and stigma also hinder some community members from leveraging telehealth’s benefits. This research study will help policymakers and healthcare providers understand the problem at hand, specific factors that have led to this divide, and actionable outcomes and programs we can implement to remedy this social justice inequality.
We live in a world that is constantly evolving: from industrial manufacturing to grocery shopping to medicine, technology has played a radical role in improving the lives of our communities. One of these resources, telehealth, has increasingly been a significant part of our society since the onset of the COVID-19 pandemic. Telehealth, in short, is the use of video-conferencing and associated platforms to allow virtual “medical visits” between patients and healthcare providers. This technology was used extensively during the pandemic, and today, it continues to be an avenue through which patients can receive medical care, allowing them to meet with a doctor anytime, anywhere, with minimal restriction and unlimited flexibility.
However, the inherent problem arises when people in remote areas and impoverished zip codes have difficulty accessing this technology, especially given inequitable access debilitates patient populations who need telehealth the most. For reasons to be discussed later in this article, specific populations, such as the Latinx community, suffer because of these inequities. While factors such as socioeconomic status may play a role, there are other inherent factors specific to the Latinx community that prevent them from accessing telehealth.1
This review aims to discuss the need for telehealth resources in the Latinx community, and discuss why this community, specifically, is largely affected by this issue. While inequitable access is prevalent to communities beyond the Latinx populations,2 being able to dissect pre-existing studies will enable us to design solutions to ensure medical care, whether physical or virtual, is available to everyone and anyone who desires it.
In December 2019, the first official cases of a new disease, originally named 2019-nCoV, or the novel coronavirus, were alerted to the World Health Organization (WHO) in Wuhan, China.3,4 A few days later, the name “coronavirus” was officially coined. Within a month, the disease began its rapid spread. The WHO declared a public health emergency, and soon after, the first cases and subsequent deaths were reported in the United States.5 Both the United States and Europe had their caseloads growing exponentially, and by March 2020, both nations declared a state of emergency, which marked the catastrophic start of the COVID-19 pandemic.6,7,8
During this tumultuous time, deaths continued to rise rapidly, and our medical system was being overworked as hospitals and healthcare providers tried to keep up with the sudden influx of COVID-19 patients.9,10,11 Another result of the pandemic was the vaccine race, as numerous pharmaceutical giants devoted their resources to creating a trial vaccine and getting their product into the market first.12,13,14 Additionally, the use of video conferencing platforms like Zoom, Google Meet, Skype, and Microsoft Teams reached new heights during the pandemic to keep families, employees, and society connected.15,16
Video conferencing allowed workplaces to conduct business as usual and enabled online education. Finally, the main and perhaps most important use of video conferencing was the adoption of telehealth.17 Telehealth, which was around before, but only utilized by particular sectors like continuing education units (CEU) and various medical specialties like radiology, cardiology, and psychiatry, saw rapid adoption during the pandemic. While persons with COVID and those who needed surgery still had to visit the hospital, telehealth allowed others virtual access to doctors and medical resources.
The advent of telehealth had many benefits and drawbacks, but the consensus was positive. Most doctors still preferred seeing patients in person,18; however, telehealth proved hugely beneficial. as it facilitated access to medical care for those who needed it most. There were drawbacks to the system, namely the deterioration of doctor-patient relationships and, in some cases, increased complications in medical care due to limited in-person patient-provider interactions.19,20 Additionally, a significant drawback was that some people simply could not or refused to use telehealth which led to deficiencies in medical care throughout the pandemic.21 Without proper discourse and legislative action to address these inequities, telehealth access will not be universally accepted or available. However, spreading awareness about these policies is instrumental in achieving healthcare equity and social justice for this community.
Before the pandemic, telehealth was used in rural areas, where state and local health departments, the U.S. Department of Defense, and other federal agencies strived to make virtual medical access in underserved areas a reality.22 For example, in the 1970s, the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), a consortium of public and private partners, marked one of the first efforts to leverage telecommunication to connect rural populations, most notably Native American reservations, to medical care.23,24 The main collaborators in this initiative included the Indian Health Service (IHS) and the Papago tribal government, with the project being conducted on the Papago Indian Reservation in Arizona. This successful collaboration paved the way for advancements in telemedicine and proved its status as a feasible and viable option for healthcare. This was followed by other innovations, from wearable technology to video conferencing, which have expanded telemedicine access today.25 With COVID-19, there was a greater demand for these services, and medical providers were forced to adapt to and adopt platforms like Teladoc, Sesame Care, MeMD, HealthTap, etc., which connected patients with medical personnel virtually.
