Unbiased Telehealth Across Cultures: A Practitioner’s Guide
In an increasingly interconnected and technology-driven world, healthcare has expanded beyond traditional in-person visits to embrace telehealth and other digital care services. This shift can present new challenges, particularly in delivering culturally competent and unbiased care to diverse demographic groups. To ensure equitable, compassionate, and high-quality care for all patients, regardless of cultural background, healthcare practitioners must adapt to these changes.
This guide provides healthcare practitioners with actionable steps to implement culturally sensitive telehealth practices, address biases, and overcome the unique challenges of cross-cultural communication in digital care. By adopting these strategies, practitioners can bridge cultural divides and enhance the effectiveness of telehealth services across all demographic groups.
The five non-negotiables
To leverage telehealth best practices across cultures, advance high-quality diagnostic protocols and procedures, and optimize patient care and treatment, healthcare practitioners must examine these five non-negotiables, which represent the core pillars for delivering unbiased telehealth services:
1. Adherence to legal and ethical guidelines
Ensuring compliance with legal frameworks such as HIPAA guidelines, state regulations, licensing requirements, and professional ethical standards is foundational to the delivery of unbiased telehealth services. These guidelines safeguard patient confidentiality, uphold the quality of care, and ensure practitioners are accountable across various jurisdictions.
2. Telehealth etiquette (“webside manner”)
Practitioners must maintain a high standard of communication during telehealth sessions, commonly referred to as “webside manner.” This includes using empathetic and clear language, being mindful of transmission delays, and employing appropriate non-verbal communication cues like active listening.
Clarifying follow-up appointments, care coordination, treatment plans, home exercises, and discharge plans are critical elements of this communication standard. Additionally, practitioners should narrate their actions (such as looking away from the camera to take notes) to prevent miscommunication and foster transparency. These combined efforts help ensure the patient feels understood and fully engaged in their care.
To strengthen your “webside manner” and enhance patient experiences in digital care, explore Medbridge’s Digital Health Academy, which provides training on essential competencies, such as telehealth, motivational interviewing, and strategies for effective digital patient communication. Developing these skills can deepen therapeutic alliances, improve care outcomes, and create a more positive, accessible virtual care environment.
3. Comprehensive clinical and diagnostic evaluations
When conducting an appointment or check-in via telehealth, practitioners should adopt a multifaceted approach to clinical and diagnostic evaluations, tailoring them to the unique needs of diverse demographic groups. This includes using evidence-based practices, promoting objectivity in decision-making, and relying on technologies like remote monitoring tools to ensure the accuracy and completeness of evaluations.
In addition to these core practices, incorporating natural language acquisition and processing, enhanced clinical diagnostic decision-making, and continuous practitioner oversight is essential. These components help ensure that cultural and linguistic nuances are considered, leading to more accurate diagnoses and better patient outcomes.
4. Personalized treatment recommendations
Treatment plans must be customized based on the results of comprehensive evaluations, using ethical and evidence-based methods. Tools such as health tracking applications, remote monitoring toolkits, and virtual care platforms like Medbridge Pathways can facilitate this personalized approach, ensuring that care plans address individual patient needs and cultural nuances.
To further personalize care, implementing patient-centered technologies such as multilingual patient portals or health tracking tools designed for varying literacy levels can greatly enhance patient engagement. These technologies empower patients to take an active role in their care, while ensuring that the tools they interact with are both accessible and culturally appropriate.
5. Overcoming biases and enhancing digital literacy
It is crucial to proactively address both inherent biases and limitations in telehealth platforms. This can be achieved through training in digital literacy and digital health literacy, helping practitioners and patients navigate healthcare technology effectively. By fostering digital fluency, healthcare practitioners can bridge the gap between diverse demographics and technology, ensuring equitable access to care.
Bridging the gap to culturally competent telehealth involves incorporating the services of multilingual healthcare technicians, interpreters, translators, and practitioners experienced in serving diverse ethnic backgrounds. This ensures that patients who face language barriers or have varying levels of digital literacy are provided with the support needed to fully engage in their healthcare.
To complement efforts in overcoming biases, healthcare systems should integrate regular cultural competency training for all practitioners. This ongoing learning helps bridge cultural divides, ensuring that care remains respectful, patient-centered, and free from unconscious biases that can impact health outcomes.
With the goal of providing unbiased telehealth, we incorporate efficient provisions for the cultural adaptation of healthcare delivery. This includes a conscious awareness of our personal preferences, perspectives, attitudes, and beliefs of our patients and the healthcare system.
