Background The COVID-19 pandemic has 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 pandemic’s disproportionate impact on Latinx populations underscores the need for information to reach Spanish speakers. However, the equity of COVID-19 information communicated through institutions’ online media to Spanish-speaking cancer patients is unknown. Objective We conducted a multimodal, 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 health care institutions in North Texas, where one in five adults is Spanish-speaking. Our focus was 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 the following question: to what extent is online content useful and culturally appropriate in meeting Spanish speakers’ information needs? Methods We reviewed 50 websites (33 English and 17 Spanish) over a period of 1 week in the middle of May 2020. We sampled seven institutions’ main oncology and COVID web pages, and both internal (institutional) and external (noninstitutional) linked content. We conducted several analyses for each sampled page, including (1) thematic content analysis, (2) literacy level analysis using Readability Studio software, (3) coding using the Patient Education and Materials Assessment Tool (PEMAT), and (4) descriptive analysis of video and diversity content. Results The themes most frequently addressed on English and Spanish websites differed. While “resources/FAQs” were frequently cited themes on both websites, English websites more frequently addressed “news/updates” and “cancer+COVID,” and Spanish websites addressed “protection” and “COVID data.” Spanish websites had on average a lower literacy level (11th grade) than English websites (13th grade), although still far above the recommended guideline of 6th to 8th grade. The PEMAT’s overall average accessibility score was the same for English (n=33 pages) and Spanish pages (n=17 pages) at 82%. Among the Dallas-Fort Worth organizations, the average accessibility of Spanish pages (n=7) was slightly lower than that of English pages (n=19) (77% vs 81%), due mostly to the discrepancy in English-only videos and visual aids. Of the 50 websites, 12 (24%) had embedded videos; however, 100% of videos were in English, including one on a Spanish website. Conclusions We identified an uneven response among the seven health care institutions for providing equitable information to Spanish-speaking Dallas-Fort Worth 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.

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 <9th 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.

e18515 Background: The COVID-19 pandemic created an urgent need for timely and accurate public health information. This is especially true for those with cancer because they face higher morbidity and mortality from COVID-19. At the same time, the disproportionate impact of the pandemic on Latinx populations underscores the need for information to reach Spanish-speakers. Given the large proportion of Spanish-speakers in the U.S., healthcare institutions have a professional and moral obligation to meet this critical need. Methods: We conducted a multi-modal, mixed method document review study to evaluate the equity of online information about COVID and cancer available to English- and Spanish-speakers from seven north Texas healthcare institutions. We sampled 50 websites (33 English, 17 Spanish) over a one-week period in May 2020. Websites included 27 healthcare institutions and 23 external organizations (e.g. CDC). Thematic content was analyzed using a coding conversion process; literacy level was measured using Readability software; accessibility was measured using the Patient Education and Materials Assessment Tool (PEMAT); and video and diversity content were defined and counted. Results: Content on Spanish websites was sub-optimal compared to English. We observed significant differences in thematic content, poor linkage to external Spanish content, and errors in translation. Whether differences were intentional was unclear. Across all sites, content specifically about COVID and cancer was more prevalent in English than Spanish (58% vs. 43%). Three institutions’ websites contained no information about COVID specifically for cancer patients, and three institutions included only a banner link to COVID updates or information from their main oncology page. Only one institution’s website included comprehensive COVID-related information specifically for cancer patients, such as postponing treatment, oral cancer treatments, and extra assurances taken for protection during in-person care; however, this website was available in English only. Spanish websites scored on average at a lower literacy level than English (11th vs. 13th grade). Using the PEMAT, healthcare institutions’ average accessibility of Spanish pages (n = 7) was slightly lower than that of English pages (n = 19) (77% vs. 81%, respectively), due mostly to discrepancies in English-only videos and visual aids; conversely, among external organizations’ websites, the average accessibility score of Spanish pages (n = 10) was higher than that of English pages (n = 13) (86% vs. 83%, respectively). Conclusions: In one region, Spanish-speakers lack equitable access to information about COVID-19 and cancer compared with English-speakers, leaving an already vulnerable patient population at greater risk for poor health outcomes. We offer recommendations for enhancing equity of access to information.