The integration of telehealth into healthcare systems has emerged as a transformative tool,
particularly in addressing geographical and accessibility barriers for women in gynecological
care. Telehealth, defined as the utilization of information and telecommunications technology in
healthcare delivery, presents a promising avenue for expanding the reach of reproductive health
services, including family planning, contraceptive services, and safety decision aids for survivors
of intimate partner violence (IPV). However, as this technology is not yet widespread, various
challenges, including digital illiteracy and limited buy-in from clinicians, hinder its potential
impact. Telehealth also encompasses mobile health applications designed to gather patients’
health data, screening questionnaires, and educational materials. I must mention the inherent
sensitivity of health information when using telehealth programs, that could compromise patient
privacy and ruin trust in healthcare systems, leading to legal and ethical consequences. In this
blog I plan to bridge the importance of telehealth in gynecological care and the need for racial
equity in access to it once its use becomes more widespread. I offer a new role of digital
navigators in an effort to highlight that with new technological avenues, we must address current
inequities.
It is crucial to recognize the dual nature of telehealth: a revolutionary innovation for some, yet a
potential source of exacerbation for existing racial disparities. These disparities include but are
not limited to age, digital literacy, internet access, language barriers, and social determinants of
health such as transportation barriers, trauma, and food insecurity. Structural racism further
contributes to health disparities, posing a challenge to the goal of achieving equitable access to
healthcare through telehealth and other innovative technological advances.
Current gynecological research emphasizes our need to address the impact of telehealth on
women's reproductive health, especially when working to resolve racial disparities. I must note,
there is a significant gap in determining whether telehealth increases access to care and produces
superior outcomes compared to in-person care, particularly concerning reproductive health and
IPV in women. In a paper published by theAgency for Healthcare Research and Quality, it was
noted that as a result of telehealth visits, there were “changes in STI risk behaviors such as
having multiple sexual partners”. There were also “changes in protective behaviors such as
sexual abstinence, mutual monogamy, delayed initiation of intercourse, and use of condoms”.
Patients also reported feeling a deeper sense of empowerment with telehealth features. Thus,
telehealth has created positive outcomes in patient behavior, especially in gynecology.
There was a surge in technology use for clinical purposes during The COVID-19 pandemic, in
response to the demand for innovative solutions to bypass traditional roadblocks in patient care.
In an effort to confront the challenges hindering the widespread adoption of telehealth, a new,
promising avenue has emerged: Digital Navigators. Digital navigators are envisioned as crucial
mediators, equipped to assist both patients and clinicians in navigating and customizing
technology, training patients on cell phone use and apps, and ensuring data quality. However,
challenges such as the need for training and the associated barriers to clinician buy-in still
persist, especially in low and middle-income countries.
A study led by psychiatrist, Dr. Wisniewski, proposes a structured training program for Digital
Navigators, covering core smartphone skills, basic technology troubleshooting, app evaluation,
clinical terminology, data management, and patient engagement techniques. Such a program will
empower Digital Navigators to facilitate the integration of telehealth into gynecological care
seamlessly.
As we move forward, the development of policies that standardize personal and data privacy
must strike a balance between user-friendliness and security, ensuring equitable access by
incorporating multilingual platforms. Additionally, addressing deeply rooted mistrust within
communities of color towards the healthcare system is imperative. Historical traumas, such as
the exploitation of Henrietta Lacks, underscore the need for building trust and transparency in
the implementation of telehealth services before they can be widespread in the US.
In conclusion, while the use of telemedicine holds the promise of higher quality care, it is
essential to navigate carefully through the challenges posed by disparities in access and digital
literacy. We should strive towards a more inclusive and equitable future for telehealth in
gynecological care for all women.
Reviewed by: Reena Kagan
Graphic by: Alejandra Gonzalez-Acosta
References
Wisniewski, Hannah, et al. “The Role of Digital Navigators in Promoting Clinical Care and
Technology Integration into Practice.” Digital Biomarkers, U.S. National Library of Medicine,
26 Nov. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7768140/.
Telehealth for Women - Agency for Healthcare Research and Quality,
effectivehealthcare.ahrq.gov/sites/default/files/pdf/telehealth-women-protocol.pdf.
Senz, Kristen. “Racial Disparities in Telemedicine: A Research Roundup.” The Journalist’s
Resource, 20 July 2022, journalistsresource.org/home/racial-disparities-telemedicine/.