The Causal Relationship Between Portal Usage and Self-Efficacious Health Information–Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data

Park, Jaeyoung; Liang, Muxuan; Alpert, Jordan; Brown, Richard F.; Zhong, Xiang

doi:10.2196/17782

Cited by 12 publications

(6 citation statements)

References 44 publications

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“…Consistent with previous studies, 9,[17][18][19]21,22,[26][27][28]37,38 we found that portal users were more likely to be younger, female, non-Hispanic White, be privately insured, have higher CCI scores and more likely to live in areas with a higher median income and higher educational attainment. A study of the 2017 and 2018 Health Information National Trends Survey (HINTS) showed higher odds of portal use in respondents with a bachelor's degree and incomes in the middle tertile.…”

Section: Discussionsupporting

confidence: 91%

“…28 Likewise, a different study of the 2017 HINTS showed that participants with higher incomes and educational attainment, and who were employed were more likely to access their online medical records. 38 Similar to our study, Goel et al explored patient use of the portal by demographics and used census data for measuring educational attainment and income. 18 They found disparities across age and gender in patients requesting advice from providers through the patient portal, both when not adjusting and adjusting for education and income.…”

Section: Discussionmentioning

confidence: 75%

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Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis

et al. 2022

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Background: The patient portal allows patients to engage with their healthcare team beyond the clinical encounter. While portals can improve patient outcomes, there may be disparities in which patients access the portal by sociodemographic factors. Understanding the characteristics of patients who use the portal could help design future interventions to expand portal adoption. Objectives: This study aimed to (1) examine the socioeconomic factors, comorbid conditions, and healthcare utilization among patients of a large academic primary care network who are users and non-users of the patient portal; and (2) describe the portal functions most frequently utilized. Methods: We included all adult patients at Atrium Health Wake Forest Baptist who had at least two primary care visits between 2018 and 2019. Patients' demographics, comorbidities, healthcare utilization, and portal function usage were extracted from the electronic health record and merged with census data (income, education, and unemployment) from the American Community Survey. A myWakeHealth portal user was defined as a patient who used a bidirectional portal function at least once during the study period. We used multivariable logistic regression to determine which patient characteristics were independently associated with being a portal user. Results: Of the 178,720 patients who met inclusion criteria, 32% (N=57,122) were users of myWakeHealth. Compared to non-users, users were more likely to be 18-64 years of age, female, non-Hispanic white, married, commercially insured, have higher disease burden, and have lower healthcare utilization. Patients residing in areas with the highest educational attainment had 51% higher odds of being a portal user than the lowest (p<0.001). Among portal users, the most commonly used function was messaging clinic providers. Conclusions: We found that patient demographics and area socioeconomic factors were associated with patient portal adoption. These findings suggest that efforts to improve portal adoption should be targeted at vulnerable patients.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 75%

Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis

et al. 2022

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“…We hypothesized that it mediated the relationship between frequency of portal use and perceived PCC. Self-efficacy in seeking health information was measured using 1 item used in previous studies [ 43 , 44 ]. In cycle 3, this item was worded as such: Overall, how confident are you that you could get advice or information about health or medical topics if you needed it?…”

Section: Methodsmentioning

confidence: 99%

Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study

Zaidi¹,

Amante²,

Anderson³

et al. 2022

JMIR Cancer

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Background Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied. Objective The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients’ self-efficacy in health information–seeking. Methods We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5–derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information–seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods. Results A total of 54.5% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6% accessed it 1 to 2 times, 24.8% accessed it 3 to 9 times, and 8.2% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information–seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95% CI 1.1-5.6) compared to those with no portal use. Conclusions Increased frequency of patient portal use was associated with higher PCC, and an individual’s health information–seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy.

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“…In addition, interacting with these tools is often associated with challenges that involve visual hierarchies of information, increasing the interaction burden [ 11 ]. With limited engagement in emerging digital health care tools to support home care, caregivers do not experience the potential benefits of improving home-based health management and communication [ 14 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Exploring the Experiences of Family Caregivers of Children With Special Health Care Needs to Inform the Design of Digital Health Systems: Formative Qualitative Study

Tennant¹,

Allana²,

Mercer³

et al. 2022

JMIR Form Res

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Background Family caregivers of children with special health care needs (CSHCN) are responsible for managing and communicating information regarding their child’s health in their homes. Although family caregivers currently capture information through nondigital methods, digital health care applications are a promising solution for supporting the standardization of information management in complex home care across their child’s health care team. However, family caregivers continue to use paper-based methods where the adoption of digital health care tools is low. With the rise in home care for children with complex health care needs, it is important to understand the caregiving work domain to inform the design of technologies that support child safety in the home. Objective The aim of this study is to explore how family caregivers navigate information management and communication in complex home care for CSHCN. Methods This research is part of a broader study to explore caregivers’ perspectives on integrating and designing digital health care tools for complex home care. The broader study included interviews and surveys about designing a voice user interface to support home care. This formative study explored semistructured interview data with family caregivers of CSHCN about their home care situations. Inductive thematic analysis was used to analyze the information management and communication processes. Results We collected data from 7 family caregivers in North America and identified 5 themes. First, family caregivers were continuously learning to provide care. They were also updating the caregiver team on their child’s status and teaching caregivers about their care situation. As caregiving teams grew, they found themselves working on communicating with their children’s educators. Beyond the scope of managing their child’s health information, family caregivers also navigated bureaucratic processes for their child’s home care. Conclusions Family caregivers’ experiences of caring for CSHCN differ contextually and evolve as their child’s condition changes and they grow toward adulthood. Family caregivers recorded information using paper-based tools, which did not sufficiently support information management. They also experienced significant pressure in summarizing information and coordinating 2-way communication about the details of their child’s health with caregivers. The design of digital health care systems and tools for complex home care may improve care coordination if they provide an intuitive method for information interaction and significant utility by delivering situation-specific insights and adapting to unique and dynamic home care environments. Although these findings provide a foundational understanding, there is an opportunity for further research to generalize the findings.

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The Causal Relationship Between Portal Usage and Self-Efficacious Health Information–Seeking Behaviors: Secondary Analysis of the Health Information National Trends Survey Data

Cited by 12 publications

References 44 publications

Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis

Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis

Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study

Exploring the Experiences of Family Caregivers of Children With Special Health Care Needs to Inform the Design of Digital Health Systems: Formative Qualitative Study

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