Table 4 Joint Display of Converging Quantitative and Qualitative Findings

Overall Telehealth Access and Use

Approximately three-fourths of participants engaged in any telehealth and half of participants in an HIV video or telephone visit after the COVID-19 pandemic began

A range of telehealth access challenges include no or unstable:

- Devices

- WiFi connectivity

- User unfriendly telehealth App (specific to AMC)

Approximately half of participants reported having difficulty with technology

Participants reported lacking competency (‘savvy’) with technology and/or telehealth

For HIV visits, 60% by video and 40% by telephone

Common for video to ‘default to phone’ during the visit

Participants mobilized to overcome challenges with access and use, inconsistently resulting in a visit

Concerns about technology/telehealth privacy

Differences in Telehealth Use by Significant Characteristics

Location of Service:

FQHC more likely to have HIV telehealth visit (and more likely to have any telehealth visit) than at the AMC

FQHC use of single sign-on system to log into a telehealth visit much simpler compared to AMC multi-step log-in and connection within ‘My Chart’ App

Mental Health or Substance Use Diagnosis:

Participants with mental health or substance use diagnoses more likely to have any telehealth visit compared to no diagnosis.

Telehealth favors ‘talk’ over physical diagnostic and care elements, which may have allowed for maintenance of therapy visits; however, see ‘influences upon ‘worse’ for caveats

Overall HIV Telehealth Quality

70% of participants reported that telehealth was ‘worse’ than in-person visits

Reasons for rating telehealth as ‘worse’: Less time with provider, increased forgetfulness, limited interpersonal physical interactions shaping quality including outcomes, altered communication, self-censoring

Technology challenges worsened the visit when it occurred

Ineffective outcomes defined as: no follow-up, referral error, generally ‘useless’ exchange

30% reported telehealth was same/better than in-person visits

Reasons for rating telehealth as ‘same/better’: more efficient transport to visit, less waiting, ‘same result’ [e.g., effective]

Reporting ‘worse’ quality did not mean unacceptable visit when recounting details if relationship established, health status stable, and outcomes are ‘same result’

Differences in Reported Telehealth Quality by Significant Characteristics

Education:

Participants with fewer years of formal education more likely to report worse quality

See Reasons related to a worse telehealth visit; intensified combination of technology challenges and loss of interpersonal communication and interactions

Language of Survey:

All Spanish language participants reported worse quality (N = 7)

See Reasons related to a worse telehealth visit; less time and in-person physical exchange may negatively impact care with language-discordant providers