Telehealth treatment with Latinx group

The mental health burden associated with the COVID-19 global pandemic is undeniable, and the psychological and emotional sequelae from the multiple losses might remain invisible for years to come. Among susceptible populations, Latinxs are at increased risk of contracting and spreading the virus, as a result of residing in densely populated areas, large representation in critical industries (eg, meat-packing plants, health care, factories), and underlying health conditions.1 At the same time, Latinxs differ from other racial and ethnic communities in their attitudes towards obtaining physical and behavioural health services in response to the COVID-19 pandemic. Due to fear of deportation, privacy concerns, and distrust resulting from a history of xenophobia in the USA, Latinxs, especially those among the undocumented and non-citizen community, are more hesitant to trust medical and mental health professionals, engage in treatment, or embrace the use of technology as a method of service delivery.234Data from the 2018 National Survey on Drug Use and Health5revealed that nearly 40% of Latinx adults between 26 and 49 years of age with serious and persistent mental illness did not receive necessary treatment. Despite the noted susceptibility, even when care is available, Latinx individuals are more likely to prematurely drop out of treatment and report dissatisfaction with available care than White Americans.6 The development, promotion, and dissemination of culturally and linguistically congruent treatments has been identified as one way of addressing the treatment gap. Prior to COVID-19, the use of technology and telehealth interventions had been suggested as one possible response.7 Data from the Pew Research Center show that Latinxs use technology at similar rates to other groups in the USA.8 For example, smartphone use is at 79%, compared with 82% for the White community and 80% for the Black community. Despite this finding, there are multiple factors that might make the transition to telehealth stressful, such as living situations that include insufficient space or privacy at home and restricted access to internet data, Wi-Fi, or a large enough viewing screen. One therapeutic intervention that can offer support in the transition from office-based treatment to telehealth is motivational interviewing, a collaborative conversation style for strengthening a person’s own motivation and commitment to change.9 

Appropriate use of the relational (ie, collaboration, acceptance, compassion, and evocation) and technical (ie, open questions, affirmations, reflections, and summary statements) elements of motivational interviewing can go a long way in developing the necessary foundation to support telehealth interventions. We propose the use of T-HOLA (the word hola means hello in Spanish), an acronym designed to offer practical guidance to providers engaging Latinx patients in telehealth interventions through the application of motivational interviewing skills and consideration of cultural values: (1) orient to Telehealth; (2) engage in Health education; (3) provide Options; (4) utilise active Listening skills; and (5) assess Adherence to cultural values. See the panel for a detailed summary of the T-HOLA framework.

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