In this March 14, 2016 photo, Evan Crudup, 4, of Algonquin, Ill., plays with his father during his appointment with Dr. Marvin Rossi via telehealth video conferencing in Crystal Lake, Ill. Rossi, a neurologist at Rush University Medical Center in Chicago, can connect with his patients in McHenry County using a telehealth platform the Epilepsy Foundation has been using for about 2 years. (Sarah Nader/Northwest Herald via AP)
Telehealth has become a routine component of health care delivery across primary care and behavioral health settings. While virtual care existed prior to the COVID-19 pandemic, it has since become a routine model of care.
As telehealth continues to evolve, health care leaders and researchers are asking an important question: Is virtual care improving health equity – or unintentionally widening existing health disparities?
Emerging research suggests that while telehealth increases convenience and access for many patients, it may also reinforce structural inequities if not intentionally designed with inclusion in mind. Access to technology, digital literacy, language, disability, geography, and trust all shape whether virtual care improves outcomes or creates new barriers.
Key Takeaways
● Telehealth is not a one-size-fits-all solution and must be adapted for specific populations.
● Digital access, health literacy, and trust are central drivers of telehealth engagement.
● Cultural competence, humility, and safety are critical in virtual care environments.
● Hybrid care models and digital health navigators can reduce access barriers.
● Equity-focused telehealth improves safety, continuity, and patient-centered outcomes.
Telehealth Through an Equity Lens
Clearly, telehealth can benefit health equity. Telehealth can reduce travel burden, increase continuity of care and improve access for individuals with chronic conditions, mobility limitations or those living in rural and remote communities.
However, the same populations that may benefit most from virtual care often face significant access barriers. Limited broadband connectivity, lack of appropriate devices, low digital literacy, language barriers, disability-related challenges and mistrust of health care institutions can all limit meaningful participation.
Studies show that older adults, low-income households, members of racial and ethnic minority groups and individuals with limited English proficiency are disproportionately affected by digital access gaps. Without careful implementation, telehealth risks becoming another structural barrier rather than a bridge to care.
Understanding the social and digital determinants of health – including infrastructure, literacy, trust and accessibility – is increasingly viewed as foundational to safe and effective virtual care delivery.
Moving Beyond a “One-Size-Fits-All” Approach
Experts emphasize that standardized telehealth models may not meet the needs of diverse patient populations. Instead, virtual care strategies must be adapted to reflect clinical, developmental, cultural and social contexts.
Health care organizations are increasingly exploring population-specific approaches to improve engagement and outcomes.
Older Adults and Telehealth Access
Older adults are among the highest users of health care services and simultaneously among the most vulnerable in virtual care environments.
Common barriers include:
Technology anxiety. Limited broadband access. Hearing or vision impairments affecting video visits. Cognitive changes that affect consent and comprehension.
Older adults also experience higher rates of chronic disease and functional limitations that may complicate telehealth participation.
Research published in the Journal of the American Geriatrics Society highlights the importance of simplified platforms, caregiver involvement and flexible scheduling when delivering virtual care to this population. A recent paper published in Frontiers in Medicine provides guidance for improving telehealth accessibility for older adults, emphasizing the importance of systematic strategies and addressing the implicit biases of clinicians.
Pediatric and Family-Centered Virtual Care
Children present distinct considerations in telehealth delivery. Developmental stage, communication ability and reliance on caregivers may influence the effectiveness of virtual encounters.
Studies in Academic Pediatrics and related journals suggest that successful pediatric telehealth often depends on:
Developmentally appropriate communication strategies. Active caregiver participation. Clear guidance for managing medically complex conditions remotely.
Family-centered telehealth models foster collaboration, capacity building, and adaptable communication strategies, acknowledging that successful pediatric telehealth depends as much on supporting caregivers as on engaging the child
Behavioral Health and Substance Use Disorder Services
Telehealth has become a central modality in behavioral health care. Research suggests that for many mental health conditions, virtual outcomes are comparable to in-person services when implemented appropriately.
However, experts caution that effective telebehavioral care requires careful attention to:
Therapeutic alliance-building. Remote risk assessment and safety planning. Crisis management protocols. Privacy protections, particularly in rural or close-knit communities.
The Substance Abuse and Mental Health Services Administration (SAMHSA) offers guidance on telebehavioral health implementation and quality standards.
Culturally and Linguistically Diverse Communities
Individuals with disabilities, immigrants, refugees and patients with non-English language preferences often face layered barriers in telehealth environments.
Challenges may include:
Complex digital platforms. Lack of integrated interpreter services. Limited privacy in shared living spaces. Lower digital literacy. Incompatibility with assistive technologies.
Experts emphasize that accessibility should be treated as a core component of health care quality rather than an optional enhancement.
Emerging literature on cultural safety – particularly in Indigenous and marginalized communities – underscores the importance of trust-building, transparency and culturally aligned care models. The World Health Organization has also identified digital inclusion as a global health priority.
Addressing the Digital Divide
Health care systems are testing multiple strategies to reduce telehealth inequities, including:
Hybrid care models combining virtual and in-person visits. Simplified telehealth platforms. Community partnerships that provide private access points. Device-lending programs. Technical support services. Digital health navigators who assist patients before and during appointments.
Some research suggests that navigation support may improve engagement among patients who might otherwise disengage from care due to technical barriers.
Cultural Competence, Humility and Safety in Virtual Care
Health care leaders increasingly argue that cultural competence in telehealth extends beyond language access.
Best practices include:
Ongoing clinician reflection on bias and power dynamics. Clear privacy and confidentiality explanations. Transparent communication about technology limitations. Adapting care to align with patients’ cultural values.
Telehealth is increasingly recognized as a relational space where empathy and trust-building are as critical as technical proficiency.
Designing Telehealth for Inclusion
Telehealth holds significant potential to improve access and continuity of care. Yet research indicates that without intentional equity-focused design, virtual care may reinforce existing disparities. Inclusive virtual care requires more than technology; it requires cultural competence, trust, flexibility and adaptability, and system-level support.
Telehealth often appears to function as a high-speed highway built for those already positioned to travel easily. With attention, it can be designed as a universal transportation system – one that accommodates diverse needs, abilities, and starting points, ensuring that innovation truly serves everyone.
Disclosures:
The views expressed in this article are those of the author and do not necessarily reflect the views of Telehealth.org. AI tools may have assisted in drafting or editing; the author or editorial team reviewed and approved all content. This article is not legal or medical advice.
Kathleen Michon, RN, MN, APN, is a Registered Nurse with a Master’s degree in Advanced Practice Nursing and serves as a clinical instructor as well as a medical RN in the acute care setting. She has extensive experience delivering telehealth services across outpatient orthopedics, pediatric chronic pain management, and mental health care. Kathleen has worked extensively with virtual care platforms to support pain education, therapeutic engagement, and improved access to care for diverse and underserved populations.
This article is licensed under CC BY-ND 4.0.