Research Article
No access
Published Online: 1 December 2017

eHealth Literacy: Patient Engagement in Identifying Strategies to Encourage Use of Patient Portals Among Older Adults

Publication: Population Health Management
Volume 20, Issue Number 6

Abstract

Innovations in chronic disease management are growing rapidly as advancements in technology broaden the scope of tools. Older adults are less likely to be willing or able to use patient portals or smartphone apps for health-related tasks. The authors conducted a cross-sectional survey of older adults (ages ≥50) with hypertension or diabetes to examine relationships between portal usage, interest in health-tracking tools, and eHealth literacy, and to solicit practical solutions to encourage technology adoption. Among 247 patients surveyed in a large integrated delivery health system between August 2015 and January 2016, eHealth literacy was positively associated with portal usage (OR [95% CI]: 1.3 [1.2–1.5]) and interest in health-tracking tools (1.2 [1.1–1.3]). Portal users compared to nonusers (N = 137 vs.110) had higher rates of interest in using websites/smartphone apps to track blood pressure (55% vs. 36%), weight (53% vs. 35%), exercise (53% vs. 32%), or medication (46% vs 33%, all P < 0.05). Portal users noted cumbersome processes for accessing portals and variations in provider availability for online scheduling and response times to messages. Portal nonusers expressed concerns about data security, lack of personalization, and limited perceived value of using portals. Both groups noted the importance of computer literacy and technical support. Patient stakeholders recommended marketing initiatives that capture patient stories demonstrating real-life applications of what patients can do with digital technology, how to use it, and why it may be useful. Health systems also must screen for eHealth literacy, provide training, promote proxy users, and institute quality assurance that ensures patients' experiences will not vary across the system.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2013.
2.
Perrin A, Duggan M. America's Internet Access: 2000–2015. 2015. www.pewinternet.org/2015/06/26/americans-internet-access-2000-2015 Accessed October 15, 2016.
3.
Fox S, Duggan M. Health online 2013. 2013. www.pewinternet.org/2013/01/15/health-online-2013 Accessed October 15, 2016.
4.
Prestin A, Vieux SN, Chou WY. Is online health activity alive and well or flatlining? Findings from 10 years of the health information national trends survey. J Health Commun 2015;20:790–798.
5.
Hong YA, Cho J. Has the digital health divide widened? Trends of health-related internet use among older adults from 2003 to 2011. J Gerontol B Psychol Sci Soc Sci 2016 [Epub ahead of print]. Accessed August 24, 2016.
6.
Gordon NP, Hornbrook MC. Differences in access to and preferences for using patient portals and other eHealth technologies based on race, ethnicity, and age: a database and survey study of seniors in a large health plan. J Med Internet Res 2016;18:e50.
7.
Hall AK, Bernhardt JM, Dodd V, Vollrath MW. The digital health divide: evaluating online health information access and use among older adults. Health Educ Behav 2015;42:202–209.
8.
Norman CD, Skinner HA. eHealth literacy: essential skills for consumer health in a networked world. J Med Internet Res 2006;8:e9.
9.
Choi NG, Dinitto DM. The digital divide among low-income homebound older adults: internet use patterns, eHealth literacy, and attitudes toward computer/internet use. J Med Internet Res 2013;15:e93.
10.
Nahm ES, Sagherian K, Zhu S. Use of patient portals in older adults: a comparison of three samples. Stud Health Technol Inform 2016;225:354–358.
11.
Olphert W, Damodaran L. Older people and digital disengagement: a fourth digital divide? Gerontology 2013;59:564–570.
12.
Goldzweig CL, Orshansky G, Paige NM, et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 2013;159:677–687.
13.
Riippa I, Linna M, Ronkko I, Kroger V. Use of an electronic patient portal among the chronically ill: an observational study. J Med Internet Res 2014;16:e275.
14.
Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res 2015;17:e148.
15.
Serrano KJ, Yu M, Riley WT, et al. Willingness to exchange health information via mobile devices: findings from a population-based survey. Ann Fam Med 2016;14:34–40.
16.
Milani RV, Lavie CJ, Bober RM, Milani AR, Ventura HO. Improving hypertension control and patient engagement using digital tools. Am J Med 2017;130:14–20.
17.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.
18.
Norman CD, Skinner HA. eHEALS: the eHealth literacy scale. J Med Internet Res 2006;8:e27.
19.
Chung S, Nahm E. Testing reliability and validity of the eHealth literacy scale (eHEALS) for older adults recruited online. Comput Inform Nurs 2015;33:150–156.
20.
Lake Research Partners. Consumers and Health Information Technology: A National Survey. 2010. www.chcf.org/publications/2010/04/consumers-and-health-information-technology-a-national-survey Accessed February 3, 2015.
21.
Agency for Healthcare Research and Quality. CAHPS Health Information Technology Item Set. www.ahrq.gov/cahps/surveys-guidance/item-sets/HIT/index.html Accessed January 20, 2015.
22.
McInnes DK, Brown JA, Hays RD, et al. Development and evaluation of CAHPS questions to assess the impact of health information technology on patient experiences with ambulatory care. Med Care 2012;50 suppl:S11–S19.
23.
Morris NS, MacLean CD, Chew LD, Littenberg B. The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract 2006;7:21.
24.
Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. J Biomed Inform 2010;43:159–172.
25.
Tieu L, Schillinger D, Sarkar U, et al. Online patient websites for electronic health record access among vulnerable populations: portals to nowhere? J Am Med Inform Assoc. 2016 [Epub ahead of print];.
26.
Wolff JL, Berger A, Clarke D, et al. Patients, care partners, and shared access to the patient portal: online practices at an integrated health system. J Am Med Inform Assoc 2016;23:1150–1158.
27.
Mackert M, Mabry-Flynn A, Champlin S, Donovan EE, Pounders K. Health literacy and health information technology adoption: the potential for a new digital divide. J Med Internet Res 2016;18:e264.
28.
Smith A. Older adults and technology use. 2014. www.pewinternet.org/2014/04/03/older-adults-and-technology-use Accessed October 15, 2016.
29.
Archer N, Keshavjee K, Demers C, Lee R. Online self-management interventions for chronically ill patients: cognitive impairment and technology issues. Int J Med Inform 2014;83:264–272.
30.
Wade-Vuturo AE, Mayberry LS, Osborn CY. Secure messaging and diabetes management: experiences and perspectives of patient portal users. J Am Med Inform Assoc 2013;20:519–525.
31.
Dhanireddy S, Walker J, Reisch L, Oster N, Delbanco T, Elmore JG. The urban underserved: attitudes towards gaining full access to electronic medical records. Health Expect 2014;17:724–732.
32.
National Cancer Institute. Health Information National Trends Survey: frequently asked questions about HINTS. http://hints.cancer.gov/faq.aspx Accessed October 15, 2016.
33.
Pew Research Center. Assessing the representativeness of public opinion surveys. 2012. www.people-press.org/2012/05/15/assessing-the-representativeness-of-public-opinion-surveys Accessed October 15, 2016.

