How Stroke Survivors Can Overcome Barriers That Limit Access to Telehealth

Telehealth offers many benefits in terms of providing outpatient stroke survivors with the healthcare they need, but there are multiple barriers that need to be addressed, according to a scientific review conducted by scientists at the University of Texas Health Science Center at Houston.

There has been a rapid switch to telehealth for patients needing chronic care over the last few years, driven by the COVID-19 pandemic. Evidence shows that telehealth is beneficial for addressing inequalities in chronic care provided to stroke survivors, according to Anjail Sharrief, an associate professor of neurology with McGovern Medical School at UTHealth Houston and the lead author of the paper.

As the use of telehealth has expanded for the management of patients living with stroke and other chronic diseases, we need to look at the potential benefits of using telehealth to provide chronic care for patients in communities that face the greatest risk of disparities, said Sharrief, who is also the director of stroke prevention at the UTHealth Houston Institute of Stroke and Cerebrovascular Disease and director of the Stroke Transitions Education and Prevention (STEP) clinical program.

While telehealth has the potential to improve access to healthcare services and treatment, it can also potentially broaden the disparity gap for patients who face barriers to telehealth due to poor digital literacy or a lack of access to high-speed Internet, as well as those who are physically or cognitively impaired.

Benefits of Telehealth

The paper, which was recently published in the scientific journal Stroke, lists several benefits that telehealth offers for treating various complications that stroke survivors may experience, such as visual, cognitive, and mobility impairments. In addition, the paper discusses the benefits of telehealth in addressing social barriers to healthcare such as economic instability, living in a remote/rural area, and having limited social support.

For example, Sharrief and her team found that telehealth was useful for overcoming barriers posed by mobility limitations and the need for mobility-aided equipment to access healthcare facilities by alleviating the need to travel altogether. Virtual visits also reduce the number of in-person visits that patients need to attend, allowing them to receive multidisciplinary care from the comfort of their own home, including having their blood pressure and cardiac arrhythmias remotely monitored.

Sharrief points out that these benefits are not limited to stroke patients alone, but also to patients with other neurological disorders.

The authors also list the primary barriers that stroke survivors have to face when using telehealth, such as stroke-related physical and/or cognitive disabilities, limited Internet access, poor digital literacy, and language barriers. The paper goes on to provide potential solutions for how these barriers could be overcome.

Limited Internet Access and Poor Digital Literacy

The authors suggested several recommendations to address barriers to telehealth arising from limited Internet access and poor digital literacy:

· Encouraging community health workers and social workers to help patients connect to programs that strive to narrow the digital divide, such as the Affordable Connectivity Program, which offers discounted Internet access, as well as digital devices at discounted prices.

· Offering patients that have limited WiFi access with devices that have mobile hotspot capabilities.

· Providing community-based telehealth centers where patients can go to receive the care they need remotely, but yet still remain close to home, avoiding the need to travel long distances to receive in-person care.

· Making use of smartphones rather than devices that require Bluetooth for monitoring vital health parameters such as blood pressure.

· Using digital tools and online platforms that don’t require access to high-speed Internet such as text messages, secure messaging platforms, and smartphone applications.

· Developing digital tools that make it easier for patients who have cognitive or digital literacy limitations to access telehealth services.

· Providing training to improve digital literacy.

· Using digital health navigators.

· Including patients with poor digital literacy in study design or intervention programs.

Some of these recommendations have already proven to be helpful for improving access to telehealth services for patients with some chronic health conditions, says Sharrief, who together with her team is currently busy testing whether they will show the same promise in improving telehealth access for stroke patients.

Physical Limitations

In addition to the above recommendations, the authors suggest that new telehealth tools need to be developed to accommodate patients with stroke-related paralysis or incoordination and to encourage family members and caregivers of stroke survivors with physical limitations to assist these patients in accessing telehealth.

The authors suggest that stroke survivors with cognitive limitations should avoid using more complex tools and platforms that involve multiple steps to gain access to a telehealth session or that are more prone to technical glitches that require frequent troubleshooting.

To overcome language barriers, the researchers suggest that telehealth platforms, as well as telemonitoring and other digital health tools, should not be limited to English alone, but should allow patients and their caregivers to choose their preferred language.