# Virtual Care Among Adults Facing Language Barriers: A Systematic Review and Meta-Analysis

## TL;DR

This study finds that adults with language barriers may face challenges in using virtual care, especially for specialist services and video visits, in high-income countries.

## Contribution

The study provides the first comprehensive meta-analysis on the impact of language barriers on virtual care use and satisfaction in high-income countries.

## Key findings

- Adults with language barriers had no significant difference in using virtual vs in-person care overall.
- They had significantly lower odds of using video vs telephone care, especially in specialist care.
- Results for caregivers of pediatric patients were limited and inconclusive.

## Abstract

Is there an association between language barriers and the use of or satisfaction with virtual care among adult patients and caregivers of pediatric patients in high-income countries?

In this systematic review and meta-analysis of 41 studies and more than 4.5 million participants, adult patients facing language barriers had no statistically significant difference in adjusted pooled odds of virtual vs in-person care use overall (examining primary and specialist care), and significantly lower adjusted pooled odds of video vs telephone care use overall, with high heterogeneity. Restricting to specialist care, adjusted pooled odds of using virtual care and video care were significantly lower among adult patients facing language barriers, and heterogeneity was low.

Adults facing language barriers may experience inequities in use of virtual vs in-person specialist care and with video vs telephone specialist care.

This systematic review and meta-analysis examines the association between language barriers and use of and satisfaction with virtual care among adult patients and among caregivers of pediatric patients in high-income countries

Patients with language barriers may experience difficulties accessing virtual care.

To synthesize the literature on the association between language barriers and use of and satisfaction with virtual care among adult patients and among caregivers of pediatric patients in high-income countries.

Four electronic databases, MEDLINE, Embase, PsycINFO, and Web of Science, were searched from inception to March 2023 using a combination of language and virtual care terms.

Eligible studies compared quantitative data on use of or satisfaction with virtual care among adult patients or caregivers of pediatric patients with or without language barriers in high-income countries.

Data were extracted by 2 independent reviewers using a piloted data extraction form. Risk of bias assessments were performed using the ROBINS-E tool. Data were synthesized by outcome type using random-effects meta-analyses stratified by primary vs specialist care and narrative synthesis. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline.

The primary outcomes were use of virtual care and satisfaction with virtual care among adult patients and among caregivers of pediatric patients with vs without language barriers.

In total, 41 studies were included, 35 with adult patients (N = 4 543 906) and 6 with caregivers of pediatric patients (N = 7921). Most studies (n = 38) were set in the US, and examined use of virtual care (n = 35). Adult patients facing language barriers had no significant difference in adjusted pooled odds of virtual vs in-person primary or specialist care use (adjusted OR [AOR], 0.91 [95% CI, 0.61-1.35]; n = 5; I2 = 95.0%) and significantly lower adjusted pooled odds of video vs telephone primary or specialist care use (AOR, 0.66 [95% CI, 0.52-0.85]; n = 5, I2 = 93.5%), with high heterogeneity. Restricting to specialist care, adult patients facing language barriers had significantly lower adjusted pooled odds of using virtual vs in-person (AOR, 0.78 [95% CI, 0.70-0.87]; n = 4; I2 = 0.0%) and video vs telephone (AOR, 0.62 [95% CI, 0.53-0.73]; n = 3; I2 = 0.0%) care, with low heterogeneity. Results for caregivers of pediatric patients were limited and showed no significant difference in odds of virtual vs in-person specialist care, with a wide confidence interval and high heterogeneity (OR, 0.62 [95% CI, 0.38-1.02]; n = 3; I2 = 91.2%). Results specific to primary care and results on other use of virtual care outcomes (eg, visit noncompletion) were inconclusive due to limited numbers of studies (eg, n = 2 studies reporting AOR of visit noncompletion for primary and specialist care, with I2 = 75.5% and 89.6%, respectively, for the corresponding meta-analyses). Results on satisfaction with virtual care, synthesized narratively, were limited and mixed. In studies of adult patients and caregivers of pediatric patients (n = 3 each), 2 of the 3 studies found no statistically significant difference in satisfaction, while 1 study found significantly lower satisfaction.

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.