Leeds Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom; College of Science and Engineering, Hamad Bin Khalifa University, Doha, Qatar.
Leeds Institute of Health Sciences, School of Medicine, University of Leeds, United Kingdom.
Int J Med Inform. 2019 Jun;126:164-175. doi: 10.1016/j.ijmedinf.2019.03.014. Epub 2019 Apr 5.
Electronic personal health records (ePHRs) are web-based tools that enable patients to access parts of their medical records and other services. In spite of the potential benefits of using ePHRs, their adoption rates remain very low. The lack of use of ePHRs among patients leads to implementation failures of these systems. Many studies have been conducted to examine the factors that influence patients' use of ePHRs, and they need to be synthesised in a meaningful way.
The current study aimed to systematically review the evidence regarding factors that influence patients' use of ePHRs.
The search included: 42 bibliographic databases (e.g. Medline, Embase, CINHAL, and PsycINFO), hand searching, checking reference lists of the included studies and relevant reviews, contacting experts, and searching two general web engines. Study selection, data extraction, and study quality assessment were carried out by two reviewers independently. The quality of studies was appraised using the Mixed Methods Appraisal Tool. The extracted data were synthesised narratively according to the outcome: intention to use, subjective measures of use, and objective measures of use. The identified factors were categorised into groups based on Or and Karsh's conceptual framework.
Of 5225 citations retrieved, 97 studies were relevant to this review. These studies examined more than 150 different factors: 59 related to intention to use, 52 regarding subjectively-measured use, and 105 related to objectively-measured use. The current review was able to draw definitive conclusions regarding the effect of only 18 factors. Of these, only three factors have been investigated in connection with every outcome, which are: perceived usefulness, privacy and security concerns, and internet access.
Of the numerous factors examined by the included studies, this review concluded the effect of 18 factors: 13 personal factors (e.g. gender, ethnicity, and income), four human-technology factors (e.g. perceived usefulness and ease of use), and one organisational factor (facilitating conditions). These factors should be taken into account by stakeholders for the successful implementation of these systems. For example, patients should be assured that the system is secure and no one can access their records without their permission in order to decrease their concerns about the privacy and security. Further, advertising campaigns should be carried out to increase patients' awareness of the system. More studies are needed to conclude the effect of other factors. In addition, researchers should conduct more theory-based longitudinal studies for assessing factors affecting initial use and continuing use of ePHRs among patients.
电子个人健康记录（ePHR）是一种基于网络的工具，使患者能够访问其部分医疗记录和其他服务。尽管使用 ePHR 有潜在的好处，但它们的采用率仍然非常低。患者对 ePHR 的使用不足导致这些系统的实施失败。许多研究已经对影响患者使用 ePHR 的因素进行了研究，需要以有意义的方式进行综合分析。
本研究旨在系统回顾影响患者使用 ePHR 的因素的证据。
检索了 42 个书目数据库（如 Medline、Embase、CINHAL 和 PsycINFO）、手工检索、查阅纳入研究和相关综述的参考文献列表、联系专家以及在两个通用网络引擎上进行搜索。由两名评审员独立进行研究选择、数据提取和研究质量评估。使用混合方法评估工具评估研究质量。根据结果（使用意向、主观使用测量和客观使用测量），以叙述方式综合提取的数据。根据 Or 和 Karsh 的概念框架将确定的因素分类为组。
在检索到的 5225 条引文，97 项研究与本综述相关。这些研究共考察了 150 多种不同的因素：59 种与使用意向相关，52 种与主观测量的使用相关，105 种与客观测量的使用相关。本综述仅能够对 18 个因素的影响得出明确的结论。在这些因素中，只有三个因素与每个结果都有联系，即：感知有用性、隐私和安全问题以及互联网接入。
在纳入研究中考察的众多因素中，本综述得出了 18 个因素的影响：13 个个人因素（如性别、种族和收入）、4 个人机技术因素（如感知有用性和易用性）和 1 个组织因素（促进条件）。利益相关者应考虑这些因素，以成功实施这些系统。例如，应让患者放心，系统是安全的，未经他们允许，任何人都无法访问他们的记录，以减少他们对隐私和安全的担忧。此外，应开展宣传活动，提高患者对该系统的认识。还需要更多的研究来得出其他因素的影响。此外，研究人员应该进行更多基于理论的纵向研究，以评估影响患者初始使用和持续使用 ePHR 的因素。
