Challenges to Video Visits for Patients With Non-English Language Preference: A Qualitative Study.

Importance: Patients 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. Objective: To investigate the perceptions of patients with NELP regarding the facilitators and barriers to usage of video visits. Design, Setting, and Participants: This 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 Measures: One-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. Results: Of 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 Relevance: In 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.