How do patients value and prioritize patient portal functionalities and usage factors? A conjoint analysis study with chronically ill patients

An empirical investigation into the preferences of the elderly for user interface design in personal electronic health record systems

Background

With the continuous advancement of digital technologies, electronic Personal Health Records (ePHR) offer end-users greater control and convenience over their health data. Although ePHR are perceived as innovative tools in medical services that provide patient-centered care and disease prevention, many system interfaces are inclined toward younger users, overlooking investigations pertinent to elderly users. Our objective is to uncover the preferences of the elderly for an ideal ePHR system interface.

Materials and methods

Relying on a literature review, we identified six interface attributes. Utilizing conjoint analysis, we constructed 16 representative design scenarios based on orthogonal design by combining different attribute levels. We invited 187 elderly participants to evaluate these scenarios. Data analysis was performed using SPSS 26.0. The results indicate that among the ePHR interface design attributes, the elderly prioritize color attributes, followed by the notification method. Designs with contrasting color schemes, skeuomorphic design approaches, and icon-centric menu navigation with segmented layouts, and voice notifications when a message is received, are the most preferred interface design choices.

Discussion

This research elucidates the ideal interface design elements for ePHR as perceived by the elderly, offering valuable references for age-friendly design considerations in ePHR systems.

Results

Implementing these insights can aid in promoting mobile health services among the elderly demographic, enhancing their user experience in health management interfaces. This, in turn, fosters the widespread adoption of mobile health service technologies, further advancing the development of a healthy aging society.

Patients' perspectives on digital health tools

Objective

Digital technology has changed the way healthcare is delivered and accessed. However, the focus is mostly on technology and clinical aspects. This review aimed to integrate and critically analyse the available knowledge regarding patients' perspectives on digital health tools and identify facilitators and barriers to their uptake.

Methods

A narrative review was conducted using the Scopus and Google Scholar databases. Information related to facilitators and barriers to uptake was synthesised and interpreted using thematic and content analyses, respectively.

Results

Seventy-one out of 1722 articles identified were eligible for inclusion. Patient empowerment, self-management, and personalisation were identified as the main factors that contributed to patient uptake in using digital health tools. Digital literacy, health literacy, and privacy concerns were identified as barriers to the uptake of digital health technology.

Conclusion

Digital health technologies have changed the way healthcare is experienced by patients. Research highlights the disconnect between the development and implementation of digital health tools and the patients they are created for. This review may serve as the foundation for future research incorporating patients' perspectives to help increase patients' engagement with emerging technologies.

Innovation

Participatory design approaches have the potential to support the creation of patient-centred digital health tools.

Patient Portals as Facilitators of Engagement in Patients With Diabetes and Chronic Heart Disease: Scoping Review of Usage and Usability

BACKGROUND

Patient portals have the potential to improve care for chronically ill patients by engaging them in their treatment. These platforms can work, for example, as a standalone self-management intervention or a tethered link to treatment providers in routine care. Many different types of portals are available for different patient groups, providing various features.

OBJECTIVE

This scoping review aims to summarize the current literature on patient portals for patients with diabetes mellitus and chronic heart disease regarding usage behavior and usability.

METHODS

We conducted this review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for scoping reviews. We performed database searches using PubMed, PsycInfo, and CINAHL, as well as additional searches in reviews and reference lists. We restricted our search to 2010. Qualitative and quantitative studies, and studies using both approaches that analyzed usage behavior or usability of patient portals were eligible. We mapped portal features according to broad thematic categories and summarized the results of the included studies separately according to outcome and research design.

RESULTS

After screening, we finally included 85 studies. Most studies were about patients with diabetes, included patients younger than 65 years, and were conducted in the United States. Portal features were categorized into educational/general information, reminder, monitoring, interactivity, personal health information, electronic/personal health record, and communication. Portals mostly provided educational, monitoring, and communication-related features. Studies reported on usage behavior including associated variables, usability dimensions, and suggestions for improvement. Various ways of reporting usage frequency were identified. A noticeable decline in portal usage over time was reported frequently. Age was most frequently studied in association with portal use, followed by gender, education, and eHealth literacy. Younger age and higher education were often associated with higher portal use. In two-thirds of studies reporting on portal usability, the portals were rated as user friendly and comprehensible, although measurement and reporting were heterogeneous. Portals were considered helpful for self-management through positive influences on motivation, health awareness, and behavioral changes. Helpful features for self-management were educational/general information and monitoring. Barriers to portal use were general (eg, aspects of design or general usability), related to specific situations during portal use (eg, login procedure), or not portal specific (eg, user skills and preferences). Frequent themes were aspects of design, usability, and technology. Suggestions for improvement were mainly related to technical issues and need for support.

CONCLUSIONS

The current state of research emphasizes the importance of involving patients in the development and evaluation of patient portals. The consideration of various research designs in a scoping review is helpful for a deeper understanding of usage behavior and usability. Future research should focus on the role of disease burden, and usage behavior and usability among older patients.

