Telemedicine perceptions and experiences of socially vulnerable households during the early stages of the COVID-19 pandemic: a qualitative study.

BACKGROUND: Early in the COVID-19 pandemic, efforts to decrease risk of viral transmission triggered an abrupt shift from ambulatory health care delivery toward telemedicine. In this study, we explore the perceptions and experiences of telemedicine among socially vulnerable households and suggest strategies to increase equity in telemedicine access. METHODS: Conducted between August 2020 and February 2021, this exploratory qualitative study involved in-depth interviews with members of socially vulnerable households needing health care. Participants were recruited from a food bank and primary care practice in Montréal. Digitally recorded telephone interviews focused on experiences and perceptions related to telemedicine access and use. In our thematic analysis, we employed the framework method to facilitate comparison, and the identification of patterns and themes. RESULTS: Twenty-nine participants were interviewed, 48% of whom presented as women. Almost all sought health care in the early stages of the pandemic, 69% of which was received via telemedicine. Four themes emerged from the analysis: delays in seeking health care owing to competing priorities and perceptions that COVID-19-related health care took precedence; challenges with appointment booking and logistics given complex online systems, administrative inefficiencies, long wait times and missed calls; issues around quality and continuity of care; and conditional acceptance of telemedicine for certain health problems, and in exceptional circumstances. INTERPRETATION: Early in the pandemic, participants report telemedicine delivery did not accommodate the diverse needs and capacities of socially vulnerable populations. Patient education, logistical support and care delivery by a trusted provider are suggested solutions, in addition to policies supporting digital equity and quality standards to promote telemedicine access and appropriate use.

The utterly unforeseen livelihood shock: COVID-19 and street vendor coping mechanisms in Hanoi, Chiang Mai and Luang Prabang.

Well before COVID-19, municipal governments in Vietnam, Thailand and Laos were enacting policies that made street vendor livelihoods increasingly challenging. Yet, vending continues to support tens of thousands of urban households in these three countries. Vendors are often rural-to-urban migrants lacking the formal education skills necessary to secure 'modern' urban employment, and despite ongoing government disapproval, vending provides a relatively low entry-cost opportunity for them to support their household's financial needs. Now add to this complex situation the livelihood shocks associated with the COVID-19 pandemic, as well as additional government restrictions across these three countries to mitigate the pandemic's impacts. Drawing on interviews with 61 street vendors in Hanoi, Chiang Mai and Luang Prabang, and rooted in conceptual discussions regarding urban livelihood shocks, we examine how street vendors, especially rural-to-urban migrants, experienced and responded to the 'first wave' of COVID-19, including additional government-imposed constraints on their livelihoods and mobility. We find that a diverse range of responses helped some-but not all-vendors overcome the initial shocks to their livelihoods and household responsibilities. Yet, we also note that the pandemic's onset altered urban-rural connections and mobility, with many vendors who turned to formerly dependable rural-urban ties for support facing unexpected barriers.