Patient Portals as a Tool for Health Care Engagement: A Mixed-Method Study of Older Adults With Varying Levels of Health Literacy and Prior Patient Portal Use

Abstract

BackgroundGrowing evidence that patient engagement improves health outcomes and reduces health care costs has fueled health providers’ focus on patient portals as the primary access point for personal health information and patient-provider communication. Whereas much attention has been given to identifying characteristics of older adults who do and do not adopt patient portals and necessary adaptions to portal design, little is known about their attitudes and perceptions regarding patient portal use as a tool for engagement in their health care within the context of health literacy, experience navigating Web-based health information, and previous patient portal use.ObjectiveThe specific aims of this study were to explore attitudes toward portal adoption and its perceived usefulness as a tool for health care engagement among adults (65 years and older) who have varying levels of health literacy and degrees of prior patient portal use.MethodsA phone survey of 100 community dwelling adults gathered sociodemographic, health, and technology related information. Older adults were purposefully selected for 4 follow-up focus groups based on survey responses to health literacy and previous patient portal use. A mixed-method approach was used to integrate phone survey data with thematic analysis of 4 focus groups. Due to variability in attitudes between focus group participants, an individual case analysis was performed and thematic patterns were used as the basis for subgroup formation.ResultsDifferences in health literacy, comfort navigating health information on the Web, and previous portal experience explained some but not all differences related to the 7 themes that emerged in the focus groups analysis. Individual cases who shared attitudes were arranged into 5 subgroups from least to most able and willing to engage in health care via a patient portal. The subgroups’ overall portal adoption attitudes were: (1) Don’t want to feel pushed into anything, (2) Will only adopt if required, (3) Somebody needs to help me, (4) See general convenience of the portal for simple tasks and medical history, but prefer human contact for questions, and (5) Appreciates current features and excited about new possibilities .ConclusionsMost of the older adults are interested in using a patient portal regardless of health literacy level, previous patient portal adoption, or experience navigating health information on the Web. Research targeting informal caregivers of older adults who are unable or unwilling to engage with information technology in health care on their own is warranted. Health care organizations should consider tailored strategies to meet the needs of older adults (and their informal caregivers) and explore alternative workflows that integrate patient portal information into phone conversations and face-to-face contact with health care providers.

Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study (Preprint)

“…When older adults require technical support or positive rewards during smart device use and an mHealth intervention, they are likely to receive instant help or feedback from a significant other, such as a family member [38]. New devices and tasks are frequently discussed with family members, who influence older adults' intent to use the intervention, which was shown in previous studies [34,38].…”

“…The most common difficulty among participants was technical challenges; they were not familiar with using highly sensitive touch screens, completion of technology training, or diverse mobile apps. Many older adults felt concerned about incorrect operation or misunderstanding due to their lack of knowledge and experience [10,20,34,38]. In this study, participants received multiple device training adjusted to their progresses and technical support on continuous use of mHealth, as suggested by a previous study [20].…”

“…Furthermore, a tailored approach is required to assure high adherence, specifically during Phases 3 and 4 [37,38]. Our interventionists tried to perform the role of health coaching rather than merely lecturing about chronic disease information [9]; therefore, we carefully assessed their healthcare needs before selecting apps.…”

“…In addition, family members should learn how to assist older adults in using mHealth interventions with effective feedback [38].…”

A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design (Preprint)

“…Patient portals linked to Electronic Health Records (EHRs) are recognized as a promising multi-faceted tool to help achieve these patient engagement goals. [6][7][8][9] The adoption and sustained use of portals has generally fallen short of initial optimism, [10][11][12][13] even in light of the significant growth in EHRs and tethered patient portals incentivized by Meaningful Use. [14] However, positive benefits of portal use have been demonstrated.…”