As COVID-19 case counts rose and sheltering in place became a public health mandate, telehealth use skyrocketed nationwide as previous regulatory restrictions were lifted and providers and patients found safe ways to access care. But despite the rapid uptake in telehealth nationally, prevailing inequities in internet and technology access still leave out too many populations from getting the quality virtual care they want and need.
Telehealth use relies on a patient’s access to technology, knowledge of how to use it and a reliable internet connection. But unfortunately, 22 million older adults (aged 65 or older) in the United States do not have broadband access, preventing the use of digital resources for health and social support. And foreign-born older adults are more than twice as likely to be offline.
Telehealth has the potential to transform the care and well-being of older adults living in affordable senior housing communities. But efforts to successfully improve virtual access to care and health outcomes for this population will be effective and sustainable long-term only if they are developed with equity, empathy and cultural competence at the beginning.
Through Lighthouse for Older Adults, we’re learning what works to improve access to technology-enabled health and well-being support for older adults in affordable senior housing communities. By centering our approach on understanding the unique needs of individual residents and communities, we are able to break down barriers to technology access.
Keeping equity at the forefront of our pilot program’s design, we asked community residents to assess their thoughts on their physical environment, health and well-being, social connectedness, and comfort with technology. Through this empathy research, we established the need for improved healthcare and digital literacy for residents, gained insights into the best approach for delivering mental health supports, and saw the need to facilitate more social connectedness for residents. We also found that linguistically appropriate technology tools with multi-lingual applications would be critical in the long-term, yet these tools are few and far between.
We also collected valuable data about what’s needed to scale equity-based telehealth programs nationally, and we are continuing to apply them as we scale to more communities. Here are a few of the lessons we’ve learned about providing equitable access to telehealth during and beyond COVID-19:
Achieving equity in telehealth care requires an empathy-based approach to technology.
Having a deeper understanding of the social-emotional needs of the residents informed our decision to provide Google Nest Hub Max devices to address the immediate challenges of social isolation. We knew it would be important to find a platform that was easy to use, so residents could more quickly benefit from features such as voice control and video chatting. When implementing any telehealth or digital health program, it is crucial to conduct audience research to make informed choices that meet the community’s needs.
Language barriers to accessing telehealth must be overcome by prioritizing thoughtful, multilingual technology development.
Despite the ease-of-use of the selected technology, every monolingual, non-English-speaking participant said they wished the device was available in their native language. As the market for telehealth technologies continues to grow, and telehealth use evolves, we must consider the need for more multilingual technology.
Onsite training and support are essential to technology use and application.
Age, race, educational attainment, immigration status and income are five major independent risk factors for digital exclusion that, when combined, create a technology gap that is particularly difficult to bridge. Even with access to broadband and devices, older adults often experience limited digital literacy.
Through our rapid deployment project, we found that many participants requested features that the devices already offered, indicating that they were unaware of these features. That’s why onsite champions and training supports are essential; 100% of participants reported that onsite training and assistance were most helpful to learn to use the device. Although the final telehealth experience is a digital one, an in-person training experience and access to individuals who can make learning relevant to the users’ needs is critical to overcoming barriers in learning how to use technology.
The fact that those who need telehealth most also face some of the largest barriers to telehealth access is a significant concern, one that can’t be left out of the conversation when considering programming that aims to bridge coverage gaps an improve access to care. When programs and policies are created without a foundation in equity and empathy, they lack the ability to meet the core needs of those they aim to help.
Lessons we’ve learned about how to most effectively reach older adults in affordable senior housing can be applied to efforts designed to reach any underserved population with digital health technology and training. As we begin the transition out of the pandemic, we cannot leave what we’ve learned about equitable, essential healthcare behind. By following the lessons we’ve learned this year, we all can work to improve healthcare experiences and permanently break down barriers to health and well-being.
David Lindeman, Ph.D., is the director of CITRIS Health and project lead for Lighthouse for Older Adults. The Center for Information Technology Research in the Interest of Society (CITRIS) and the Banatao Institute work to leverage the research strengths of the University of California campuses at Berkeley, Davis, Merced and Santa Cruz.