Reframing Equity: A Multi-Perspective Analysis of Telehealth Screening Tools Through The Lens of Patients and Clinicians

Abstract

Background: Telehealth usage increased dramatically during the COVID-19 pandemic, but equitable access remains a concern. Patients lacking technology access, skills, and digital literacy might not benefit fully. Validated telehealth literacy screening instruments are lacking. This study evaluated existing tools from patient and clinician perspectives. Methods: Five telehealth literacy screening tools were identified through a literature review: 1) Digital Literacy Self-Assessment Tool (DLSAT), 2) Electronic Health Literacy Scale (eHEALS), 3) Digital Health Care Literacy Scale (DHLS), 4) Telehealth Literacy Screening Tool (TLST), and 5) University of Alabama-Birmingham Technology Comfort Survey (TCS). Patients (n = 44) and clinicians (n = 24) completed an online survey rating each tool across domains of 1) User experience, 2) Engagement, 3) Relevance, and 4) Health literacy. Results: Patients ranked the TCS highest overall, while clinicians ranked the DHLS highest. The DLSAT ranked high for both groups and received above-average ratings across all categories. Interestingly, while the TLST is the only telehealth-specific tool, it was only ranked 3rd and 4th for patients and clinicians, respectively. The eHEALS was consistently the lowest-ranked tool by both patients and clinicians. Patients valued simplicity and clarity, while clinicians favored brevity and clinical focus. Conclusion: Perspectives differed between patients and clinicians regarding optimal telehealth literacy screening tools. Screening instruments should align with key engagement drivers: access, competency, digital literacy, relevancy, trust, and preferences. Tailored tools co-designed with patients and clinicians can promote equitable telehealth adoption and engagement.