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Communication barriers faced by limited English proficient (LEP) patients have led to worse outcomes. Such disparities are entrenched in digital health and call into question the impact of tools such as patient portals, the primary digital touchpoint for patients. Over the last decade, portals have been implemented broadly but have done little to address the needs of LEP communities, who make up almost 10% of the U.S. population. The surge in telemedicine during the COVID-19 pandemic, which has relied in part on portals, increases the urgency for a comprehensive approach to digital disparities. We present recommendations grounded in the 7Ps of Stakeholder Engagement (policymakers, payers, product makers, purchasers, providers, patients, and principal investigators) for the next generation of portals (version 2.0). Our recommendations focus on expanding language accessibility, establishing messaging workflows to integrate language services, extending federal guidelines for language equity, and ensuring digital access and literacy.

Background . Studies exploring the relationship between foreign-born status and mental health among Latinos in the United States have varied in their conclusions. We examined 2000–2002 MESA data on Latinos and compared responses between immigrants and non-immigrants on the Center for Epidemiologic Studies Depression (CES-D) scale and the Spielberger anxiety and anger scales. Methods . We used logistic and linear regression to examine whether immigrant status was associated with these psychological outcomes in Latinos-overall, Mexicans-only and Other-Latinos (non-Mexicans). Results . Compared with U.S.-born Latinos, foreign-born Latinos had significantly higher odds of meeting CES-D caseness- a score above 16, classifying depressive symptoms (p≤.05), higher anger scores (p≤.001) and a trend towards higher anxiety. These associations were similar within the Mexicans-only subgroup. Discussion . When examining self-reported distress symptoms as outcomes, our findings do not coincide with the paradoxical effect of immigration on mental health. Furthermore, associations between immigrant status and psychological outcomes differed among the Latino subgroups.