Cottage Health

Katy Bazylewicz

The emergence of virtual care platforms has changed the healthcare landscape, adding a new tool to help bring accessible, convenient and high-quality care wherever the patient is. The COVID-19 pandemic dramatically increasedthe prevalence and use of virtual healthcare and yet, language and cultural barriers continue to prevent large segments of the population, often the more vulnerable and marginalized, from using these platforms. 

Cottage Health, a leading health system in Santa Barbara County on the California Central Coast, launched a virtual care platform in Spanish to address this disparity in access to care for Hispanic/Latino and Spanish-speaking community members.

Representing 46 percent of the total population in the county, Hispanic/Latino residents disproportionately have lower rates of insurance coverage, tend to have lower rates of connection to a primary care provider, and report poorer health outcomes. Building on experience with Cottage Virtual Care in English, Cottage Health embarked on a design process in partnership with virtual technology experts at Zipnosis and gathered input from local Hispanic/Latino residents to develop a culturally responsive platform.

Developing Culturally Responsive Virtual Care

Cottage Health’s Marketing, Digital Health and Population Health teams worked together with community members to create and implement a technology solution that addresses health needs and connects with patients’ cultural and language preferences.

Beginning with a literature review and landscape analysis of inclusive design approaches and existing Spanish virtual care solutions, the team identified a lack of direct-to-consumer platforms in Spanish on the market. Understanding that innovation in this space needed to be guided by those who would use the product and those experiencing the health disparity, the Cottage Center for Population Health conducted community-based research to learn about needs and perceptions and gather recommendations for Spanish virtual care. 

“Beginning with a literature review and landscape analysis of inclusive design approaches and existing Spanish virtual care solutions, the team identified a lack of direct-to-consumer platforms in Spanish on the market.”

Cottage Health engaged five focus groups with 48 Hispanic/Latino community members, who provided varied and largely positive perspectives on virtual care. Many agreed that, with the right technology and support, they would utilize virtual care for certain needs, particularly follow-up visits, and simple medical questions and prescriptions. Barriers noted ranged from affordability, personal, and structural factors to technological and logistical challenges. Potential users ultimately wanted a platform in Spanish that is easy to use, allows for provider selection, is well-promoted in Spanish, and is supported with assistance and training opportunities.

The Marketing and Digital Health teams brought these findings to the development process with Zipnosis to help inform an interface and functionality that would be culturally relevant and linguistically appropriate. Core aspects of the platform were guided by participants’ feedback, including the hiring of a bilingual, bicultural nurse practitioner to serve as an advocate and provide services, and the implementation of a low cost, flat rate for care regardless of insurance status. Launched in February 2023, Cottage Virtual Care in Spanish addresses more than 50 common medial conditions and is accessible from any device.   

Creating Avenues for Connection

Based on focus group findings and prior experience with community health workers, Cottage Health developed a tiered approach to support access to the platform and increase equity.  Local community health workers from the Santa Barbara County Promotores Network were engaged to help, bringing to the program a skilled team of 40 health advocates who are trusted and integrated in the community. The Spanish-speaking Promotores trained as Cottage community health workers, learning Cottage Virtual Care’s functionality and how to share the platform with friends, family, and neighbors. From this broader group, six received additional training as digital health navigators to offer tailored support to individuals facing barriers to access or utilization.

Educational and outreach materials were developed from focus group findings, including multimedia promotional materials that directly respond to barriers raised by participants. A Spanish Virtual Care Community Advisory Workgroup, consisting of community health workers and digital heath navigators, provides ongoing feedback for improvements. A Spanish-language marketing campaign pairs with a Cottage outreach team to connect with the broader public, using print, social media, email, and radio to increase awareness of the tools.

Broader Impacts

In healthcare settings, a lack of language proficiency can lead to miscommunication, misunderstanding, and compromised delivery of care. Monolingual Spanish speakers, as well as those with limited English proficiency, face numerous challenges in accessing health services in the United States and communicating their medical concerns.

Cottage Virtual Care in Spanish has intuitive user interfaces and communication tools that enable patients to connect with healthcare providers in their native language. Within a familiar language environment, users are empowered to express their symptoms, concerns, and medical history to healthcare professionals for appropriate diagnosis and treatment.

Cottage Virtual Care was designed to go beyond language interpretation. The platform recognizes the importance of cultural nuances, beliefs, and practices in healthcare delivery, ensuring that users receive care that aligns with their values. By prioritizing patient education and health literacy, Cottage further equips individuals with the knowledge and resources to make informed medical decisions. Fostering this type of culturally competent care promotes patient satisfaction, engagement and adherence to treatment plans. 

Virtual care platforms designed for Spanish speakers have the potential to break throughlanguage barriers, enhance patient-provider communication and advance healthcare equity. With language-specific tools, culturally sensitive care, and a trained outreach team, these platforms help Hispanic/Latino community members access quality healthcare services when they need them. Investing in these innovative solutions can bridge the language and cultural gaps that persist in healthcare and ultimately improve health outcomes.