Demand preferences for health management services in a population of older adults with visual impairment in China: a conjoint analysis

Background

Visual impairment (VI) seriously affects the quality of life of the older adults. It is important to formulate appropriate health management strategies for the older adults with VI to help delay the disease development and progression, and improve life quality. The aim of this study was to understand the demand preference for health management services of the older adults with VI, and to provide a reference for the development of future health management strategies in this population.

Methods

The conjoint analysis method was used to analyze demand preferences for health management services of the older adults with VI. 11 keywords were extracted after literature analyzed, 6 keywords were selected as the attributes of health management strategy after expert discussion and the level of each attribute was determined. Then 18 representative virtual health management strategies were formed by combination of different attribute levels through orthogonal design, and older adults with VI were asked to score. A total of 334 older adults with VI who attended the ophthalmology department of the First Affiliated Hospital of China Medical University and the Fourth People's Hospital of Shenyang from February 27, 2021 to June 30, 2021were enrolled in this study by stratified sampling. Of the 334 included people, 80 had grade 1 VI, 80 had grade 2 VI, 84 had grade 3 VI, and 90 had grade 4 VI.

Results

The relative importance of health management services ranked by older adults with VI was continuing care (24.033%), visual aid application (19.61%), health education (16.241%), preventive healthcare (15.667%), safety management (12.757%), and rehabilitation training (11.392%). The utility values of each level of continuing care, safety management and preventive healthcare were positive, whereas the utility values of each level of visual aid application, health education and rehabilitation training were negative. The relative importance and utility values of health management services were different for the older adults with different grades of VI.

Conclusions

From the whole group, the older adults with VI have a higher preference for continuing care and a lower preference for rehabilitation training. The preference of the older adults with different grades of VI is different, so medical workers can formulate corresponding health management strategies according to their different demand preferences, and carry out hierarchical health management. Services that they preferred should be satisfied as much as possible in the health management strategy, while the reasons for the services with lower preference can be explored and make targeted improvement to meet the demand preferences of them.

Sociodemographic disparities in the use of health information technology by a national sample of head and neck cancer patients

BACKGROUND

Quantifying disparities in health information technology (HIT) use among head and neck cancer (HNC) patients may help clinicians reduce care gaps and improve outcomes.

METHODS

Relationships between HIT usage and sociodemographic characteristics were studied for adults with HNC between 2011 and 2018 through a retrospective analysis of the US National Health Interview Survey.

RESULTS

Multivariate logistic regression indicated HIT usage disparities based on race, age, educational attainment, and insurance status. Black (aOR 0.07, 95% CI 0.01-0.52, P = 0.010), uninsured (aOR 0.21, 95% CI 0.06-0.79, P = 0.022), and senior patients (aOR 2.72, 95% CI 1.55-4.80, P < 0.001) emailed providers less than non-Hispanic White, privately insured, and middle-aged (45-64) patients, respectively. Similar disparities were found among patients searching for health information, scheduling appointments, and filling prescriptions online.

CONCLUSION

Black, older, less educated, and un/underinsured HNC patients use HIT less than their counterparts. Reducing these inequities may help improve their outcomes.

Improvement and Evaluation of the TOPCOP Taxonomy of Patient Portals: Taxonomy-Evaluation-Delphi Approach (TED)

Background

Patient portals have been introduced in many countries over the last 10 years, but many health information managers still feel they have too little knowledge of patient portals. A taxonomy can help them to better compare and select portals. This has led us to develop the TOPCOP taxonomy for classifying and comparing patient portals. However, the taxonomy has not been evaluated by users.

Objective

This study aimed to evaluate the taxonomy’s usefulness to support health information managers in comparing, classifying, defining a requirement profile for, and selecting patient portals and to improve the taxonomy where needed.

Methods

We used a modified Delphi approach. We sampled a heterogeneous panel of 13 health information managers from 3 countries using the criterion sampling strategy. We conducted 4 anonymous survey rounds with qualitative and quantitative questions. In round 1, the panelists assessed the appropriateness of each dimension, and we collected new ideas to improve the dimensions. In rounds 2 and 3, the panelists iteratively evaluated the taxonomy that was revised based on round 1. In round 4, the panelists assessed the need for a taxonomy and the appropriateness of patient engagement as a distinguishing concept. Then, they compared 2 real portals with the final taxonomy and evaluated its usefulness for comparing portals, creating an initial requirement profile, and selecting patient portals. To determine group consensus, we applied the RAND/UCLA Appropriateness Method.

Results

The final taxonomy consists of 25 dimensions with 65 characteristics. Five new dimensions were added to the original taxonomy, with 8 characteristics added to already existing dimensions. Group consensus was achieved on the need for such a taxonomy to compare portals, on patient engagement as an appropriate distinguishing concept, and on the comprehensibility of the taxonomy’s form. Further, consensus was achieved on the taxonomy’s usefulness for classifying and comparing portals, assisting users in better understanding portals, creating a requirement profile, and selecting portals. This allowed us to test the usefulness of the final taxonomy with the intended users.

