A case for "little English" in Nurse Notes from the Telehealth Intervention Program for Seniors: Implications for Future Design and Research

Community telehealth programs (CTPs) enable low-income older adults to receive telehealth services in community settings (e.g., retirement homes). The Telehealth Intervention Program for Seniors (TIPS) is a CTP that provides vital sign monitoring services managed by remote nurses. TIPS has successfully recruited and retained Limited English Proficient (LEP) participants, but lack of language services might hinder LEP participants' equitable access to care. We conducted a two-part mixed-methods study. We first qualitatively analyzed 40 nurse notes to identify challenges nurses encounter gathering information due to language barriers and the workarounds they employed to address these. We then tested our qualitative findings on 23,975 nurse notes to quantify and compare how these challenges and workarounds scale between LEP and English-proficient TIPS participants. We present future research implications beyond low-hanging solutions, such as automated translation services, and discuss how novel technological solutions can support and ameliorate nurse workarounds and caregiver burden.