Cancer care telehealth access needs in underrepresented patients: Development and implementation of the pragmatic access to telehealth needs assessment survey.

Abstract

We developed and implemented the Access to Telehealth Needs Assessment Survey (AcTNAS) based on Five A's of TelEquity (Awareness-Application, Agency, Attitude, Accessibility, and Accommodation) that we created. We iteratively developed the AcTNAS in English (mid 2021-early 2022) and transcreated (culturally and linguistically adapted) it into languages spoken in the service area. Women with breast cancer in safety net hospital and academic medical center cancer clinics in New York City completed the AcTNAS. Participants (N = 441) self-identified as foreign-born (77 %, n = 338), Black (56 %, n = 222), and Hispanic (36 %, n = 158). Most preferred speaking English (69 %, n = 306) or Spanish (27 %, n = 118). The AcTNAS assessed telehealth Awareness-Application (21 % did not know about the patient portal; 57 % had never participated in video telehealth), Agency (52 % were "not good with technology"), Attitude (voice-only [57 %] and video [51 %] appointments not as good as in-person appointments), Accessibility (38 % without good telephone service, 8 % no Wi-Fi/plug-in/public internet access), and Accommodation (50 % needed telehealth connection assistance). Insurance status (p ≤ .009) was associated with a prior televisit. Age (p < .001), education (p < .001), region of origin (p = .001), ethnicity (p = .028), and language (p < .001), were associated with prior portal usage. AcTNAS administration helped identify telehealth access needs among underserved patients with cancer.