# Reach, Engagement, and Acceptability of a Subclinical Telehealth Service for Spanish-Speaking Adults: Retrospective Mixed Methods Pilot Study

## TL;DR

A digital mental health service for Spanish-speaking adults in the US was found to be widely used and well-received, with high satisfaction and engagement rates.

## Contribution

This study provides empirical evidence on the reach and acceptability of culturally tailored telehealth services for Latino/x communities.

## Key findings

- Over 6,000 users accessed the service across all 50 US states, with high appointment scheduling rates and session engagement.
- Users reported high satisfaction with the service, citing affordability, cultural fit, and provider professionalism as key strengths.
- Qualitative interviews revealed diverse user backgrounds and a preference for the platform over traditional mental health services.

## Abstract

There is a gap in mental health care among Latino/x and Spanish-speaking communities, and the care that is available is often difficult to access, lacks cultural nuance, and results in low engagement and satisfaction.

The study aimed to evaluate the reach, adoption, and acceptability of digital Spanish-language psychosocial and emotional wellness services among Latino/x adults offered by the digital health company Sanarai.

Data included in this study were collected between August 2020 and September 2024 by Sanarai as part of its ongoing services. Quantitative data sources included individual customers’ appointment data, individual session payment data, and customer satisfaction data. Qualitative data were obtained from transcribed notes of telephone or video-based user interviews conducted by Sanarai staff between August 2020 and May 2024.

Between August 2020 and September 2024, Sanarai served 6163 users (n=3662, 59.42% women participants) across all 50 US states, with the highest concentration of participants in Texas and California. Results showed 94% (n=5793) of users scheduled a first appointment within 1 week, with 43% (n=2650) doing so within 1 day. Over 62.60% (n=3858) of participants engaged in two or more sessions, attending an average of 8.94 (SD 13) sessions over 110 days (SD 169). The platform delivered a total of 36,858 appointments, including individual and couples sessions. Only 22.47% (n=1385) of users responded to a customer satisfaction survey for a total of 2287 distinct responses; among this subgroup, session satisfaction was high with an average satisfaction rating of 4.88 out of 5.0 (SD 0.49) and a Net Promoter Score of +85. Nearly all responses (n=2174, 95.06%) expressed intent to schedule another session, but these results should be interpreted with caution, given the low response rate. Qualitative interviews with 30 users (n=21, 70% women) revealed a diverse user base. Many users reported prior mental health service experiences, while one-third were new to care. Participants cited cost, cultural fit, language access, and convenience as key reasons for choosing Sanarai over local services. Users highlighted the platform’s affordability, scheduling flexibility, and provider professionalism as central to their positive experiences.

These findings underscore the value of culturally responsive, accessible online mental health care for Spanish-speaking communities.