Information & Authors

Information

Published In

cover image Population Health Management
Population Health Management
Volume 20Issue Number 6December 2017
Pages: 486 - 494
PubMed: 28384076

History

Published in print: December 2017
Published online: 1 December 2017
Published ahead of print: 6 April 2017

Permissions

Request permissions for this article.

Topics

Authors

Affiliations

Eboni G. Price-Haywood, MD, MPH
Ochsner Clinic Foundation, Center for Applied Health Services Research, New Orleans, Louisiana.
Ochsner Clinical School, University of Queensland, New Orleans, Louisiana.
Jewel Harden-Barrios, MEd
Ochsner Clinic Foundation, Center for Applied Health Services Research, New Orleans, Louisiana.
Robin Ulep, MBBS
Ochsner Clinical School, University of Queensland, New Orleans, Louisiana.
Qingyang Luo, PhD
Ochsner Clinic Foundation, Center for Applied Health Services Research, New Orleans, Louisiana.

Notes

This work was presented as an abstract at the AcademyHealth Annual Research Conference, June 2016, Boston, Massachusetts.
Address correspondence to:Eboni G. Price-Haywood, MD, MPHOchsner Clinic FoundationCenter for Applied Health Services ResearchAcademic Building–2nd Floor1401 Jefferson HighwayNew Orleans, LA 70121E-mail: [email protected]

Author Disclosure Statement

The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors received no financial support for the research, authorship, and/or publication of this article.

Metrics & Citations

Metrics

Citations

Export citation

Select the format you want to export the citations of this publication.

View Options

Get Access

Access content

To read the fulltext, please use one of the options below to sign in or purchase access.

Society Access

If you are a member of a society that has access to this content please log in via your society website and then return to this publication.

Restore your content access

Enter your email address to restore your content access:

Note: This functionality works only for purchases done as a guest. If you already have an account, log in to access the content to which you are entitled.

View options

PDF/EPUB

View PDF/ePub

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media

Back to Top