COVID-19 Communication From Seven Health Care Institutions in North Texas for English- and Spanish-Speaking Cancer Patients: Mixed Method Website Study.

Background The COVID-19 pandemic created an urgent need to rapidly disseminate health information, especially to those with cancer because they face higher morbidity and mortality rates. At the same time, the disproportionate impact of the pandemic on Latinx populations underscores the need for information to reach Spanish-speakers. However, the equity of information about COVID-19 to Spanish-speaking cancer patients communicated through institutions' online media is unknown. Objective We conducted a multi-modal, mixed method document review study to evaluate the equity of online information about COVID-19 and cancer available to English and Spanish speaking populations from seven healthcare institutions in North Texas, where one in five adults is Spanish-speaking. Our focus is less on the "digital divide", which conveys disparities in access to computers and the Internet based on the race/ethnicity, education, and income of at-risk populations; rather, our study asks: to what extent is online content useful and culturally appropriate in meeting Spanish-speakers' information needs? Methods We reviewed 50 websites (33 English, 17 Spanish) over a period of one week in mid-May 2020. We sampled seven institutions' main oncology and COVID web pages, as well as both internal (institutional web pages) and external (non-institutional web pages) linked content. We conducted several analyses for each sampled page: (a) thematic content analysis, (b) literacy level analysis using Readability Studio software, (c) coding using the Patient Education and Materials Assessment Tool (PEMAT), and (d) descriptive analysis of video and diversity content. Results The themes most frequently addressed on English and Spanish websites differed somewhat. While "resources/FAQs" were frequently cited themes on both websites, English websites more frequently addressed "news/updates" and "cancer+COVID", whereas Spanish websites addressed "protection" and "COVID data". Spanish websites were on average lower literacy (11th grade) than English (13th grade), although still far above recommended guidelines of 6th-8th grade. The overall average accessibility score using the PEMAT analysis was the same for English (n=33 pages) and Spanish pages (n=17 pages) at 82%. Among the DFW organizations, the average accessibility of the Spanish pages (n=7) was slightly lower than that of the English pages (n=19) at 77% vs. 81%, respectively, due mostly to the discrepancy in English-only videos and visual aids. Twelve of the 50 websites (24%) had embedded videos in them, however 100% of videos were in English, including one that was on a Spanish website. Conclusions We identified an uneven response among the seven healthcare institutions to providing equitable information to Spanish-speaking DFW residents concerned about COVID and cancer. Spanish-speakers lack equal access in both diversity of content about COVID-19 and access to other websites, leaving an already vulnerable cancer patient population at greater risk. We recommend several specific actions to enhance content and navigability for Spanish-speakers.