JMIR Publications

ABSTRACT

Background:

Persisting sex- and gender-based disparities in access to high-quality, personalized health care in the United States can lead to devastating outcomes with long-lasting consequences. Strategic use of virtual resources could expand equitable health care access for women. Optimal approaches and timing for individualized, virtually-delivered health care for women, however, are currently unclear.

Objective:

We thus sought to conduct a detailed analysis of the current literature to answer the following question: What do women and health care teams report are successes and challenges to accessing, delivering, and engaging in synchronous virtual healthcare for women?

Methods:

We conducted a qualitative evidence synthesis using a best-fit framework approach based upon the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework and concepts from the Public Health Critical Race Praxis (PHCRP). We searched MEDLINE, Embase, and CINAHL from January 1, 2010 to October 10, 2022, using a combination of database-specific, relevant, controlled vocabulary terms and keywords; this search was updated in MEDLINE through October 2023. Additional citations were identified through handsearching. Our eligibility criteria were developed using the Sample, Phenomenon of Interest, Design, Evaluation, Research Type (SPIDER) tool to identify qualitative studies addressing synchronous virtual care for women. Citations were screened in duplicate and eligible articles were abstracted. An iterative thematic synthesis approach was used to identify descriptive themes related to the successes and challenges related to delivering high-quality virtual care. Data reduction was carried out via inductive and deductive reasoning. Quality assessment was conducted using Critical Appraisal Skills Programme (CASP) and certainty of evidence using CERQual approaches. Our protocol is registered with PROSPERO (CRD42021283791).

Results:

Of 85 eligible articles, we sampled 51 for data extraction based on representation of patient and provider perspectives, marginalized voices, and relevance to a variety of clinical contexts. We identified concerns regarding the impact of the virtual setting upon building rapport and emotional connections, as well as the amplification of communication barriers for women with pre-existing challenges (e.g., language barriers, limited transportation, family and social commitments, limited options for women-specific health needs). Among individuals adopting virtual care, we also identified concerns regarding the negative impact on patient and provider well-being. Patient perceptions of privacy and safety differed regarding the associated benefits and harms, depending on patient home context. Abundant evidence supported the value of convenience and cost-savings offered by virtual care and the importance of patient choice in visit modality. Virtual care also provides a feasible strategy for addressing important health care needs for women located in clinical desserts.

Conclusions:

The benefits of virtual care upon health care access may be more acutely felt by women, especially those with pre-existing challenges. Strategic incorporation of virtual modalities into health care delivery for women could improve equitable access to high quality, patient-centered care.