Irizarry Taya, Shoemake Jocelyn, Nilsen Marci Lee, Czaja Sara, Beach Scott, DeVito Dabbs Annette
School of Nursing, University of Pittsburgh, Pittsbrugh, PA, United States.
Department of Psychology, Ohio State University, Columbus, OH, United States.
J Med Internet Res. 2017 Mar 30;19(3):e99. doi: 10.2196/jmir.7099.
Growing 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.
The 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.
A 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.
Differences 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 .
Most 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.
越来越多的证据表明，患者参与可改善健康状况并降低医疗成本，这促使医疗服务提供者将重点放在患者门户网站上，将其作为获取个人健康信息和患者与医疗服务提供者沟通的主要接入点。尽管人们十分关注确定采用和不采用患者门户网站的老年人的特征以及对门户网站设计的必要调整，但对于他们在健康素养、浏览基于网络的健康信息的经验以及之前使用患者门户网站的背景下，对将患者门户网站用作参与自身医疗保健工具的态度和看法却知之甚少。
本研究的具体目标是探讨不同健康素养水平和之前使用患者门户网站程度不同的成年人（65岁及以上）对采用门户网站的态度及其作为医疗保健参与工具的感知有用性。
对100名居住在社区的成年人进行电话调查，收集社会人口统计学、健康和技术相关信息。根据对健康素养和之前使用患者门户网站情况的调查回复，有目的地选择老年人参加4个后续焦点小组。采用混合方法将电话调查数据与对4个焦点小组的主题分析相结合。由于焦点小组参与者之间态度存在差异，进行了个体案例分析，并将主题模式用作形成亚组的基础。
健康素养、在网络上浏览健康信息的舒适度以及之前的门户网站使用经验方面的差异解释了与焦点小组分析中出现的7个主题相关的部分而非全部差异。根据态度将个体案例从最不愿意和最无能力通过患者门户网站参与医疗保健到最愿意和最有能力进行排列，分为5个亚组。各亚组对门户网站采用的总体态度分别为：（1）不想被强迫做任何事，（2）仅在有要求时才会采用，（3）需要有人帮助我，（4）看到门户网站在简单任务和病史方面的一般便利性，但对于问题更喜欢与人接触，以及（5）欣赏当前功能并对新可能性感到兴奋。
大多数老年人对使用患者门户网站感兴趣，无论其健康素养水平、之前是否采用过患者门户网站或在网络上浏览健康信息的经验如何。有必要针对那些无法或不愿意自行参与医疗保健信息技术的老年人的非正式护理人员开展研究。医疗保健组织应考虑制定量身定制的策略，以满足老年人（及其非正式护理人员）的需求，并探索将患者门户网站信息整合到电话交谈以及与医疗服务提供者面对面接触中的替代工作流程。
