Limited English proficiency complicates telehealth visits

Though Mandarin speakers with limited English proficiency view telehealth as a convenient and necessary service, they face issues with healthcare providers' and interpreters' communication skills, new research reveals.

Limited English proficiency is a significant access barrier to telehealth utilization. People with LEP have a primary language other than English, which can hinder their ability to participate in telehealth visits. According to a study published in November 2021, the odds of participating in video visits among patients with LEP was 28.9%, while patients without LEP had a higher likelihood of participating at 35.9%.

Further, another study published in May 2024 showed that patients with LEP have worse video visit experiences than their peers proficient in English. Researchers in this Kaiser Permanente study found that patients with LEP were 40% more likely than their counterparts to rate video visit experience as worse than in-person appointments.

They set out to better understand the experiences of adults with LEP. The study included 20 patients who had completed at least one primary care telehealth visit in August 2021 at a Kaiser Permanente Northern California location. The patients were 40 or older and had an EHR-documented need for a Mandarin interpreter.

The researchers conducted semi-structured telephone interviews with the patients in Mandarin to collect information about their experiences with telehealth in general and telehealth visits supported by interpreters.

Of the 20 study participants, all had prior experience with audio-only telehealth visits, and 17 (85%) had experience with video visits.

The interviews revealed significant potential for a mismatch of dialect or Mandarin proficiency between the interpreter and the patient, which could result in critical information being lost in translation or influence cultural attitudes toward one another.

Further, the researchers found that patients who felt more confident in English preferred to use it for the simpler parts of the conversation, relying on the interpreter during the more complex or technical aspects. Patients also expressed concerns about whether it would be impolite to interrupt to explain their communication preferences.

The participants asked for patience from the healthcare provider and interpreter to resolve language barrier issues.

"We think of translation as a somewhat technical service, but what we heard from patients is that it is a very human process, and that human part of the translation is surprisingly prominent in their care experience," said study senior author Mary Reed, DrPH, a Kaiser Permanente research scientist, in a press release.

Additionally, study participants asked for more written materials in Chinese languages and more bilingual support staff.

The researchers concluded that healthcare providers and interpreters require additional training to better handle the unique communication challenges inherent in telehealth visits with LEP patients.

"It's very important to learn more about how to effectively provide these services to our members in all the care formats we have available," said study co-author Silvia Teran, MD, an OB-GYN with The Permanente Medical Group, in the press release.

Alleviating language barriers to healthcare is an overarching goal of the Department of Health and Human Services. Last November, the federal agency released an updated HHS Language Access Plan that builds on previous laws prohibiting discrimination based on race, color, national origin, disability, and more.

The updated plan requires all entities receiving HHS funds to adhere to the prior anti-discrimination legal statutes. It also charges the Language Access Steering Committee with helping individual HHS divisions create their own language access plans for different programs and report on progress annually.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.