Promoting Equity in Telehealth Among Racially and Ethnically Diverse Adolescents: A Quality Improvement Initiative

Purpose/Objectives: The COVID-19 pandemic magnified the long-standing health disparities and unique health needs of adolescents from racially and ethnically diverse backgrounds. With the rapid expansion of telehealth nationally, it is essential that health systems consider how telehealth could influence health equity and be leveraged to meet the needs of diverse populations. We launched a quality improvement (QI) initiative at a large safety-net hospital to assess adolescent and parent perspectives on the use of telehealth, specifically exploring barriers and facilitators to implementation, and then develop recommendations for adapting telehealth practices to optimize care and promote equity for diverse populations of adolescents.

Design/Methods: From January-May 2021, we conducted surveys with adolescents ages 12-21 who had a telehealth visit at a county safety-net hospital during the COVID-19 pandemic (n=70) and their parents (n=41). We purposively sampled for adolescents from populations known to be underutilizing telehealth within our system; in our final sample, 39% were Latinx and 33% were Black, with 30% of Black adolescents identifying as Somali. The electronic surveys, which were delivered in English, Spanish or Somali, included questions about respondents’: experiences and satisfaction with telehealth; barriers and facilitators to telehealth; experiences of racism and discrimination in healthcare; indicators of high-quality adolescent care and demographics. We analyzed data using descriptive statistics for quantitative variables, and content analysis for qualitative (open-ended) responses. We then hosted four listening sessions with adolescents (n=9) and parents (n=4) to collectively review findings and develop recommendations to optimize care for diverse adolescents and their families.

Results: Participants were generally satisfied with telehealth and rated visits highly on quality of care (Figure 1). Commonly reported barriers to telehealth included: difficulty connecting to the visit, a lack of private space, feeling the provider may not be able to evaluate them fully during the visit, and not being able to get labs or imaging. Seven percent of adolescents and 15% of parents reported experiencing discrimination in healthcare, with over one-third (36%) of these experiences occurring during telehealth visits. Nearly half of adolescents (44%) expressed concern that something private from the visit might be shared with their parents, and 10% of adolescents did not have a private space to talk to their providers. Drawing on findings from surveys and listening sessions, we developed recommendations for clinicians and health systems (Table 1) and disseminated them across our hospital system.

Conclusion/Discussion: Our QI initiative engaged a diverse population of adolescents and parents in developing recommendations for clinician- and systems-level changes for improving equity in the delivery and, ultimately, access to telehealth care. Our findings have implications, not only for our large safety-net county medical center, but also for other clinics serving racially and ethnically diverse young people.