Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review (Preprint)

Abstract

BACKGROUND The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. OBJECTIVE The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. METHODS We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. RESULTS We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. CONCLUSIONS We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post–COVID-19 reality.

Needs, gaps and opportunities for standard and e-mental health care among at-risk populations in the Asia Pacific in the context of COVID-19: a rapid scoping review

“…Given the diversity of the included papers and the emergent nature of the literature, a critical appraisal was not conducted. To capture a diversity of perspectives in this emergent field, we included a broad scope of published papers including primary research studies [ 20 ] and non-research-based papers including commentaries [ 21 ], letters and correspondence [ 20 ], reviews [ 13 ], perspectives and viewpoints [ 1 ], editorials [ 1 ], recommendations [ 2 ], clinical observations and notes from the field [ 3 ], and brief reports [ 22 ]. Table 22 lists type of paper, population(s) and country (ies) of focus for each included record.…”

“…The COVID-19 pandemic, however, has underscored the urgency of addressing disparities in access to care for both standard and e-mental health care. It also is leading to increased calls for attention to equity issues in the field of digital health [12][13][14]159]. This review and the associated TEAM-CAP study will lead to improved evidence and recommendations for the equitable delivery of emental health care across the APEC region.…”

“…The digital divide, or the gap in access to digital technologies and infrastructure, may be greater in at-risk groups [ 12 ], resulting in further health care marginalization of the most vulnerable populations [ 12 , 12 ]. Though there is limited existing literature specific to equity concerns in e-health, earlier contributions published during the pandemic also speak to the risks that the increased use of e-health technologies will exacerbate inequities in care access among marginalized populations [ 13 , 58 , 75 ]. Crawford et al [ 159 ] advance a Digital Health Equity Framework that captures the interconnections of socio-economic and cultural contexts, intermediate health factors (e.g.…”

“…‘Low tech’ options, such as text-based or telephone interventions, can be beneficial where privacy and safety are of concern [ 35 , 53 ] and/or when there are digital literacy challenges. As recommended in relation to promoting equitable access to e-health in general [ 13 , 159 ], e-mental health care must be offered in a variety of languages and be culturally validated to ensure that it is both appropriate and accessible to diverse populations such as migrant, Indigenous communities and racial or ethnic minorities [ 56 , 12 , 13 , 13 ]. It is also essential to develop clear policies and guidelines for the delivery of e-mental health care with a focus on equity and accessibility for a variety of at-risk and vulnerable populations [ 73 , 91 ].…”

“…When exploring e-mental health options available in Canada during the pandemic however, a recent review noted that little assessment of equity issues exists in the literature [ 12 ]. Though more attention to this issue is emerging [ 13 ], comprehensive international evidence regarding equitable access to mental health care by specific at-risk populations is limited thus far. This demonstrates the need for equity-oriented research, recognizing the intersections of sex, gender, age, ethnicity and other factors, to identify needs and gaps to equitable mental health care delivery, including both standard and e-mental healthcare approaches [ 14 , 15 ].…”