The total sample consisted of 14 women who self-identified as either Latina or Hispanic (see Table 1). Participants' ages ranged from 18 to 41 (mean 31.7), with 85% of the sample indicating they lived in urban areas. The main themes of the focus group and interview data included considerations of technological factors and access to telehealth from a cultural lens (see Figure 1). Subthemes across each area are discussed below. Exemplar quotes and comments from Latina participants related to the specific codes are also included.
The following themes were central to practical factors related to the utilization of technology including internet/device access, familiarity with technology, and ease of videoconferencing platform and portal login.
Video quality/Internet access
Participants noted that not having access to quality internet or having an older device were barriers to entry into telehealth. This appeared to be more of a concern for older women or women who had recently immigrated to the U.S. Two quotes that were illustrative of these factors:
[I] don’t really have the up-and-coming technology that everybody – everybody else has.
…because I ran out of [internet] service and I had no battery left.
Familiarity with technology
Latina participants indicated that their familiarity with and knowledge of technology would impact their decision to engage in telehealth services. Additionally, participants also discussed age and generational factors impacting use of technology in their day-to-day communications. Participants ranged in only feeling comfortable using phones to text and call families, while others were familiar with videoconferencing platforms such as Zoom, Whatsapp, and Skype. These varying experiences meant that some would feel at ease in engaging in telehealth for perinatal depression while others needed more reassurance and exposure to the platforms.
I had done it [videoconferencing] before, in others, with different ones, then I knew more or less what, what, what I had to do, it was not something new.
Older people maybe having more difficulty login into a system like this one, but it may be possible that younger people is a bit more open to everything that is related to technology.
Ease of videoconferencing platform/portal login
Participants shared that having a platform and instructions that were accessible and resulted in minimal to no frustrations would promote utilization of telehealth services. They also indicated that it was important to have someone who could troubleshoot quickly when problems arose. Participants indicated that if access to the technology was easy, it often reduced hesitations around engaging with telehealth.
For me it was easy because, you were giving me instructions for me to follow.
It [the portal login] was easy.
I had problems with the password, I don't know why, the good thing is that you were contacting me by text messages, then it was like – it wasn't really a problem because I knew you were there attentive to what I needed in the moment. So, I knew…you were going to fix it and you did it super fast.
Access to Telehealth
The second broader theme is access to telehealth. Participants described several logistical and relational factors that facilitated or prevented engagement in telehealth. Specifically, logistical issues such as transportation, scheduling, being busy, and childcare were discussed by the participants. Additional factors that emerged included connections through technology, provider distrust, and privacy concerns.
Transportation as a barrier to mental health access. Participants expressed that the option to utilize telehealth would remove the barrier of needing transportation to attend doctor’s/counselor visits. This was especially true for rural participants. Being able to utilize telehealth for mental health services from home was seen as a benefit.
…so I would have to actually travel 30+ miles just to get to…a counselor.
… we only have one car.
It is a benefit to take the call from home.
Scheduling & Being Busy. Scheduling and having time to participate in a telehealth program was a concern for participants who were juggling multiple roles. For some it was challenging to balance time for themselves when navigating work and caring for children or the home. Additionally, some participants felt that as Latinas there was added pressure of working that did not allow for time and participation in mental health services.
…mostly it’s the time, isn’t it? And sometimes the schedule in which classes are taking place.
…[to] go one needs to have the time.
…everybody from Mexico…[we all] work all the time.
Childcare. Participants also shared that having access to telehealth would be helpful when caretaking for other children. Other participants noted having groups available during the day would be helpful to manage household responsibilities.
…if you still have little ones at home, it would be rather easy [to participate].
… [scheduling] when kids are in school.
Relational Connection through Technology
Thirdly, the last broad themes relates to aspects of relational connection and how these are influenced by telehealth. Some participants reported that technology enhanced connection with others, while other participants expressed reservation regarding connection through technology. Participants also shared a general distrust in use of technology by providers and their attention to care for these women. The women also shared concerns about having privacy for telehealth in their homes.
Mistrust of Providers when using Technology
Participants specifically shared concerns that providers may be attending to other things and not giving full attention to them during telehealth visits. They wanted providers to give them full attention and to make eye contact during these visits. The lack of trust within the Latina community may be amplified with the added layer of the screen.
I will be here, and here he [referring to the provider] will be - he will be attending to his affairs.
A little mistrust…hesitation [when having a provider via telehealth].
… the doctor is with other people and the call is supposed to be [with me].
I need you to look me in the eye. If not, I'll just get up and walk away. I'll just.. just forget it. Just forget about it.
Concerns of Privacy
Participants discussed issues of privacy related to using telehealth at home where they lacked privacy at times. The complexity around undocumented communities being fearful about information getting out intensified the need for privacy and confidentiality. Further, fear of others knowing about their mental health issues which could be heightened within the telehealth context when others are around the home.
I think the fears and barriers would just be them just not feeling sure of where that information – if that information is private, you know, if it’s gonna get out.
I mean… it is a benefit to take the call from home, but at the same time I feel that sometimes you [should] be careful in this situation.
I have to be lowering the volume or lowering my voice so that others can’t hear. Like I said, I live with three other roommates and I don’t want them to be listening when I am there crying or anything like that.
Technology and Relational Connection
Participants noted that technology at times fostered connection while others worried about losing the connection that is often experienced during in-person groups. The participants noted that having the ability to see other members improved perceived connection with others. Participants noted that glitches in technology would be a hindrance to connection with providers and participants.
The connection is not going to be felt. That is, it will see connection, true, technological, but not the connection that one feels.
…like people would glitch out or we couldn’t see one another.
I was able to see everybody in, like a row – I always got to see everybody…Oh, okay. I made a joke, so I can see everybody laughing.
[I use] technology mainly (to be) connected to other people.