A cross-sectional study exploring equity of access to telehealth in culturally and linguistically diverse communities in a major health service
Victor M. Gallegos-Rejas
A B * , Jaimon T. Kelly A B , Karen Lucas C , Centaine L. Snoswell A B , Helen M. Haydon A B , Sue Pager D , Anthony C. Smith A B E and Emma E. Thomas A B
A
B
C
D
E
Abstract
The utilisation of telehealth among culturally and linguistically diverse communities in Australia remains unexplored. We aimed to describe telehealth (telephone and videoconference) utilisation within a major health service and identify sociodemographic factors that may contribute to limited telehealth access.
A cross-sectional study was performed using service activity data from four metropolitan hospitals in Queensland, Australia. Outpatient department data (January to December 2021) were examined. These data included patients (N = 153 427) of all ages who had an outpatient appointment within 10 speciality services (i.e. Hepatology, Gastroenterology, Immunology and Psychology) that were the most frequent videoconference users. This study measured telehealth utilisation across the four tertiary hospitals and its association with sociodemographic factors. Descriptive statistics and regression analysis were used. Multivariate regression models were adjusted by sex, socioeconomic level and language use.
Overall, 39% of appointments were delivered through telehealth, with 65% of all reported telehealth services involving a telephone consultation. People who required interpreter services were 66% less likely to use telehealth services (OR adjusted 0.33, 95% CI 0.31–0.36, P < 0.05) than English-speaking people. Among those using telehealth, people requiring interpreter services were 13% less likely to use videoconference than phone (OR adjusted 0.87, 95% CI 0.77–0.98, P < 0.005).
There is a gap in Australian telehealth service use for people with culturally diverse backgrounds and limited English proficiency. This study highlights a critical need to determine how people from culturally diverse backgrounds would like to engage with digital care options such as telehealth and the necessary support to enable this.
Keywords: culturally and linguistically diverse, digital divide, digital inclusion, equitable access, health disparities, health equity, language barriers, racial and ethnic minorities, telehealth.
References
1 Snoswell CL, Chelberg G, De Guzman KR, et al. The clinical effectiveness of telehealth: A systematic review of meta-analyses from 2010 to 2019. J Telemed Telecare 2023; 29: 669-684.
| Crossref | Google Scholar | PubMed |
2 Hobson GR, Caffery LJ, Neuhaus M, et al. Mobile Health for First Nations Populations: Systematic Review. JMIR Mhealth Uhealth 2019; 7: e14877.
| Crossref | Google Scholar | PubMed |
3 O’Brien J, Fossey E, Palmer VJ. A scoping review of the use of co-design methods with culturally and linguistically diverse communities to improve or adapt mental health services. Health Soc Care Community 2021; 29: 1-17.
| Crossref | Google Scholar | PubMed |
4 Pham TTL, Berecki-Gisolf J, Clapperton A, et al. Definitions of Culturally and Linguistically Diverse (CALD): A Literature Review of Epidemiological Research in Australia. Int J Environ Res Public Health 2021; 18: 737.
| Crossref | Google Scholar | PubMed |
5 Bastos JL, Harnois CE, Paradies YC. Health care barriers, racism, and intersectionality in Australia. Soc Sci Med 2018; 199: 209-218.
| Crossref | Google Scholar | PubMed |
6 Suphanchaimat R, Kantamaturapoj K, Putthasri W, et al. Challenges in the provision of healthcare services for migrants: a systematic review through providers’ lens. BMC Health Serv Res 2015; 15: 390.
| Crossref | Google Scholar | PubMed |
7 Truong M, Yeganeh L, Cook O, et al. Using telehealth consultations for healthcare provision to patients from non-Indigenous racial/ethnic minorities: a systematic review. J Am Med Inform Assoc 2022; 29: 970-982.
| Crossref | Google Scholar | PubMed |
9 Brady B, Saberi G, Santalucia Y, et al. ‘Without support CALD patients will be left behind’: A mixed-methods exploration of culturally and linguistically diverse (CALD) client perspectives of telehealth and those of their healthcare providers. J Telemed Telecare 2023;
| Crossref | Google Scholar | PubMed |
10 Xu P, Hudnall M, Zhao S, et al. Pandemic-Triggered Adoption of Telehealth in Underserved Communities: Descriptive Study of Pre- and Postshutdown Trends. J Med Internet Res 2022; 24: e38602.
| Crossref | Google Scholar | PubMed |
11 Rodriguez JA, Saadi A, Schwamm LH, et al. Disparities In Telehealth Use Among California Patients With Limited English Proficiency. Health Aff 2021; 40: 487-495.
| Crossref | Google Scholar |
12 Saeed SA, Masters RM. Disparities in Health Care and the Digital Divide. Curr Psychiatry Rep 2021; 23: 61.
| Crossref | Google Scholar | PubMed |
13 Zhang D, Shi L, Han X, et al. Disparities in telehealth utilization during the COVID-19 pandemic: Findings from a nationally representative survey in the United States. J Telemed Telecare 2021;
| Crossref | Google Scholar | PubMed |
14 Reis FJJ, Fernandes LG, Saragiotto BT. Telehealth in low- and middle-income countries: Bridging the gap or exposing health disparities? Health Policy Technol 2021; 10: 100577.
