Dataset Information

Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth.

ABSTRACT:

Introduction

The COVID-19 pandemic has led to a large increase in telemedicine encounters. Despite this rise in virtual visits, patients who speak non-English languages have experienced challenges accessing telemedicine. To improve health equity, medical education on telehealth delivery should include instruction on working with interpreters in telehealth.

Methods

We developed a 25-minute self-directed module with collective expertise of faculty with experience in medical education, interpreter training, and communication training. The module was delivered online as part of a longitudinal health equity curriculum for third-year medical students. In addition to didactic information, the module contained video examples of interpreter interactions in telehealth.

Results

Sixty-four third-year medical students participated in the study, and 60 completed a postmodule survey. Students were satisfied with the content of the module, as well as the duration of time required to complete the tasks. Approximately 90% would recommend it to future students. Nearly 80% of students rated the module as being quite effective or extremely effective at increasing their comfort level with visits with patients with non-English language preference.

Discussion

Our module provides a basic framework for medical students on how to successfully work with interpreters during a language-discordant virtual visit. This format of asynchronous learning could also be easily expanded to resident physicians and faculty seeking more resources around working with interpreters in telemedicine.

SUBMITTER: Shin TM

PROVIDER: S-EPMC10719426 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth.

Shin Tiffany M TM Dodenhoff Kristen A KA Pardy Mariana M Wehner Abigail Smith AS Rafla Samuel S McDowell Leslie Doroski LD Denizard-Thompson Nancy M NM

MedEdPORTAL : the journal of teaching and learning resources 20231214

<h4>Introduction</h4>The COVID-19 pandemic has led to a large increase in telemedicine encounters. Despite this rise in virtual visits, patients who speak non-English languages have experienced challenges accessing telemedicine. To improve health equity, medical education on telehealth delivery should include instruction on working with interpreters in telehealth.<h4>Methods</h4>We developed a 25-minute self-directed module with collective expertise of faculty with experience in medical educatio ...[more]

PMID: 38098759

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Project description:BackgroundOver 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients.MethodsThe Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services.ResultsPre- and post-tests were administered to assess students' familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort's aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01).ConclusionsImplementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.

Project description:PurposeTelemedicine care dramatically expanded during the COVID-19 pandemic. We characterized facilitators and barriers to telemedicine implementation among safety-net primary care clinics serving patients with limited English proficiency (LEP).MethodsWe collected data on telemedicine volume and patient demographics among safety-net clinics participating in a telemedicine learning collaborative. Data on various metrics were reported to the collaborative from February 2019 through August 2021. We conducted semi-structured interviews with clinical and quality leaders, purposively sampling clinics serving high proportions of patients with LEP. We analyzed interviews with a mixed inductive-deductive approach applying the Consolidated Framework for Implementation Research.ResultsBy September 2020, the 23 sites served 121,589 unique patients with in-person and 120,338 with telephone visits; 47% of these patients had LEP. Of 10,897 unique patients served by video visits, 38% had LEP. As a proportion of total visits, telemedicine (telephone and video) visits increased from 0-17% in October 2019-March 2020 to 10-98% in March-August 2020. We conducted 14 interviews at 11 sites. Themes included (1) existing telemedicine platforms and interpreter services were not optimized to support patients with LEP; (2) clinics invested significant labor iterating workflows; (3) sites with technological infrastructure and language-concordant staff were best suited to serve patients; (4) patients speaking less-represented languages or experiencing intersecting literacy barriers were underserved with telemedicine. Interviewees recommended innovations in telemedicine platforms and community-based access.ConclusionsSafety-net sites relied on existing resources to accommodate patients with LEP, but struggled providing access for the most marginalized. Proactive, data-driven strategies to address patient and community barriers as well as optimize clinical workflows with high-quality, certified medical interpreters are needed to ensure equitable access.

