×
Home Current Archive Editorial board
News Contact
Original Clinical Research

Reframing Equity: A Multi-Perspective Analysis of Telehealth Screening Tools Through the Lens of Patients and Clinicians

By
Matthew Sakumoto, MD Orcid logo ,
Matthew Sakumoto, MD
Contact Matthew Sakumoto, MD

Department of Medicine, University of California, San Francisco , San Francisco , United States

Sarah Krug, MS
Sarah Krug, MS

The Health Collaboratory,New York , New York , United States

CANCER101, New York , New York , United States

Abstract

Background: Telehealth usage increased dramatically during the COVID-19 pandemic, but equitable access remains a concern. Patients lacking technology access, skills, and digital literacy may not benefit fully. Validated telehealth literacy screening instruments are lacking. This study evaluated existing tools from patient and clinician perspectives.  Methods: Five telehealth literacy screening tools were identified through a literature review: 1) Digital Literacy Self-Assessment Tool (DLSA), 2) Electronic Health Literacy Scale (eHEALS), 3) Digital Health Literacy Scale (DHCLS), 4) Telehealth Literacy Screening Tool (TLST), and 5) University of Alabama-Birmingham Technology Comfort Survey (TCS). Patients (n=44) and clinicians (n=24) completed an online survey rating each tool across domains of 1) User experience, 2) Engagement, 3) Relevance, and 4) Health literacy.  Results: Clinicians overall had greater technology comfort and more digital healthcare usage than patients. Patients ranked TCS highest overall, while clinicians preferred DHCLS. TLST performed well for both groups. All participants ranked eHEALS lowest. Patients valued simplicity and clarity while clinicians favored brevity and clinical focus.   Conclusion: Perspectives differed between patients and clinicians regarding optimal telehealth literacy screening tools. Screening instruments should align with key engagement drivers: access, competency, digital literacy, relevancy, trust, and preferences. Tailored tools co-designed with patients and clinicians can promote equitable telehealth adoption and engagement.

References

1.
Greenwood S. Mobile technology and home broadband 2021.
2.
Collaboratory H. TechQuity tool for patient preferences [Internet. 2023;
3.
Center for Devices and Radiological Health. Patient Preference Information (PPI) in medical device decision making. FDA [Internet. 2023;
4.
SteelFisher GK, McMurtry CL, Caporello H, Lubell KM, Koonin LM, Neri AJ, et al. Video Telemedicine Experiences In COVID-19 Were Positive, But Physicians And Patients Prefer In-Person Care For The Future. Health Affairs. 2023;42(4):575–84.
5.
Houser SH, Flite CA, Foster SL. Privacy and security risk factors related to telehealth services—a systematic review. Perspect Health Inf Manag. 2023;10;20(1):1f.
6.
Saadi A, Rodriguez JA. Addressing privacy concerns central to success of telehealth use among undocumented immigrants.
7.
Yee V, Bajaj SS, Stanford FC. Paradox of telemedicine: building or neglecting trust and equity. The Lancet Digital Health. 2022;4(7):e480–1.
8.
Hodgkins M, Barron M, Jevaji S, Lloyd S. Physician requirements for adoption of telehealth following the SARS-CoV-2 pandemic. npj Digital Medicine. 4(1).
9.
Kuek A, Hakkennes S. Healthcare staff digital literacy levels and their attitudes towards information systems. Health Informatics Journal. 2020;26(1):592–612.
10.
Liang L, Brach C. Health literacy universal precautions are still a distant dream: analysis of U.S. data on health literate practices. Health Lit Res Pract. 2017;(v;1(4):e216–30).
11.
Sakumoto M, Jelinek R, Joshi AU. Identification of gaps in graduate medical education telehealth training. Telehealth Med Today [Internet. 2021;
12.
Piggott L, Piggott S, Simon K, Kelly M. Impact of telehealth implementation on non-consultant hospital doctors training experience [Internet. 2023;
13.
Jezewski E, Miller A, Eusebio M, Potter J. Targeted Telehealth Education Increases Interest in Using Telehealth among a Diverse Group of Low-Income Older Adults. International Journal of Environmental Research and Public Health. 19(20):13349.
14.
Hughes HK, Canino R, Sisson SD, Hasselfeld B. A simple way to identify patients who need tech support for telemedicine. Harv Bus Rev [Internet. 2021;
15.
Garvin LA, Hu J, Slightam C, McInnes DK, Zulman DM. Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness. Journal of General Internal Medicine. 2021;36(8):2274–82.
16.
Kalicki AV, Moody KA, Franzosa E, Gliatto PM, Ornstein KA. Barriers to telehealth access among homebound older adults. Journal of the American Geriatrics Society. 2021;69(9):2404–11.
17.
Abernethy A, Adams L, Barrett M, et al. The Promise of Digital Health: Then, Now, and the Future. NAM Perspectives. 6(22).
18.
SurveyMonkey [Internet.
19.
Collaboratory H. The Health Collaboratory.
20.
Bird M, McGillion M, Chambers EM, Dix J, Fajardo CJ, Gilmour M, et al. A generative co-design framework for healthcare innovation: development and application of an end-user engagement framework. Research Involvement and Engagement. 2021;7(1).
21.
Irfan A, Lever JM, Fouad MN, Sleckman BP, Smith H, Chu DI, et al. Does health literacy impact technological comfort in cancer patients? The American Journal of Surgery. 2022;223(4):722–8.
22.
Gillie M, Ali D, Vadlamuri D, Carstarphen KJ. Telehealth Literacy as a Social Determinant of Health: A Novel Screening Tool to Support Vulnerable Patient Equity. Journal of Alzheimer’s Disease Reports. 2022;6(1):67–72.
23.
Nelson LA, Pennings JS, Sommer EC, Popescu F, Barkin SL. A 3-Item Measure of Digital Health Care Literacy: Development and Validation Study. JMIR Formative Research. 6(4):e36043.
24.
Norman CD, Skinner HA. eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research. 8(4):e27.
25.
Center E. EdTech Center @ World Education.
26.
Health Literacy in healthy people. 2030;
27.
Berkman N, DeWalt D. Health literacy interventions and outcomes: an updated systematic review. 2004.
28.
van Kessel R, Wong BLH, Clemens T, Brand H. Digital health literacy as a super determinant of health: More than simply the sum of its parts. Internet Interventions. 2022;27:100500.
29.
Ramsetty A, Adams C. Impact of the digital divide in the age of COVID-19. Journal of the American Medical Informatics Association. 2020;27(7):1147–8.
30.
Barron M, Mishra V, Lloyd S, Augenstein J. How to measure the value of virtual health care. Harvard Business Review [Internet.
31.
Bouabida K, Lebouché B, Pomey MP. Telehealth and COVID-19 Pandemic: An Overview of the Telehealth Use, Advantages, Challenges, and Opportunities during COVID-19 Pandemic. Healthcare. 10(11):2293.

Citation

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.