Designing telehealth for first-generation immigrants
TLDR: Creating a seamless telehealth experience for mature, first-generation immigrants creates a curb-cut effect that solves for other overlooked populations. Here’s a simple guide, with prototypes, to make it easy for designers to get started. Access the Figma Starter Kit here.
As we grow more and more reliant on digital healthcare experiences, a trend propelled by the pandemic, you, the designers, are tasked with creating the interfaces and the user experiences that make it easier for us to live healthy lives. From the HIPPA-compliant video platforms that allow therapists to continue their weekly meetings with patients struggling with depression, to the messaging apps that allow doctors to easily switch out a medication that may not be working for a patient, your work in the healthcare space touches more lives now than ever before.
As you create, remember to democratize. Design with the overlooked user in mind: the person who only has access to limited high-speed internet via their mobile phone, does not own a laptop, has little to no understanding of the English language, and in turn, has to rely on someone else to help. People like our parents.
This guide came from countless frustrating experiences helping our parents from Korea, Bolivia, and Mexico attend telehealth visits during the pandemic. It is with these users in mind that we set out to tackle the current state of telehealth for mature first-generation immigrants.
Accessing the televisits required them to navigate a series of steps: log into an email, which then led them to a confusing dashboard filled with medical jargon, where they would find a link to access a platform, that would sometimes require them to download an app.
It was virtually impossible for them to complete all of the steps themselves. The responsibility fell to us, their English-speaking, digitally-savvy daughters.
As designers and dreamers of a more inclusive digital landscape, we decided to take this on to empower our immigrant parents and many others like them. They are not edge cases, corner cases, or extreme users, as we say in the UX world. There are millions of people like them living in the US. And they deserve equitable access to all forms of healthcare, including online.
To gauge how well these users are served by current telehealth design, we spoke to a researcher at one of the largest telehealth providers, a UX designer at a major healthcare company, and a representative of a marketing agency that serves doctors’ offices and hospitals. The result was clear: these are not the users designers prioritize when designing healthcare experiences.
Building Inclusive Telehealth Benefits Doctors and Telehealth Companies
Equitable access to telehealth doesn’t just help patients — it also helps doctors. With more patients having access to effective telehealth, doctors can improve productivity, reduce administrative costs, and reduce burnout. Telehealth software providers also benefit. We spoke to a director at VCU Health, a Virginia hospital, who admitted they were switching telehealth providers because of the lack of ability to have more than two people on a call — a solution we’ve recommended below. When telehealth companies solve for the end-users, and not just the doctor’s office experience with using the tool, everyone wins.
Creating a Curb-Cut Effect
Although they account for about one-sixth of U.S. workers, immigrants make up more than one-third of the workforce without digital skills (meaning they can complete basic computer tasks but would have difficulty sorting emails). As of 2016, 41 percent of foreign-born Hispanics with children said that they only ever accessed the internet via a mobile device.
The digital divide doesn’t just affect immigrants. Many of those living in rural areas are also impacted. Rural Americans are 10 times more likely to lack broadband access than their urban counterparts.
The CDC calls these conditions, which affect things like life expectancy, social determinants of health (SDOH). They include considerations for factors like:
- Neighborhood and built environment — Where do your users live? Do they have access to broadband internet there?
- Education Access and Quality — What is their reading level? Can they understand the technical language and jargon?
- Economic Stability — Can they afford a laptop or desktop, or you need to design for mobile-first instead?
The Surprisingly Simple Solutions
Through reviewing various telehealth apps, speaking to patients and their families, and mapping their journey for a simple virtual doctor visit, we found five key barriers that are not being widely considered in the current telehealth user experience. We aimed to turn those barriers into opportunities by providing possible solutions for each case.
Let’s dive in.
1. Solving for low digital literacy
Attending a telehealth visit currently involves multiple steps, from having to log into an email in order to log into a dashboard, to sometimes even having to download an app. That’s up to six steps and three applications before someone can see their doctor. A simple solution is to provide a mobile option, the most popular device for this user, and include the one-click link right in a text message — no additional sign-in needed.
2. Solving for language barriers
Currently, few telehealth apps have translation features, and if they do, the translations can be difficult to understand because they use technical language. In addition to using plain language, providing a language toggle with plain text language is a simple solution. If no interpreter is available during the call, a translation API, like Google’s, can be connected so that the doctor and patient can have a seamless conversation. See it in action here.
3. Solving for distrust
Because these users are often overlooked in the healthcare system, they are wary of the healthcare system. Adding various markers to build trust can be as simple as providing the doctor’s image, credentials, and information about their practice.
4. Solving for low data/wifi access
Video calls take up a lot of data, and many of these users may not have access to wifi or an unlimited data plan. To solve this issue, VCU Health provides patients with tablets with wifi air cards to monitor their health. For providers that don’t have that luxury, the telehealth platform can automatically identify a low connection and offer an alternative, like an audio or text call with image upload functionality (see it in action here). If the call is lost, an automatic text can be sent to let the patient know that they can reschedule or resume connection via an audio call.
5. Solving for the participation of a third person on the call
Currently, most telehealth apps only allow the doctor and the patient to attend. Yet non-English speaking patients frequently require translation and interpretation support during appointments. They may turn to members of their family, medical interpreters, and medical students or staff. The option to add more than two people to a call could be facilitated right from the page.
User Testing
We gathered all these features into a prototype and shared it with our parents to test. The results? See for yourself.
“It’s so easy I feel like I barely did anything.” — Sheila’s Mom
“I feel like I can manage this on my own rather than have to wait for Gaby to come to visit again to help me.” — Gaby’s Mom
What else can you do?
Outside of UI, designers can also help to solve for overlooked users by
- building a team of researchers and designers with diverse perspectives or interdisciplinary teams (IDT)
- checking their unconscious bias
- and by having a diverse range of users audit their UX
While we can urge our lawmakers to address the digital divide by increasing access to the internet and digital skills, we as designers can have a greater impact by doing our part to create an equitable digital landscape for all. We have the power to make it easier for everyone to not only receive equitable healthcare services, but to get access to training and education, and find and maintain work.
Click here to access our Figma starter package to access all the design assets featured here.
From the authors
This project came from our own experiences helping our Korean, Bolivian, and Mexican first-generation American parents attend telehealth visits during the pandemic. As VCU Brandcenter students, strategists, designers, and dreamers of a more inclusive digital landscape, we decided to take this on to empower our immigrant parents and many others like them.
Co-authors: Sharon Seunghye Byun and Gabriela Olivera
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