Telemedicine perceptions and experiences of socially vulnerable households during the early stages of the COVID-19 pandemic: a qualitative study

Alayne M. Adams; Khandideh K.A. Williams; Jennifer C. Langill; Mylene Arsenault; Isabelle Leblanc; Kimberly Munro; Jeannie Haggerty

doi:10.9778/cmajo.20220083

Article Figures & Tables

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure 1:
Participant recruitment flow diagram.

Tables

Figures

View popup

Table 1:

Characteristics of members of socially vulnerable households needing health care during early stages of the COVID-19 pandemic

Characteristic	No. (%) of participants n = 29
Gender^*
Women	14 (48)
Men	15 (52)
Age^*
Younger (~18–39 yr)	6 (21)
Middle-age (~40–64 yr)	15 (52)
Older (≥ 65 yr)	8 (28)
Language of interview
English	15 (52)
French	13 (45)
Spanish	1 (3)
Immigrant status
Canadian-born	5 (17)
Immigrant ≤ 10 yr	8 (28)
Immigrant > 10 yr	15 (52)
Missing	1 (3)
Family structure
Single person	16 (55)
Nuclear family	11 (38)
Other	2 (7)
Access to Internet
Yes	22 (76)
No	4 (14)
Missing	3 (10)
Family physician
Yes	21 (72)
No	8 (28)
Type of health need
Acute	7 (24)
Chronic	14 (48)
Chronic and acute	7 (24)
Missing	1 (3)
Received health care
Yes	26 (90)
No	3 (10)
Used telemedicine
Yes	20 (69)
No	6 (21)
Family member	1 (3)
Missing	2 (7)
Type of telemedicine used
Telephone	18 (62)
Video	3 (10)
Did not use telemedicine	6 (21)
Missing	2 (7)

↵* Subjective assessment based on participant appearance at time of in-person screening (n = 23). For participants recruited by family physicians or residents, age based on known date of birth and self-identified gender were available (n = 6).

View popup

Table 2:

Representative quotations from members of socially vulnerable households needing health care during early stages of the COVID-19 pandemic

Theme	Quotation or summary	Respondent characteristics
Pandemic-related delays in seeking health care	The ultrasound had been scheduled before the beginning of the pandemic, but she delayed it until August and saw the doctor in September. She was offered a telephone appointment to review the results, but she wanted to talk to the doctor in person and refused to use the telemedicine service.	Female Middle-age Immigrant > 10 yr Chronic health need
	“In one word, I have not been well” … I don’t want to complain about the situation, however, because “it’s like this for everyone … pretty unusual, pretty extraordinary.”	Female Middle-age Immigrant > 10 yr Chronic and acute health need
	She couldn’t walk, but she didn’t want to go to the hospital because she was afraid of contracting the virus. She waited until a month and a half later to seek care. She says that the lockdown was difficult for her because she couldn’t go out to walk due to the pain in her foot.	Female Younger Canadian-born Acute health need
	“I’m not upset because I know that they were dealing with a lot of COVID at that time, so I understand. Maybe I would be upset if I was, you know, in a bad condition and nobody helped me, but it was a good thing that it was mild so I didn’t need that much care. So, for me, they had to take care of the more serious ones.”	Female Middle-age Immigrant > 10 yr Chronic and acute health needs
Challenges with appointment booking and logistics of encounter	“I could not contact the secretary. I kept on calling and calling and calling and they kept on transferring me and there was no answer. I was so frustrated, and I was getting angry. I don’t want to book anymore.”	Female Younger Immigrant ≤ 10 yr Chronic and acute health needs
	He does not have access to a computer, so he wouldn’t be able to meet a doctor online. He has Internet on his phone, but he doesn’t really know how to use it. He says that smartphones are very complicated for him.	Male Older Immigrant > 10 yr Chronic health needs
	“If I needed to get in touch with my doctor, I would have to go through a myriad of secretaries. Before it was easy: as soon as I would have my yearly check-up, they would give me a little piece of paper to let me know when to come back for the next follow-up. Now they don’t give you the paper, so I have to go through many different receptionists and find out the doctor’s availability. It took me many months to get an appointment.”	Male Older Canadian-born Chronic health needs
Concerns about quality and continuity of care using telemedicine	“I cannot tell you the problems I have in my body; you cannot test me on the phone.”	Male Middle-age Immigrant ≤ 10 yr Chronic health needs
	“I prefer to see him in person. He can say ‘open your mouth,’ ‘open this, open that.’ That’s why I wouldn’t trust video. I could open whatever I open, but I don’t think the doctor could see whatever he’s looking at. But if he’s right there in front of you, he will see what he wants to see.”	Male Middle-age Immigrant > 10 yr Chronic health needs
	“I want to know everything about my health, and they can discuss more when you are in-person. Over the phone, sometimes you’re busy and they’re also busy maybe … when you have an appointment … in the office or in the clinic, you can sit and discuss.”	Female Younger Immigrant ≤ 10 yr Chronic and acute health needs
Conditional acceptance of telemedicine	“If I have nothing serious for me to see my doctor and I could just do it over the phone, it’s completely understandable to me because they will be busier treating the people who are at more risk.”	Male Younger Immigrant ≤ 10 yr Acute health need
Conditional acceptance of telemedicine	“If I have access to the same doctor, who has my case file and is already familiar with me and all the appointments are follow-up appointments, as long as there’s continuity, I don’t mind having the interactions over the phone or video calls. But if I’m going to keep getting transferred from doctor to doctor, then no. No video calls and no phone calls.”	Female Younger Immigrant ≤ 10 yr Chronic and acute health needs