The emergence of the COVID-19 pandemic caused a rapid large-scale shift to telehealth services, widening existing disparities for underserved communities. According to the New England Journal of Medicine, one in four Americans do not have the digital literacy skills or access to digital devices with internet access to make video visits. Patients with limited English proficiency, limited digital literacy, low socio-economic status or older age often lack the resources needed to overcome the structural barriers to accessing telecare.
Digestive Disease and Sciences argues that these underserved patient populations benefit most from telehealth services, but challenges from the lack of infrastructure hinder the long-term implementation of telehealth services.
As the son of Salvadoran immigrants with limited digital literacy and limited English language skills, I was responsible for looking after my family’s medical care. I arranged telehealth visits with their caregivers as needed and guided them through their appointments as an interpreter, a role I often fulfilled before the transition to video visits. My parents’ health could have deteriorated without my involvement due to the combined challenges of existing inequalities and telehealth services.
As community members, we are responsible for promoting equal opportunity in telehealth by bridging the digital divide in access to healthcare through community service and fostering institutional change.
As an employee at a remote chronic disease treatment company, I taught patients how to take their blood glucose and blood pressure at home so their primary care providers could view their vital signs remotely. It became apparent that routine telehealth services were hampered by the limitations of internet-enabled devices or digital literacy. Even patients with appropriate devices lacked broadband internet access or the ability to understand information about digital devices, preventing successful management of chronic disease, especially in older adults.
Despite inhabiting the largest city in Silicon Valley, residents of San Jose face a digital divide that prevents access to essential services and resources. In response, the San Jose Public Library system has established community-based programs aimed at improving digital literacy and device access, such as the multilingual SJ Access initiative or the Digital Engagement Project for Older Adults. These programs can serve as guidelines for other communities to create a network foundation to close the gap in telehealth and other essential services.
Health programs such as Medicare and Medicaid, which receive federal funding, are required to provide language services in the patient’s preferred language. Yet a third of hospitals in the country do not provide linguistically appropriate services. Healthcare systems should have access to language interpreters to ensure clear communication between doctor and patient in telehealth services, especially for states such as California, which has 6.6 million residents with limited English proficiency.
Policy changes at the local, state and federal levels are needed to ensure telehealth access for disadvantaged communities facing existing barriers to primary care. Elected officials have a duty to advocate for policies that support the continuation of equitable telehealth services for vulnerable patients, including changes to Medicaid that ensure fair costs for video and phone visits.
On an individual level, we can educate others about the resources and services offered in our area to close the telehealth gap.
Here are available resources for Bay Area residents:
● SJ Access: A multilingual citywide initiative through the San Jose Public Library to provide residents with access to free WiFi, access to digital literacy devices and programs.
● Digital Engagement Project for Older Adults: A San Jose Public Library program that addresses the digital divide among older adults by increasing access to digital literacy programs and community resources.
● Neighborhood Tech Connect: A program created by the Community Living campaign to provide older adults and people with disabilities in San Francisco with tablets, Internet access, and training to connect with family members and manage their health.
Brandon Aguilar of San Jose is a pre-medical student and participant in the LEAP program of the Stanford School of Medicine’s Center of Excellence in Diversity in Medical Education.
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