Table 2.

Usability studies of PWPs targeting patients with diabetes and/or providers

Study	Study design	Sample, age	Clinical area	Country	Study description	Findings
Beaudoin et al. [56]	Within-subject “think aloud” protocol	N = 16, adults	Web portal users	USA	Usability of different PWP formats: serial vs menu-driven	Greater user satisfaction with menu-driven format
Ma et al. [24]	Mixed-method: surveys and interviews/focus groups	N = 12 patients, 51 y N = 5 providers	Type 2 and providers	USA	Introduction to PWP, reminder calls to use the system, and follow-up focus groups and satisfaction surveys	Patients found portal usable, reported positive feedback Providers reported both positive and critical feedback All providers would recommend portal to patients Prioritization of educational information based on patient characteristics may have limited benefit for patients who have very well-controlled diabetes, and for those who are very confident in their diabetes knowledge
Hess et al. [20]	Qualitative: focus groups	N = 39, 54 y	Type 1 and 2	USA	Assessed barriers and successes of PWP via pre and post implementation focus groups. Compared number of patient/provider communications pre and post implementation	No significant change in the number of phone calls, post implementation. Significantly more email messages through PWP Patients report a belief that PWP would increase communication with providers Patients appreciate remote access to laboratory results, and are generally receptive to technology Patients expect quick responses from providers through PWP
Ross et al. [25]	Qualitative: interviews	N = 37, adults	Type 1 and 2	USA	Interviewed users of Diabetes-STAR PWP	User preferences include the following: Addressing differences in types of users (ADA guideline concordant vs non-concordant users) Sending out alerts when new information is available Providing more oversight of user diary data
Bryce et al. [21]	Mixed-method: focus groups and surveys	N = 39, 54 y	Type 1 and 2	USA	Rated usefulness of 15 features of PWP for diabetes management. Assessed patients’ willingness to pay for PWP services	Patients rated online calculator to estimate BG control, appointment reminder systems, email access to providers, personal tracking logs, and online scheduling as most useful features Patients are not willing to pay for PWP services Patients feel that the health care system benefits from disease management and should provide PWP services to patients for free
Fonda et al. [18]	Mixed-method: “think-aloud” protocol, interviews, and surveys	N = 6	Providers (NPs and care managers)	USA	Assessed usability of Internet-based informatics application, CDMP	Providers rated usability of CDMP as neutral to favorable Reported problems with ease of use, performance, and support features Reported satisfaction with visual appeal and educational content Areas for improvement include navigation and terminology
Olshansky et al. [19]	Qualitative: focus groups	N = 39 adults	Type 1 and 2	USA	Explored perceptions of people with diabetes about their experiences with disease management in focus groups, pre and post portal implementation	Patients stressed the importance of “normalizing an identity as a person with diabetes” Education through PWP can help normalize diabetes for patients by framing life changes as healthy changes for all people, as opposed to diabetes specific changes.
Zickmund et al. [22]	Qualitative: focus groups	N = 39, 54 y	Type 1 and 2	USA	Assessed the role of the patient-provider relationship in patient interesting using a PWP	Interest in portal use was linked to dissatisfaction with provider-patient communication/responsiveness Interest in portal use was linked to dissatisfaction with current access to information and/or laboratory results Patients feared that they would have difficulty using the PWP, that they might lose personal relationships with their providers Patients who had fears about email use transferred those fears to the PWP
Britto et al. [42]	Quantitative: time for task completion and surveys	N = 16, 39 y	Parents of pediatric patients with diabetes, cystic fibrosis, and arthritis	USA	Measured the time it took parents to complete or give up on PWP tasks. Analyzed themes in PWP use, and results from Computer Usability Satisfaction Questionnaire	Mean task completion ranged from 73 seconds to locate a document to 431 seconds to graph laboratory results Challenging tasks include: graphing data, locating data, requesting access, and interpreting data Usability assessments can help improve patient use and satisfaction, as mean satisfaction scores improved as changes were made to PWP based on assessment results
Nordqvist et al. [41]	Qualitative: interviews	N = 20, NR	Providers	Sweden	Practitioners assessed PWP	PWP development can enhance a sense of community among health care providers Providers view PWP as complement to the care they provide Providers expect email communication to save them time, but emphasize the importance of face-to-face visits
Wald et al. [28]	Quantitative: surveys	N = 126, 59 y	Type 2 and providers	USA	Patient Gateway; pre-visit electronic journal linked with PWP	60% of patients reported feeling more prepared for their appointments after using the electronic journal 53% of patients reported that they provided more accurate information to their provider after using electronic journal 44% of patients reported that the electronic journal improved communication with their provider Providers reviewed the journal before the appointment in 61% of the cases

ADA—American Diabetes Association; BG—blood glucose; CDMP—Comprehensive Diabetes Management Program; NP—nurse practitioner; NR—not reported; PWP—patient web portal; USA—United States of America.