Preparing patients for telehealth in American Indian and Alaska Native communities
Preparation is important, both for providers who are new to using telehealth to treat American Indian and Alaska Native communities and for patients who are participating in telehealth care.
Here are several ways your providers and staff can make sure telehealth visits are successful for you and your patients.
One of the most significant barriers to telehealth adoption in American Indian and Alaska Native communities is high-speed internet. According to the National Indian Health Board (PDF), only 46.6% of houses on Tribal lands have access to fixed terrestrial broadband at Federal Communications Commission (FCC) standard speeds. Helping patients access reliable internet from the safety of their homes is crucial to improving health outcomes.
The Affordable Connectivity Program is an FCC benefit program that helps ensure that households can afford the broadband they need. The benefit provides a discount of up to $30 per month toward internet service for eligible households and up to $75 per month for households on qualifying Tribal lands. Encourage your patients to apply for this program if they qualify and live within range of internet services.
Other forms of telehealth
If your patient does not have access to reliable and stable internet connections, it is important to be flexible. Other forms of non-video communication could include:
- Phone calls
- Chat through a healthcare portal
As of 2022, there are 574 federally recognized tribes in the United States across 37 states. Each tribe has its own set of customs, but there are cultural values that are shared by most, if not all tribes. Some of these values include:
- A sense of traditional spirituality—a connection with nature and/or ancestors
- Respect for elders
- Strong family support systems
- Historic distrust of institutions
It is important to keep these values in mind when you or your staff is conducting a telehealth visit. It will allow you to fully understand your patient’s needs and make patients feel more comfortable using telehealth. Use these do’s and don’ts as a guide to communicating with American Indian and Alaska Native patients virtually.
- Greet the patient in their native language, when possible and as appropriate
- Learn how a community prefers to be called and use proper pronunciation
- If a family member or caretaker is present during a telehealth appointment, speak to the patient directly but acknowledge the family member or caretaker’s presence
- Be honest and clear about your role as a health care provider and how you will work with them to meet their needs
- Listen and observe more than you speak; be genuine and initiate casual conversation
- Allow the patient to tell their story without interruptions
- Allow the patient to set the pace and tone of the appointment; be prepared to slow your rate of speech and/or use a softer tone
- Respect confidentiality and verbalize it
- Accept and acknowledge when you have limited cultural knowledge; invite the patient to share cultural information when appropriate
- If necessary, seek assistance and additional information from community members after a visit
- Be aware of cultural nuances, traditions and norms, such as eye contact, preferred learning styles and health related traditions
- Stereotype based on looks, language, dress, and other outward appearances
- Ask intrusive questions
- Interrupt the patient
- Impose personal values, morals and beliefs
Culture Card: A Guide to Build Cultural Awareness: American Indian and Alaska Native (PDF) — from Substance Abuse and Mental Health Services Administration (SAMHSA)
Culturally Relevant Best Practices - from Indian Health Service (IHS)
Conducting a telehealth visit
Before the telehealth appointment
There are several things you can do prior to your patient appointments to make sure they feel comfortable.
- Provide an overview of what telehealth is and what to expect if they have never used telehealth before
- Confirm your patient has access to the Internet or time available on their mobile data plan
- Ask them to consider any concerns ahead of time
- Arrange for a translator if necessary
- Ask if they need assistive devices for the telehealth appointment
- Ask that they wear loose clothing in case you need to examine parts of their body
- Make sure they receive and understand instructions on how to get online
- Make sure they have a quiet, private and safe space for the telehealth visit
During the telehealth appointment
There are also several ways to help your patient feel comfortable and confident during the appointment.
- Introduce yourself and ask if the patient has privacy and feels safe to speak
- Ask what questions or concerns they may have
- Make sure they understand test results or diagnoses that you are giving them
- Include the patient’s spouse, partner, or other family member in the discussion if the patient wants to them to be a part of the video chat
- Follow up on remote monitoring results or concerns
- When offering recommendations, make sure that necessary resources are accessible and culturally appropriate
After the telehealth appointment
Telehealth care doesn’t end when your video chat is finished. Here are several ways to follow up with your patient and continue building the relationship.
- Follow up with links or mail handouts relevant to the visit
- Send your patients for referrals to specialists, mental health professionals or substance abuse counselors, if needed
- Schedule any follow up telehealth appointments or phone conversations if necessary