Cross-sectional evaluation of online Spanish-language dermatology resources at academic medical centers.

To the Editor: US Census Bureau data report that 16 million Spanish speakers in the United States have limited English proficiency (LEP).1US Census BureauLanguage spoken at home for the population 5 years and over.https://data.census.gov/cedsci/table?q=spanish%20language&g=0100000US&tid=ACSDT1Y2019.C16001&hidePreview=falseDate: 2019Date accessed: January 2, 2021Google Scholar Hispanic patients, especially those with LEP, are less likely to seek health information online than other racial/ethnic groups.2Millar R.J. Sahoo S. Yamashita T. Cummins P.A. Literacy skills, language use, and online health information seeking among Hispanic adults in the United States.Patient Educ Couns. 2020; 103: 1595-1600https://doi.org/10.1016/j.pec.2020.02.030Crossref PubMed Scopus (18) Google Scholar, 3Jacobs W. Amuta A.O. Jeon K.C. Health information seeking in the digital age: an analysis of health information seeking behavior among US adults.Cogent Soc Sci. 2017; 31302785https://doi.org/10.1080/23311886.2017.1302785Crossref Scopus (336) Google Scholar, 4Tripathi R. Knusel K.D. Ezaldein H.H. Scott J.F. Bordeaux J.S. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States.JAMA Dermatol. 2018; 154: 1286https://doi.org/10.1001/jamadermatol.2018.3114Crossref PubMed Scopus (65) Google Scholar Most academic medical centers have websites with patient-oriented care information in English, but the availability of this information in Spanish is unknown. We aimed to characterize the availability of online Spanish-language dermatology information on academic dermatology websites and identify gaps in this information. Between December 2021 and February 2022, we reviewed the websites of all US dermatology programs accredited by the Accreditation Council for Graduate Medical Education, excluding programs in Puerto Rico. We evaluated their academic medical center's homepage and dermatology care homepage for translation capacity, dermatology-related Spanish-language patient information, and Spanish-speaking dermatologists. We denote 12 specific categories of information reviewed in Table I and Fig 1. Data were collected in real time using REDcap, and descriptive statistics were calculated with Microsoft Excel.Table ISpanish-language resources on websites of academic medical centersSpanish translation availability, N = 138Institutional homepageDermatology homepageYes30 (22%)23 (17%) Website26 (19%)19 (14%) Browser4 (3%)4 (3%)Partial13 (9%)2 (1%)No94 (68%)97 (70%)No dermatology home page-16 (12%)Availability by resourceEnglishSpanishAppointment scheduling131 (95%)24 (17%)Insurance information126 (91%)25 (18%)Telehealth information95 (69%)26 (19%)Telehealth instructions90 (65%)29 (21%)Location information123 (89%)17 (12%)Dermatology services114 (83%)15 (11%)Physician information127 (92%)12 (9%)Designation of Spanish-speaking physicians87 (63%)6 (4%)Educational material about skin disease85 (62%)19 (14%)Billing and financial assistance information127 (92%)86 (62%)Medication information sheets6 (4%)2 (1%)Patient rights and responsibilities116 (84%)61 (44%)Availability by regionRegionAvg number Spanish-language resourcesLEP Spanish-speaking population (%)∗US Census Data.1Ratio of resources to LEP Spanish-speaking populationCentral2.290.870.24Northeast3.162.170.33Southern1.601.890.29Western3.352.470.17∗ US Census Data.1US Census BureauLanguage spoken at home for the population 5 years and over.https://data.census.gov/cedsci/table?q=spanish%20language&g=0100000US&tid=ACSDT1Y2019.C16001&hidePreview=falseDate: 2019Date accessed: January 2, 2021Google Scholar Open table in a new tab Of the 138 websites we evaluated, 26 (19%) included full translations of the general medical centers' homepages and 23 (17%) included full translations of dermatology-specific content, including the institution's dermatology homepage. Of the remaining websites, 35 (25%) contained no Spanish-language resources and 13 (9%) included partial site translations or a page with general institutional information in Spanish (Table I). The 2 most common Spanish-language resources identified were billing and financial assistance (86 programs, 62%) and patient rights and responsibilities (61 programs, 44%). Eighty-seven websites offered information regarding Spanish-speaking dermatologists, and 325 (7%) out of 4605 academic dermatologists were labeled as Spanish speaking. Furthermore, we quantified online resource availability by region and found centers in the Western United States had the most Spanish-language resources, in correlation with a larger LEP Spanish-speaking population. There is a dearth of online Spanish-language dermatology resources at academic medical centers. Available Spanish-language resources are often embedded in otherwise entirely English-language websites. While poor website design alone may not deter LEP patients from navigating to and accessing care information, a lack of Spanish-language information on appointment scheduling, dermatology services, and facility information such as addresses, directions, and parking may contribute to an underutilization of dermatology services.4Tripathi R. Knusel K.D. Ezaldein H.H. Scott J.F. Bordeaux J.S. Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States.JAMA Dermatol. 2018; 154: 1286https://doi.org/10.1001/jamadermatol.2018.3114Crossref PubMed Scopus (65) Google Scholar In total, our study demonstrated that only 7% of dermatologists were identifiable as Spanish speaking, and only 18% of websites contained dermatology patient information in Spanish; this represents a significant barrier to access to care. This study is limited to academic medical centers and did not evaluate private dermatology practices or nonacademic multispecialty centers. We did not assess quality or readability of available information, which may also impact LEP patients' ability to utilize online resources to seek information and care.5Mazmudar R.S. Sheth A. Tripathi R. Scott J.F. Readability of online Spanish patient education materials in dermatology.Arch Dermatol Res. 2020; 313: 201-204https://doi.org/10.1007/s00403-020-02036-7Crossref PubMed Scopus (10) Google Scholar Expanding our evaluation to include nonacademic practices and evaluating readability are important next steps for a more comprehensive evaluation of online dermatology resources in the United States. Expanding dermatology language-specific information on websites of academic medical centers will better serve the needs of Spanish-speaking patients and may be an important step in reducing health disparities among LEP patients. None disclosed.