Conclusions

The TOPCOP taxonomy aims to support health information managers in comparing and selecting patient portals. By providing a standardized terminology to describe various aspects of patient portals independent of clinical setting or country, the taxonomy will also be useful for advancing research and evaluation of patient portals.

Development and Validation of a Useful Taxonomy of Patient Portals Based on Characteristics of Patient Engagement

Objective  Taxonomies are classification systems used to reduce complexity and better understand a domain. The present research aims to develop a useful taxonomy for health information managers to classify and compare patient portals based on characteristics appropriate to promote patient engagement. As a result, the taxonomy should contribute to understanding the differences and similarities of the portals. Further, the taxonomy shall support health information managers to more easily define which general type and functionalities of patient portals they need and to select the most suitable solution offered on the market.

Methods  We followed the formal taxonomy-building method proposed by Nickerson et al. Based on a literature review, we created a preliminary taxonomy following the conceptional approach of the model. We then evaluated each taxa's appropriateness by analyzing and classifying 17 patient portals offered by software vendors and 11 patient portals offered by health care providers. After each iteration, we examined the achievement of the determined objective and subjective ending conditions.

Results  After two conceptional approaches to create our taxonomy, and two empirical approaches to evaluate it, the final taxonomy consists of 20 dimensions and 49 characteristics. To make the taxonomy easy to comprehend, we assigned to the dimensions seven aspects related to patient engagement. These aspects are (1) portal design, (2) management, (3) communication, (4) instruction, (5) self-management, (6) self-determination, and (7) data management. The taxonomy is considered finished and useful after all ending conditions that defined beforehand have been fulfilled. We demonstrated that the taxonomy serves to understand the differences and similarities by comparing patient portals. We call our taxonomy “Taxonomy of Patient Portals based on Characteristics of Patient Engagement (TOPCOP).”

Conclusion  We developed the first useful taxonomy for health information managers to classify and compare patient portals. The taxonomy is based on characteristics promoting patient engagement. With 20 dimensions and 49 characteristics, our taxonomy is particularly suitable to discriminate among patient portals and can easily be applied to compare portals. The TOPCOP taxonomy enables health information managers to better understand the differences and similarities of patient portals. Further, the taxonomy may help them to define the type and general functionalities needed. But it also supports them in searching and comparing patient portals offered on the market to select the most suitable solution.

Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study

Background

The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk.

Objective

Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET).

Methods

A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET.

Results

Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app.

Conclusions

A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived.

Using Patient and Family Engagement Strategies to Improve Outcomes of Health Information Technology Initiatives: Scoping Review

BACKGROUND

Many health care organizations around the world have implemented health information technologies (ITs) to enhance health service efficiency, effectiveness, and safety. Studies have demonstrated that promising outcomes of health IT initiatives can be obtained when patients and family members participate and engage in the adoption, use, and evaluation of these technologies. Despite knowing this, there is a lack of health care organizations using patient and family engagement strategies to enhance the use and adoption of health ITs, specifically.

OBJECTIVE

This study aimed to answer the following three research questions (RQs): (1) what current frameworks or theories have been used to guide patient and family engagement in health IT adoption, use, implementation, selection, and evaluation?, (2) what studies have been done on patient and family engagement strategies in health IT adoption, use, implementation, selection, and evaluation?, and (3) what patient and family engagement frameworks, studies, or resources identified in the literature can be applied to health IT adoption, use, implementation, selection, and evaluation?

METHODS

This scoping review used a five-step framework developed by Arksey and O'Malley and adapted by Levac et al. These steps include the following: (1) identifying the RQ, (2) identifying relevant studies, (3) selecting studies, (4) charting relevant data, and (5) summarizing and reporting the result. Retrieved academic and grey literature records were evaluated using a literature review software based on inclusion and exclusion criteria by two independent reviewers. If consensus was not achieved, two reviewers would resolve conflicts by discussion. Research findings and strategies were extracted from the studies and summarized in data tables.

RESULTS

A total of 35 academic articles and 23 gray literature documents met the inclusion criteria. In total, 20 of the 35 included studies have been published since 2017. Frameworks found include the patient engagement framework developed by Healthcare Information and Management Systems Society and the patient and family engagement framework proposed by Carman et al. Effective strategies include providing patients with clear expectations and responsibilities and providing reimbursement for time and travel. The gray literature sources outlined key considerations for planning and supporting engagement initiatives such as providing patients with professional development opportunities, and embedding patients in existing governance structures.

CONCLUSIONS

Several studies have reported their findings regarding successful strategies to engage patients and family members in health IT initiatives and the positive impact that can emerge when patients and family members are engaged in such initiatives in an effective manner. Currently, no framework has consolidated all of the key strategies and considerations that were found in this review to guide health care organizations when engaging patients and family members in a health IT-specific project or initiative. Further research to evaluate and validate the existing strategies would be of value.