# Patient-Centered Communication in Telehealth Settings

## TL;DR

This study finds that telehealth can support good patient-centered communication, though factors like education and English proficiency affect outcomes.

## Contribution

The study explores how individual and county-level factors influence patient-centered communication in telehealth, particularly in vulnerable communities.

## Key findings

- Optimal patient-centered communication was comparable across racial and ethnic groups but lower for those with limited English proficiency or less education.
- Associations between education and communication quality were strongest in the most vulnerable counties.
- Digital health literacy was linked to better communication outcomes in telehealth visits.

## Abstract

This cross-sectional study assesses whether individual-level characteristics are associated with optimal patient-centered communication in telehealth visits and whether any associations differ by county-level factors stratified by the Minority Health Social Vulnerability Index among US adults.

Are individual-level characteristics associated with optimal patient-centered communication (PCC) in telehealth visits and do these associations differ by county-level factors per the Minority Health Social Vulnerability Index (MHSVI)?

In this cross-sectional study of 2754 US adults, approximately 40% to 50% self-reported optimal levels of 7 PCC items, which were largely comparable by race and ethnicity and MHSVI strata, whereas English nonproficiency and educational attainment were associated with lower odds of optimal PCC. When stratified by MHSVI, associations were evident across both strata for English nonproficiency but only in the most vulnerable counties for educational attainment.

Findings indicate that telehealth may facilitate optimal PCC.

Patient-centered communication (PCC) is key to high-quality health care but remains understudied in telehealth visits.

To examine associations between individual-level characteristics and optimal levels of 7 PCC items and to assess whether these associations differ by county-level vulnerability to public health emergencies per the Minority Health Social Vulnerability Index (MHSVI).

This was a cross-sectional, online survey of a nonprobability sample of adults, 18 years of age or older, who resided in MHSVI least- or most-vulnerable US counties. Data were collected between February 23 and August 26, 2022, and analyzed between January 10 and May 5, 2025.

Participant characteristics and county-level vulnerability.

Self-reported optimal levels of 7 PCC items. For each item, multivariable logistic regression models were fit for the overall sample and stratified by MHSVI.

The survey participation rate was 17.0%. A total of 2754 adults (mean [SE] age, 43.9 [0.3] years) had at least 1 telehealth visit in the past year and resided in 649 of the MHSVI least- or most-vulnerable counties. The sample included 1568 females (56.9%), with 1650 participants (59.9%) self-identifying as White and 1104 participants (40.1%) self-identifying as being in a racial or ethnic minority group (Black or African American, 465 [16.9%]; Hispanic or Latino, 501 [18.2%]; and other, 138 [5.0%]). Optimal PCC ranged from 1069 participants (38.8%) self-reporting that clinicians spent sufficient time with them to 1372 participants (49.8%) reporting that clinicians ensured their understanding. Decreased odds of reporting optimal PCC (eg, clinicians ensuring understanding) were associated with educational attainment (adjusted odds ratio [AOR], 0.86 [95% CI, 0.77-0.96]) and not being proficient in English (AOR, 0.39 [95% CI, 0.28-0.53]). Increased odds were associated with digital health literacy domains (eg, access to digital services that work AOR, 1.49 [95% CI, 1.09-2.04]). Hispanic or Latino and Black or African American participants reported optimal PCC that was largely comparable with White participants. Associations between individual-level characteristics and optimal PCC differed by MHSVI. For example, Black or African American participants were less likely to report optimal time spent with clinicians in the MHSVI most-vulnerable counties (AOR, 0.73 [95% CI, 0.54-0.98]), but more likely to report that clinicians explained things in least-vulnerable counties (AOR, 1.74 [95% CI, 1.03-2.94]). Educational attainment was associated with lower odds of reporting optimal PCC in the MHSVI most-vulnerable counties only (eg, clinicians ensured understanding AOR, 0.85 [95% CI, 0.74-0.98]), whereas associations with English nonproficiency (eg, clinicians ensured understanding AOR, 0.40 [95% CI, 0.27-0.59] for most vulnerable and 0.35 [95% CI, 0.20-0.59] for least vulnerable) and digital health literacy (eg, clinicians gave the opportunity to ask questions for access to digital services that work AOR, 2.29 [95% CI, 1.50-3.49] for most vulnerable and 2.09 [95% CI, 1.31-3.36] for least vulnerable) were largely consistent across both MHSVI strata.

In this cross-sectional study, optimal PCC was comparable by race and ethnicity but not by educational attainment or English proficiency. Overall, the findings suggest that telehealth may facilitate optimal PCC.