However, several challenges persisted in adopting telehealth services, including technical issues like poor Wi-Fi connections and lack of broadband internet access. These issues were exacerbated by reduced reimbursement from Medicare, housing instability, and reduced affordability.26 Additionally, in some cases, healthcare providers could not correctly diagnose issues through a video call, and an in-person consultation was often needed after telemedicine visits.27 Despite its drawbacks, many benefited from telehealth and could access comprehensive medical care when no other avenue was available.28
While the benefits of telehealth are many, there arises an issue when a specific ethnic group has a markedly lower usage of telehealth compared to other communities. The Latinx community was one such group that utilized this technology disproportionately compared to other ethnic groups.29 The consensus was that socio-economic factors played a role in this disparity, but this community had difficulty accessing telehealth options even with normalizing for these factors. Factors beyond economic status are also critical to understanding the rationale behind this inequality and help us gauge the feasibility of solutions allowing the Latinx population to access telehealth on a scale similar to other ethnic groups in the U.S.
Due to multiple social determinants, the Latinx population has had a disproportionate number of COVID-19 cases in the U.S. This emphasizes the need to leverage telehealth resources, which contributes to increased health equity and social justice interventions. In Washington state, over 30% of COVID cases are from Latinx communities, despite their population being less than 15% of the state.30 This disparity stems from various factors, the main one being that a large percentage of the community is uninsured.31 Latinx society has the highest uninsured rate compared to other racial groups, partly due to labor, transportation, and housing disparities. Additionally, access to testing and treatments was disproportionately lower for this population. Language barriers were another reason behind the limited use of telehealth in the Latinx community, contributing to a decline in health and digital literacy for Spanish speakers.
In addition, the decreased reliance on mainstream news channels may have fostered the spread of misinformation in the Latinx community and eventually made them more susceptible to the disease.32 On a macro scale, Latinx communities make up about 18% of the U.S. population, but over 30% of the COVID cases, indicating that the statewide trend in Washington is applicable across the U.S. as well.33 Hospitalization rates for Latinx people were almost five times higher than that of the general population, and mortality rates were nearly double. Additionally, rural Latinx populations face even more significant barriers to healthcare, which may lead to adverse health outcomes.31 All these factors contributed to a significant health crisis for the Latinx population, prompting the need for policy change. However, it is essential to note that this review does not encompass the entirety of the Latinx community. Still, some are disadvantaged, live in rural areas, or are recent/early-generation immigrants who haven’t had the time to adapt to the United States and its healthcare system. This article will dive deeper into why this sub-segment is marginalized due to a lack of access to telehealth and discuss avenues to mitigate and potentially solve this disparity.
Telehealth presents a viable tool to mitigate barriers to care in these Latinx communities. However, it is essential to note that these Latinx communities have accessed telehealth disproportionately less than other ethnic groups. A telehealth implementation at an academic clinic, showed that telehealth users were more likely to be of white or Asian ethnicities, English speaking, and have private versus public insurance. Meanwhile, the lowest users of telehealth were Latinx and requested translators.34
The reported lack of telehealth care in Latinx indicates societal deficiencies and inequalities. While the tendency to prefer in-person visits over telehealth is not specific to the Latinx population,35 must understand the driving factors for this behavior.
One primary reason is internet access: Hispanics have a lower accessibility rate to broadband internet compared to Asians and non-Hispanic Whites,36 partly because internet access is usually expensive and, in some cases, unaffordable. An analysis of electronic health records (EHR) in the Healthjump database from ~3 million unique patients from March 2020 to December 2020 showed that Hispanic patients had a 41% lower likelihood of using telehealth compared to their non-Hispanic counterparts, which proves the inherent disproportionality in their utilization of telehealth.29 Additionally, several members of the Latinx population lack technical support, contributing to a decline in telehealth use.37 Even if they could access the platform, the information was hard to interpret, especially in a community with many non-English speaking natives.38
The limited access to digital resources and literacy, also known as the “digital divide” phenomena,39 meant that the Latinx community had a lower likelihood of completing their scheduled telehealth visit;40 a critical reason for the telehealth disparity in this sub-group.
On a practical scale, the decreased usage of telehealth services could be detrimental, especially regarding abortion care. In the Midwest and South, Latinx peoples were less likely to have telehealth visits for contraceptive care, and the quality of these visits was not on par with expectations. This proves that even when they used telehealth, these interactions’ productivity didn’t meet their needs.41 A study of Black and Latino perceptions also showed that telemedicine provided clear benefits, such as access to medical advice and specialists, and reduced wait times. However, both racial groups were hesitant to adopt this technology due to concerns around privacy, confidentiality of data, and lack of in-person interactions with medical care providers.42
While there are multiple reasons why the Latinx community cannot access telehealth, we know that with proper discourse, education, and legislative efforts, we can reduce this disparity and ensure this historically underrepresented and marginalized population enjoys the benefits of medical healthcare access.
Many researchers have found that the best way to mitigate telehealth disparity is by increasing digital literacy; one study found that an increase in eHealth literacy proportionally decreased the odds of not using telehealth.43 A quality improvement initiative, which included perspectives from most Latinx respondents using telehealth, was launched at a large safety-net hospital. Through this effort, several barriers affecting telehealth access were diagnosed, such as lack of privacy, difficulty connecting via the internet, and hesitancy to approach the provider in an online setting. This proves we can drive actionability to uncover the rationale for telehealth misuse, mitigating the increased burden of COVID-19 on this population while pushing for social justice goals and health equity.