| Crossref | Google Scholar |
15 López L, Green AR, Tan-Mcgrory A, et al. Bridging the Digital Divide in Health Care: The Role of Health Information Technology in Addressing Racial and Ethnic Disparities. Jt Comm J Qual Patient Saf 2011; 37: 437-445.
| Crossref | Google Scholar | PubMed |
16 Thomas EE, Haydon HM, Mehrotra A, et al. Building on the momentum: Sustaining telehealth beyond COVID-19. J Telemed Telecare 2022; 28: 301-308.
| Crossref | Google Scholar | PubMed |
17 Cortelyou-Ward K, Atkins DN, Noblin A, et al. Navigating the Digital Divide: Barriers to Telehealth in Rural Areas. J Health Care Poor Underserved 2020; 31: 1546-1556.
| Crossref | Google Scholar | PubMed |
18 Gallegos-Rejas VM, Thomas EE, Kelly JT, et al. A multi-stakeholder approach is needed to reduce the digital divide and encourage equitable access to telehealth. J Telemed Telecare 2022; 29: 73-78.
| Crossref | Google Scholar |
19 Ospina-Pinillos L, Davenport T, Mendoza Diaz A, et al. Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study. J Med Internet Res 2019; 21: e14127.
| Crossref | Google Scholar | PubMed |
20 Jayawardana D, Gannon B. Use of telehealth mental health services during the COVID-19 pandemic. Aust Health Rev 2021; 45: 442-446.
| Crossref | Google Scholar | PubMed |
21 Scott A, Bai T, Zhang Y. Association between telehealth use and general practitioner characteristics during COVID-19: findings from a nationally representative survey of Australian doctors. BMJ Open 2021; 11: e046857.
| Crossref | Google Scholar | PubMed |
22 Queensland Health. People with culturally and linguistically diverse backgrounds. 2022. Available at https://metrosouth.health.qld.gov.au/health-equity-and-access/culturally-and-linguistically-diverse-cald-people [accessed 27 October 2022].
23 Elm Ev, Altman DG, Egger M, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335: 806-808.
| Crossref | Google Scholar | PubMed |
26 Taylor A, Caffery LJ, Gesesew HA, et al. How Australian Health Care Services Adapted to Telehealth During the COVID-19 Pandemic: A Survey of Telehealth Professionals. Front Public Health 2021; 9: 648009.
| Crossref | Google Scholar |
27 Rodriguez JA, Saadi A, Schwamm LH, et al. Disparities In Telehealth Use Among California Patients With Limited English Proficiency. Health Aff 2021; 40: 487-495.
| Crossref | Google Scholar | PubMed |
28 Odendaal WA, Anstey Watkins J, Leon N, et al. Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; CD011942.
| Crossref | Google Scholar | PubMed |
29 Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health 2019; 18: 174.
| Crossref | Google Scholar | PubMed |
30 Mao A, Tam L, Xu A, et al. Barriers to Telemedicine Video Visits for Older Adults in Independent Living Facilities: Mixed Methods Cross-sectional Needs Assessment. JMIR Aging 2022; 5: e34326.
| Crossref | Google Scholar | PubMed |
31 Mussallem A, Panko TL, Contreras JM, et al. Making virtual health care accessible to the deaf community: Findings from the telehealth survey. J Telemed Telecare 2022;
| Crossref | Google Scholar | PubMed |
32 Tsami L, Lerman D, Toper-Korkmaz O. Effectiveness and acceptability of parent training via telehealth among families around the world. J Appl Behav Anal 2019; 52: 1113-1129.
| Crossref | Google Scholar | PubMed |
33 Olavarrieta GA, Benuto L. Narrative Exposure Therapy: A Case for Use With Refugees via Telehealth With the use of an Interpreter. Clin Case Stud 2022; 21: 419-437.
| Crossref | Google Scholar |
34 Cockrell H, Wayne D, Wandell G, et al. Understanding hispanic patient satisfaction with telehealth during COVID-19. J Pediatr Surg 2022; 58: 1783-1788.
| Crossref | Google Scholar |
35 Hsueh L, Hirsh AT, Maupomé G, et al. Patient–Provider Language Concordance and Health Outcomes: A Systematic Review, Evidence Map, and Research Agenda. Med Care Res Rev 2021; 78: 3-23.
| Crossref | Google Scholar | PubMed |
36 Snoswell CL, Haydon HM, Kelly JT, et al. How do consumers prefer their care delivered: In-person, telephone or videoconference? J Telemed Telecare 2023;
| Crossref | Google Scholar | PubMed |
37 Serino-Cipoletta J, Dempsey C, Goldberg N, et al. Telemedicine and Health Equity During COVID-19 in Pediatric Gastroenterology. J Pediatr Health Care 2022; 36: 124-135.
| Crossref | Google Scholar | PubMed |
38 Payvandi L, Parsons C, Bourgeois FC, et al. Inpatient Telehealth Experience of Patients With Limited English Proficiency: Cross-sectional Survey and Semistructured Interview Study. JMIR Form Res 2022; 6: e34354.
| Crossref | Google Scholar |
