Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
Department of Epidemiology, Columbia University Mailman School of Public Health, NY, NY, United States.
J Med Internet Res. 2021 Feb 10;23(2):e18750. doi: 10.2196/18750.
Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied.
The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM.
A total of 12 items of the American Men's Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma.
The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV.
PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.
患者门户模块，包括电子个人健康记录、健康教育和处方续配订购，可用于解决包括艾滋病毒在内的性传播感染（STI）负担，针对男同性恋、双性恋和其他性少数群体男性（SMM）。实施科学中的理论框架强调检查创新属性和绩效预期的结构，作为行为意图和新的基于网络的健康技术使用的关键决定因素。然而，SMM 中使用患者门户进行艾滋病毒和其他 STI 预防和护理的行为意图研究不足。
本研究旨在为全国性 SMM 样本开发一种用于测量 STI 预防和护理使用患者门户的态度的简短工具。
从之前的研究中改编了美国男性互联网调查-患者门户性健康工具（AMIS-PPSHI）的 12 个项目。对报告有网络访问其健康记录的 2018 年 AMIS 参与者的随机子样本（N=1375）进行了 AMIS-PPSHI 项目的心理测量分析。在探索性因素分析（EFA）中，平行分析和主成分分析（PCA）中的特征值检查有助于保留因素。EFA 后，使用 Cronbach α 检验量表及其子量表的内部一致性。采用验证性因素分析（CFA）评估最终因子结构的拟合优度。我们计算了 AMIS-PPSHI 量表的总分，以便在包括年龄、性传播感染诊断史、最近检测、严重精神疾病和预期医疗保健耻辱感在内的组内类别中进行比较。
EFA 产生的 AMIS-PPSHI 量表由 12 个项目组成，具有良好的内部一致性（α=.84）。EFA 表明有 3 个子量表：性健康参与和意识（α=.87）、增强对偶沟通（α=.87）和管理性健康护理（α=.79）。CFA 表明在 3 因素 PPSHI 结构中有良好的拟合度：均方根误差近似值=0.061、比较拟合指数=0.964、塔克-刘易斯指数=0.953、标准化均方根残差=0.041。最显著的差异是艾滋病毒感染者的增强对偶沟通子量表得分较低。
PPSHI 是一种具有较强心理测量特性的简短工具，可适用于大型调查和其他环境中的患者问卷。评分表明，患者门户是美国针对 SMM 提供的侧重于性传播感染预防和护理的基于网络的优质解决方案。在艾滋病毒感染者中，需要更多关注传统医疗保健环境之外的人际使用患者门户的隐私影响。