On a broader level, a few other overarching themes were identified, such as leveraging a preventative care model, encouraging more Latinxs to pursue the medical profession, pushing funding and resources into telehealth, and increasing telehealth coverage via insurers and other federal entities.30
A more comprehensive version of these goals can be found within the “T-HOLA” framework, which stands for orient to Telehealth, engage in Health education, provide Options, use active Listening skills, and Assess adherence to cultural values.44 Bilingual interventions are critical, as the barrier to access is significantly mitigated when Latinx communities can use telehealth resources in their language.45 Another way to reduce health disparities in the community is to leverage telepsychology clinics, enhancing access to care and tackling the root cause of health issues and telehealth usage.31 Research showed that by implementing a telehealth framework, providers can understand the rationale behind disparities and provide behavioral training and therapy to Latinx youth and their families.46
While the Latinx community is deficient in using telehealth, there are several initiatives we can explore to connect the community with telehealth resources and drive actionable recommendations.
Through this analysis, it is clear that major inhibiting factors in telehealth accessibility are the limited availability of technological devices and lower digital literacy. While many have devices, broadband internet access is not widely available, which makes it challenging to access eHealth portals or complete a telehealth visit successfully. However, we would accomplish two things by driving legislative action to increase internet access in underserved areas and soliciting volunteers to educate communities about the benefits of telehealth visits. First, it would increase digital literacy IQ, and second, it would enable them access to virtual and in-person healthcare, resulting in improved outcomes and promoting proactive disease prevention.
Another barrier to telehealth access for the Latinx community is bilingualism. For many in the Latinx community, English is not their first language; this often leads to a lack of proper communication during telehealth visits and long-term distrust in the system. Without a translator or a bilingual medical provider, Latinx people might hesitate to use telehealth, which could be detrimental when needed.
To address this, language intervention programs need to be in place, and hospitals should potentially have in-house or third-party translators to ensure that Latinx people receive the care they need and want. Hospitals and entities could also provide incentives for healthcare workers to learn a second language or encourage bilingual individuals to explore the healthcare field to help break down barriers. To summarize, proactive measures can be taken to alleviate language barriers and allow Latinx people to access telehealth in a safe and comfortable environment.
Overall, resolving the digital divide gap and incorporating bilingualism in telehealth visits will go a long way in enhancing the use of telehealth by the Latinx community. However, what may be more critical is ensuring the longevity of these programs and making sure the community is comfortable with telehealth visits. For this, we will need to gauge community perception of this technology by conducting routine check-ins and surveys with Latinx users of telehealth, assessing what needs to change, and acting on feedback promptly. These impactful changes will promote health equity and create a precedent to fight social injustice issues currently affecting this population.
Overall, systemic changes will help the Latinx community achieve equitable telehealth access. However, the real question that needs to be answered is the tangible effects of equitable access and how it could benefit this population. These questions are paramount to understanding the intention of this review and its implications.
As previously discussed, the Latinx community is more susceptible to diseases such as COVID-19. While providing telehealth access might not be the magic bullet, it will undoubtedly offer an avenue to the Latinx community to access healthcare resources, receive treatment, and prompt diagnosis of conditions they otherwise wouldn’t have known they had.
COVID-19 turned our lives upside down. While the pandemic has thankfully slowed down in recent years, it is more important than ever before that preventative measures such as telehealth are in place and communities are comfortable using it. By developing resources to drive better access to telehealth, Latinx people can connect with medical providers in need and ensure their treatment and medical care isn’t at risk. These strategic efforts will go a long way in solving the healthcare access gap and potentially lead to a decline in diseases like COVID-19 affecting the Latinx community.
With the world going into lockdown three years ago, many people had limited access to essential medical care. Telehealth enabled healthcare visits and much-needed medical advice via online electronic health (eHealth) portals. However, despite the apparent and obvious benefits of telehealth, many communities couldn’t access these resources and weren’t willing to fully trust the system even if they could. One of these groups, the Latinx community, was also affected by lack of access to Telehealth. Compounded with their susceptibility to contracting COVID-19, this community suffered several health setbacks during the pandemic. Several efforts have been taken to address this disparity to drive improved health outcomes and ensure the Latinx community has access to telehealth. In addition to these efforts, this review suggests other interventions, including legislative action to increase online resources, improve digital literacy, adopt bilingual intervention programs, and stress the need for long-term accommodations for this group. By taking the necessary steps and providing essential resources to the Latinx community, we can afford them improved healthcare access and ensure the well-being of one of the most important, culturally diverse ethnic groups in the United States.
The author have no relevant financial disclosures or conflicts of interest.
Jonathan Jose is a senior at Carroll Senior High School. He is interested in solving inequities in healthcare by exploring the cognitive and psychological bases behind them. After high school, he intends to pursue a neuroscience or psychology major.