The Connection Between Virtual Care and Language Barriers

There is no doubt that COVID-19 presented its share of challenges, from the lives lost, to individuals facing loneliness and depression. However, out of the darkness is a glimmer of light—the prominence of virtual care. Also known as telehealth, its various perks include an increased access to care for patients in rural areas, cost-effectiveness, and the timeliness factor.

Telehealth and health inequities

Of course, there are two sides to every coin. Telehealth brings current health inequities to the forefront, including language barriers. These are considered a social determinant of health—non-medical factors that impact health outcomes—which can result in poorer quality of care, disappointment with care, and lengthier stays in the hospital.¹ There are even qualitative studies conducted in the United States that have suggested that virtual care models, particularly those utilizing video, have been difficult for patients who are experiencing these language barriers, due to a lack of instructions in other languages aside from English, and a lack of technological literacy.¹

The study: Objectives and methodology

With these challenges in mind, researchers conducted a study published in JAMA Network Open¹ to explore whether language barriers are linked to the use of and satisfaction with virtual care among adult patients and caregivers of pediatric patients in high-income countries.

The previously published data was pulled using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline 2020 guidance.

Specifically, investigators featured quantitative, comparative studies of adults 18 years of age or older who resided “high-income” countries, per the World Bank). As previously alluded to, adult caregivers of pediatric patients were also considered, but examined separately, since healthcare visits from these two perspectives can differ greatly. The studies compared groups who experienced and did not experience language barriers.

This particular study presented two main outcomes:

1. The use of virtual care, such as video calls, secure messaging between patients and an HCP, and outpatient phone calls
2. Satisfaction with virtual care among patients with and without language barriers, which was measured in the form of average patient satisfaction scores or satisfaction percentages. These measures consisted of the percentage of patients who used virtual versus in-personal virtual care; utilized one virtual care mode over another, used versus never used virtual care; did or didn’t finish a completed schedule virtual visit; and the total rate of virtual care visits.

A total of 41 studies were included in this authors’ analysis, 35 with adult patients (a total of 4,543,906 participants) and six with caregivers of pediatric patients (a total of 7,921 participants). Thirty-eight studies occurred in the United States, while 35 of them explored the use of virtual care. Adult patients facing language barriers had no significant difference in adjusted pooled odds of virtual versus in-person primary or specialist care use (adjusted OR [AOR], 0.91 [95% CI, 0.61-1.35]; n = 5; I² = 95.0%) and there was a significantly lower adjusted pooled odds of video versus telephone primary or specialist care use (AOR, 0.66 [95% CI, 0.52-0.85]; n = 5, I² = 93.5%), with high heterogeneity. When broken down into specialist care, adult patients who dealt with language barriers had significantly lower adjusted pooled odds of using virtual compared to in-person (AOR, 0.78 [95% CI, 0.70-0.87]; n = 4; I² = 0.0%) and video versus telephone (AOR, 0.62 [95% CI, 0.53-0.73]; n = 3; I² = 0.0%) care, with low heterogeneity.

As for the caregivers of pediatric patients, these results were limited, demonstrating a lack of major difference when it came to the odds of virtual versus in-person specialist care, presenting a wide confidence interval and high heterogeneity (OR, 0.62 [95% CI, 0.38-1.02]; n = 3; I² = 91.2%). The results surrounding primary care and other uses of virtual care came back inconclusive, being that there were a limited number of studies. Virtual care satisfaction results were also limited, as two of the three studies found no statistically significant difference in satisfaction.

The study investigators concluded that “in this systematic review and meta-analysis, adult patients facing language barriers had no significant difference in pooled odds of using virtual compared with in-person care overall, and significantly lower pooled odds of using video compared to telephone care overall. Restricting to specialist care, pooled odds of using virtual care and video care were significantly lower among adult patients facing language barriers, with low heterogeneity. Further research on virtual care among individuals facing language barriers is needed, focusing on virtual primary care, patient satisfaction, and caregivers of pediatric patients.”

Reference

1. Wennberg E, Mohmand Z, D’Arienzo D, et al. Virtual Care Among Adults Facing Language Barriers: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(6):e2513906. doi:10.1001/jamanetworkopen.2025.13906