Satisfaction can co-exist with hesitation: qualitative analysis of acceptability of telemedicine among multi-lingual patients in a safety-net healthcare system during the COVID-19 pandemic

Michelle-Linh T Nguyen,George Su,Malini A Nijagal,Jennifer Juarez,Elaine C Khoong,Billy Zeng,Courtney R Lyles,Faviola Garcia,Urmimala Sarkar

doi:10.1186/s12913-022-07547-9

Abstract

BackgroundThe COVID-19 pandemic triggered unprecedented expansion of outpatient telemedicine in the United States in all types of health systems, including safety-net health systems. These systems generally serve low-income, racially/ethnically/linguistically diverse patients, many of whom face barriers to digital health access. These patients’ perspectives are vital to inform ongoing, equitable implementation efforts.MethodsTwenty-five semi-structured interviews exploring a theoretical framework of technology acceptability were conducted from March through July 2020. Participants had preferred languages of English, Spanish, or Cantonese and were recruited from three clinics (general medicine, obstetrics, and pulmonary) within the San Francisco Health Network. Both deductive and inductive coding were performed. In a secondary analysis, qualitative data were merged with survey data to relate perspectives to demographic factors and technology access/use.ResultsParticipants were diverse with respect to language (52% non-English-speaking), age (range 23-71), race/ethnicity (24% Asian, 20% Black, 44% Hispanic/Latinx, 12% White), & smartphone use (80% daily, 20% weekly or less). All but 2 had a recent telemedicine visit (83% telephone). Qualitative results revealed that most participants felt telemedicine visits fulfilled their medical needs, were convenient, and were satisfied with their telemedicine care. However, most still preferred in-person visits, expressing concern that tele-visits relied on patients’ abilities to access telemedicine, as well as monitor and manage their own health without in-person physical evaluation.ConclusionsHigh satisfaction with telemedicine can co-exist with patient-expressed hesitations surrounding the perceived effectiveness, self-efficacy, and digital access barriers associated with a new model of care. More research is needed to guide how healthcare systems and clinicians make decisions and communicate about visit modalities to support high-quality care that responds to patients’ needs and circumstances.

Highlights

The COVID-19 pandemic triggered unprecedented expansion of outpatient telemedicine in the United States in all types of health systems, including safety-net health systems
The Coronavirus Disease 2019 (COVID-19) pandemic triggered unprecedented expansion of outpatient telemedicine encounters throughout all medical settings in Nguyen et al BMC Health Services Research (2022) 22:195 the United States (U.S.) [1, 2]
In contrast to before the pandemic, when telemedicine was being used primarily in specialized patient populations or to increase access to care for rural patients, in August 2020, telemedicine encounters accounted for 50-60% of all primary care delivered in two large delivery systems in San Francisco—including the study site for this research [3]

Summary

Introduction

The COVID-19 pandemic triggered unprecedented expansion of outpatient telemedicine in the United States in all types of health systems, including safety-net health systems These systems generally serve low-income, racially/ethnically/linguistically diverse patients, many of whom face barriers to digital health access. In contrast to before the pandemic, when telemedicine was being used primarily in specialized patient populations (e.g. heart failure) or to increase access to care for rural patients, in August 2020, telemedicine encounters (including telephone and video visits) accounted for 50-60% of all primary care delivered in two large delivery systems in San Francisco—including the study site for this research [3] Given this widespread experience with and normalization of telemedicine in all settings in the United States, almost all healthcare settings are preparing to continue telemedicine into the future [4,5,6,7]. A safety-net healthcare delivery system may offer video visits, but uptake will still be limited if the patients they serve face barriers to digital device/ connectivity access [12,13,14,15], consider telemedicine visits inferior in quality to in-person visits, and/or have higher trust or preference for in-person visits and communication with providers [16]

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Results

Discussion

Conclusion