Whittemore Robin, Jeon Sangchoon, Akyirem Samuel, Chen Helen N C, Lipson Joanna, Minchala Maritza, Wagner Julie
School of Nursing, Yale University, Orange, CT, United States.
Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States.
JMIR Form Res. 2025 Mar 25;9:e67293. doi: 10.2196/67293.
Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status.
This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs.
A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function.
In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% <high school), and no health insurance (12/22, 55%). All participants had access to a Smartphone, but 91% (20/22) had never accessed a health app. The baseline hemoglobin A level was 8.31%. Portal activation was high; 100% (22/22) of participants created a portal account and logged in within the first month. Mean participant logins per week over the first 3 months was 3.16 (SD 1.55) and 1.45 (SD 0.93) over the final 3 months; mean logins per month over the first 3 months was 12.65 (SD 6.21) and 5.79 (SD 3.74) over last 3 months. Engagement was high; 96% (20/21) logged in at least twice per month in the first 3 months and 76% (16/21) between 3 and 6 months. At 6 months, improvements were seen in technology confidence, digital health literacy, diabetes self-efficacy, and diabetes distress. Participant satisfaction with MAP was high as was intention to continue portal use. Barriers to clinical integration and recommendations for portal development were identified.
MAP shows promise for improving health equity in portal use for T2D. Larger, controlled studies are needed to determine how best to implement MAP in complex clinical settings and to evaluate efficacy over time.
ClinicalTrials.gov NCT05180721; https://clinicaltrials.gov/study/NCT05180721.
通过患者门户网站提供的糖尿病自我管理教育与支持（DSMS）能显著改善血糖控制。然而，患者门户网站使用方面的差异依然存在。社区卫生中心（CHC）为任何有需求的人提供医疗服务，无论其收入或保险状况如何。
本研究旨在评估一项多级干预措施在社区卫生中心接受医疗服务的2型糖尿病（T2D）患者中增加门户网站访问和使用（MAP）的可行性、可接受性及初步疗效。
采用受试者内前后测设计。从2家社区卫生中心招募对门户网站不熟悉的成年T2D患者。在获得知情同意后，参与者与一名社区卫生工作者会面，以获取健康社会决定因素的转诊服务、获得一部配有移动电话服务的平板电脑，并接受关于平板电脑和门户网站使用的个性化培训。接下来，一名护士与参与者单独会面，制定一份DSMS计划，然后在头3个月每周至少通过门户网站与患者沟通两次，后3个月每周沟通一次。在基线、3个月和6个月时收集数据。主要结局是患者对门户网站的激活和参与度。次要结局包括技术态度、数字健康素养、健康相关结局和心理社会功能。
共有26名患者符合条件，23名接受了干预，1名失访。样本主要为拉丁裔或西班牙裔（17/22，77%），报告低收入（19/22，86%<40,000美元/年）、低教育水平（13/22，59%<高中）且无医疗保险（12/22，55%）。所有参与者都能使用智能手机，但91%（20/22）从未使用过健康应用程序。基线糖化血红蛋白水平为8.31%。门户网站激活率很高；100%（22/22）的参与者在第一个月内创建了门户网站账户并登录。前3个月参与者每周的平均登录次数为3.16（标准差1.55），后3个月为1.45（标准差0.93）；前3个月每月的平均登录次数为12.65（标准差6.21），后3个月为5.79（标准差3.74）。参与度很高；96%（20/21）在前3个月每月至少登录两次，76%（16/21）在3至6个月期间每月至少登录两次。在6个月时，技术信心、数字健康素养、糖尿病自我效能感和糖尿病困扰均有改善。参与者对MAP的满意度很高，继续使用门户网站的意愿也很高。确定了临床整合的障碍以及门户网站开发的建议。
MAP有望改善T2D患者在门户网站使用方面的健康公平性。需要开展更大规模的对照研究，以确定如何在复杂的临床环境中最佳实施MAP，并长期评估其疗效。
ClinicalTrials.gov NCT05180721；https://clinicaltrials.gov/study/NCT05180721 。
