Exploring the Use of Telehealth Intervention Among Asian Americans and Native Hawaiians: A Systematic Review

Background and Purpose: Telehealth is the delivery of health care at a distance by health care professionals using information and communication technologies (WHO, 2010). Interest in the use of telehealth interventions has been growing in the U.S. and worldwide as a delivery modality to increase access to healthcare services. Telehealth services are found to be particularly promising for those who confronting cultural and language barriers, those living in rural areas with limited service available, and those avoiding healthcare due to stigma. Asian Americans and Native Hawaiians (AANHs) have unique cultural and language barriers to healthcare access in the U.S. Telehealth is a viable mode of health service delivery as long as there are a few health service providers in the area who apprehend the culture and language of a particular client. To date, the use of telehealth for AANHs has not been extensively examined. To address this gap, we conducted a systematic review on the use of telehealth interventions to serve AANHs. It is imperative to analyze what outcomes have resulted from the use of telehealth to examine the efficacy of this mode of service.

Methods: We performed a systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines. We searched through Pubmed, CINAHL Plus, PsychINFO, Cochran Library, and Embase with the specific search criteria including Telehealth OR Mobile technology OR internet technology OR SMS text message AND Asian American or Native Hawaiian. We initially found 400 articles, applied initial inclusion criteria (i.e., published between 2010–2020 in English, included human subjects, full-text available), and removed duplicate articles. It resulted in the 194 studies, which we reviewed and applied further eligibility criteria (i.e., used a telehealth intervention, provided outcome data, and included a disaggregated sample of AANHs. We conducted a manual search of the bibliographies of included studies to identify additional critical studies for possible review. We selected 22 articles at the end of the review process.

Results: Identified studies included telehealth interventions targeting various health outcomes such as, diabetes, blood pressure, depression, psychiatric treatment, physical activity, weight loss, obesity, and women’s health including Pap test, menopausal symptoms, and breast cancer. We identified 16 unique telehealth programs that utilized a range of technologies for intervention, including web-based, mobile, tele-counseling, or blended technologies. Findings show that telehealth improves physical and psychological wellbeing along with clinical outcomes among AANHs and indicate the acceptability and feasibility of telehealth interventions, presenting positive evaluations and high satisfaction among participants. In addition, AANHs who used telehealth services especially appreciated the cultural sensitivity of the consultation and the comfortable interaction with the provider.

Conclusion: This systematic review reinforces the value of telehealth and highlights the modalities effectiveness and acceptability among AAHNs that have struggled to access and utilize health care. The findings of this systematic review affirm key issues in relation to the cultural applicability and effectiveness of telehealth modality. Furthermore, it reveals that telehealth among AANHs are practical, employing a range of technologies, effective, showing beneficial outcomes, and culturally adaptive.