Language-Related Barriers to Digital Health Engagement in Pediatric Primary Care

Abstract

Background:

Health care systems increasingly rely on digital tools, including patient portals such as Epic MyChart® and telemedicine platforms, to optimize communication between patients and providers. Families with language barriers face disproportionate challenges in accessing and utilizing these services equitably. This study examines the association between language preference and digital health engagement, with a particular focus on patient portal activation and telemedicine use among pediatric patients.

Methods:

We conducted a retrospective analysis of pediatric patients in a large primary care network, categorizing them into three groups based on language use: English Proficient (EP), Limited English proficiency (LEP), and Intermittent Interpreter Users (IIU). Patients are predominantly seen for office visits but are also offered telemedicine for clinically appropriate acute and chronic conditions. Measures of digital engagement included Epic MyChart activation status, the proportion of appointments scheduled online, and telemedicine utilization. Social Drivers of Health (SDOH) were also incorporated into the analysis to account for potential confounding factors.

Results:

Of the total patients, 66% were classified as EP, 20.4% as LEP, and 13.6% as IIU. LEP patients showed significantly lower digital engagement across all measures. Telemedicine use was notably lower among LEP patients (EP = 95.5%, IIU = 2.2%, LEP = 2.3%). Epic MyChart activation rates were also lower in LEP (60.3%) and IIU (76.2%) groups compared with EP patients (82.2%). Online scheduling was least frequent among LEP patients (LEP = 2.3%, IIU = 5.7%, EP = 8.6%). When reviewing SDOH responses, among patients who used telemedicine, transportation-related challenges were more pronounced in the LEP group (EP = 12.4%, IUI = 0%, LEP = 16.7%).

Conclusions:

These findings underscore the need for targeted interventions to improve digital health access for non-English-speaking pediatric patients in the primary care setting.