Project description:ImportancePatients with non-English language preference (NELP) participate in video visits considerably less often than their English-speaking counterparts. Understanding the capability, opportunities, and motivation of patients with NELP to use video visits is key to determining how this technology may benefit their care.ObjectiveTo investigate the perceptions of patients with NELP regarding the facilitators and barriers to usage of video visits.Design, setting, and participantsThis qualitative analysis of semistructured interviews of patients with NELP from an ambulatory clinic network of a large, urban, academic health system in California serving a linguistically diverse population was conducted from November 2022 to September 2023. Electronic health data were used to identify Spanish- and Cantonese-speaking patients with at least 1 clinic visit but no video visits in the prior 12 months. Data were analyzed from September 2023 to February 2024.Main outcomes and measuresOne-on-one semistructured interviews were conducted by telephone to capture perceptions on facilitators and barriers to video visit use. Interviews were audio-recorded until reaching thematic saturation, deidentified, transcribed and translated, and analyzed using rapid qualitative analysis. Common themes were identified and matched to relevant domains of the capability, opportunities, and motivation model.ResultsOf the 31 patients successfully contacted by telephone, 27 participants (mean [SD] age, 66 [15] years; 18 women [67%]), including 16 Spanish-speaking and 11 Cantonese-speaking participants, were interviewed. Four major themes emerged, including (1) video visits creating additional communication challenges and potentially exacerbating communication difficulties for patients who face language barriers; (2) video visits perceived as having some drawbacks for medical evaluations as well as some appealing benefits; (3) limited digital literacy, device and data access, and non-user-friendly video visit processes as important barriers; and (4) in-person teaching, simpler technologic processes, opportunities to repetitively practice video use, troubleshooting support, and language-concordant instructions, clinicians, and clinic staff as facilitators of video visits. For some, the disadvantages were sufficient to deter use of video visits, while for others, they were counterbalanced by the ease of access provided by video visits.Conclusions and relevanceIn this qualitative study, participants with NELP perceived multiple barriers to video visits, including greater communication difficulties, lower medical evaluation quality, and technical issues. These findings suggest that addressable technical challenges associated with language barriers hamper access to video visits and decrease motivation for use and that interventions are needed to increase telehealth equity.

Project description:BackgroundTelemedicine's dramatic increase during the COVID-19 pandemic elevates the importance of addressing patient-care gaps in telemedicine, especially for patients with limited English proficiency.ObjectiveTo examine the associations of patient language and patient-provider language concordance with telemedicine visit type (video versus telephone visit).DesignCross-sectional automated data study of patient-scheduled primary care telemedicine appointments from March 16, 2020, to October 31, 2020.SettingNorthern California integrated healthcare delivery system.ParticipantsAll 22,427 completed primary care telemedicine visits scheduled by 13,764 patients with limited English proficiency via the patient portal.MeasurementsCross-sectional association of electronic health record-documented patient language (Spanish as referent) and patient-provider language concordance with patients' choice of a video (versus telephone) visit, accounting for patient sociodemographics, technology access, and technology familiarity factors.ResultsOf all patient-scheduled visits, 34.5% (n = 7747) were video visits. The top three patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). Adjusting for sociodemographic and technology access and familiarity factors and compared to patients speaking Spanish, video visit use was higher among patients speaking Cantonese (OR = 1.34, 95% CI: 1.18-1.52), Mandarin (OR = 1.33, 95% CI: 1.16-1.52), or Vietnamese (OR = 1.27, 95% CI: 1.09-1.47), but lower among patients speaking Punjabi (OR = 0.75, 95% CI: 0.75, 0.62-0.91). Language concordance was associated with lower video visit use (OR = 0.86, 95% CI: 0.80-0.93) and moderated associations of speaking Spanish, Cantonese, and Korean with video visit use. In addition, for all language groups, those with prior video visit use were more likely to re-use video visits compared to those with no prior use (p < .05 for all languages except Hindi with p = 0.06).ConclusionsAmong linguistically diverse patients with limited English proficiency, video telemedicine use differed by specific language. Disaggregating patient subpopulation data is necessary for identifying those at greatest risk of being negatively impacted by the digital divide.

Dataset Information

Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth.

Introduction

Methods

Results

Discussion

Publications

Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth.

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