ObjectiveTo test an intervention designed to improve patient engagement in telehealth visits by encouraging patients to use active communication behaviors.MethodsUS Veterans with type 2 diabetes mellitus receiving primary care using telehealth were randomized 1:1 to receive both a pre-visit educational video and pamphlet (intervention) or pamphlet alone (control) prior to their scheduled telehealth visit. Data were collected before and after the intervention from the medical record and at telephone interviews (questionnaires). Analyses compared the intervention and control groups using bivariate statistics and multiple regression.ResultsThere were no statistically significant differences in baseline Hemoglobin A1c (HbA1c) between intervention and control groups (P> 0.05). Patient's ratings of physicians' communication and post-visit empathy were higher (P≤ 0.05) in the intervention group than control group and after adjusting for baseline values the intervention group reported higher scores on post-visit therapeutic alliance with the provider and higher patient engagement, compared with the control group,P= 0.01 andP= 0.04, respectively, but post-visit HbA1c was not statistically different.ConclusionsThe educational video was useful as pre-visit preparation for patients prior to a primary care telehealth visit.InnovationThis study showed the efficacy of a pre-visit video to improve patient engagement and therapeutic alliance after telehealth visits.ClinicalTrials.govIdentifier:NCT02522494