The LEARN model
To ensure unbiased telehealth services, healthcare practitioners are encouraged to adopt the Listen, Explain, Acknowledge, Recommend, and Negotiate (LEARN) model. This model offers a comprehensive framework for efficient cross-cultural communication that supports mutual understanding and improved patient care (Ohlan, et al., 2022).
| Listen | While showing warmth and empathy, we actively listen to the patient’s interpretation of their concerns and symptoms as well as their diagnosis, prognosis, causes, severity, and treatment recommendations. As we build trust and rapport, we embrace a mindset of curiosity and cultural humility. |
| Explain | Throughout the patient’s encounter or visit, we honestly and authentically explain our assessment of the health condition alongside the prognosis, care regime, and treatment outcomes. |
| Acknowledge | Considering the patient’s cultural and ethnic background, we genuinely convey mutual respect and understanding of different perspectives for care coordination, treatment plans, and clinical recommendations. We acknowledge related and varying areas of agreement and the potential for diverse belief systems contributing to a therapeutic dilemma. |
| Recommend | During the exchange of cross-cultural communication, we implement a team approach for developing a treatment plan that elicits the patient’s or family’s engagement and feedback. We recommend culturally relevant approaches to strengthening patient satisfaction and proactive treatment outcomes. |
| Negotiate | To reach an agreement, we develop a partnership and systematically negotiate treatment options that comprise the patient’s cultural viewpoints for healing and recovery. |
How to promote culturally competent telehealth
To provide effective telehealth services, healthcare practitioners must develop a deeper understanding of how personal values and cultural factors influence their interactions with patients. Practitioners should recognize that their own beliefs and assumptions can impact patient relationships and decision-making during virtual care.
Equally important is understanding how a patient’s cultural background shapes their worldview of healthcare management, including diagnostic evaluations and treatment plans. Ethical decision-making requires an all-inclusive understanding of how ineffective cross-cultural communication can lead to misdiagnosis, reduced patient care and compliance, and poor treatment outcomes (Ogbogu, et al., 2022). Healthcare practitioners must actively work to mitigate the risks posed by ineffective communication, which can have serious implications for patient care.
To stay current with emerging trends and challenges in digital care, healthcare practitioners should pursue continuing education in cultural competency and ethics. For physical and occupational therapists, annual ethics training is required to maintain licensure, highlighting the importance of ethical decision-making in delivering telehealth care. Ongoing training enables practitioners to adapt to the diverse cultural needs of their patients, fostering trust and improving the quality of care in telehealth settings.
Building trust and reducing bias
To deliver effective telehealth services, healthcare practitioners must focus on establishing trust and rapport with their patients from the very first interaction. Developing a connection remotely requires clear communication, empathy, and a deep understanding of the patient’s expectations.
Being mindful of both individual and implicit biases is critical for increasing accountability and ensuring that care is delivered equitably. Practitioners should actively work to recognize and minimize biases that may influence clinical decisions, as well as avoid making assumptions that can lead to clinical errors or inappropriate treatment recommendations.
Asking clarifying questions and engaging in thoughtful dialogue with patients ensures a deeper understanding of their needs, promotes sound clinical judgment, and supports accurate evaluations and treatment planning. Additionally, healthcare practitioners should commit to continuous self-evaluation and self-critique, ensuring a lifelong commitment to improving cultural competency and reducing power imbalances in the practitioner-patient relationship.
A commitment to culturally competent care
To create meaningful change, we must embody the change we wish to see. As healthcare practitioners, we are charged with promoting equity and accessibility without cultural, social, linguistic, or geographical barriers. We have a duty to be strong advocates for sustainable and affordable healthcare solutions for the uninsured, underinsured, disabled, unhoused, and other vulnerable communities.
By progressively and effectively implementing culturally sensitive and competent digital care programs, we can transform our healthcare systems.
References
- Ogbogu, P. U., Noroski, L. M., Arcoleo, K., Reese, B. D., & Apter, A. J. (2022). Methods for Cross-Cultural Communication in Clinic Encounters. The Journal of Allergy Clinical Immunology: In Practice, 10(4), 893-900. https://dx.doi.org/10.1016/j.jaip.2022.01.010
- Ohlan, S., Singhal, P., Dagar, R., Goyal, M., & Goyal, S. (2022). A LEARN model approach in health care for improvising the doctor-patient relationship. International Journal of Community Medicine and Public Health, 9(4), 1921–1926. https://doi.org/10.18203/2394-6040.ijcmph20220875
