JMIR Publications

ABSTRACT

Background:

Background:

COVID-19 pandemic has propelled a shift to digital and telehealth strategies. If digital strategies are not adapted for low-income minority patients, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients.

Objective:

Objective:

To present practical guidelines for staff and providers conducting virtual visits with populations who have limited digital literacy skills.

Methods:

Methods:

All patients were English or Spanish speakers with diabetes and depression receiving care at a public healthcare delivery system in San Francisco, which serves patients on Medicaid and those without insurance. We compared pre-COVID in-person recruitment of patients into a digital health intervention to post-COVID remote recruitment and onboarding procedures. We documented all changes in study procedures to orient patients, most of whom are not regular mobile application users, to self-enroll into our smart smartphone-based intervention via video or phone calls.

Results:

Results:

Patient recruitment matched the overall digital access and literacy among low-income individuals nationwide, with relatively high rates of smartphone ownership but low self-reported confidence in configuring apps. Alterations to study procedures led a previous in-person study to become a fully digitized clinical trial.

Conclusions:

Conclusions:

Low-income patients have high interest in using digital platforms to manage their health, but may require additional upfront human support to gain access. Overall, one-on-one staff-patient partnerships can provide unique technical assistance personalized to each patient’s digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. Clinical Trial: ClinicalTrials.gov identifier: NCT03490253