Table 2.

Qualitative or mixed methods studies on patient portal for diabetes management.

Authors, country	Study aim	Study design	Sample	Portal features	Measures or questions	Findings
Sieverink et al (2014) [17], Netherlands	To explore factors associated with diffusion of a personal health record (PHR) for patients with type 2 diabetes mellitus (T2DM) in primary health care workers	Semistructured interview with primary care nurses: qualitative	N=11	e-Vita (diabetes mellitus [DM]-specific) by the Diabetes Center in Zwolle allows patients (Ps) to access diabetes education; access electronic health record (EMR) data; receive messages from providers	What are the reasons for using a PHR?; What training do you receive?; How to embed PHR in your daily routine?; What are the barriers and facilitators for embedding PHR in daily routine?; What are your expectations?	Practice nurses indicated barriers for using a PHR: lack of integration with work routines, time constraints, and experience usability problems.
Osborn et al (2013) [18], United States	To understand Ps with T2DM who use MyHealthAtVanderbilt (MHAV) and reasons for use and nonuse, how users are using a portal to manage medications, and explore ideas for functionality improvement	Focus groups and medical chart review: mixed methods	N=75; females: 67%; white: 63%; age: 56.9 (SD 8.8) years	MHAV by Vanderbilt University Medical Center (VUMC) allows Ps to access EHR data; message providers; manage appointments; assess risks; access education	Do you use MHAV or not? How and why?; What could be added to MHAV to help manage medications?; What do you think about an email reminder to refill or dose reminders?	Users were more likely to be white, have higher incomes, and be privately insured. Reasons for nonuse: unaware of the portal (n=3), no access to a computer (n=3), and helped by a family member (n=1). Users used the portal to request prescription refills and view medication list, and Ps were enthusiastic about the idea of adding refill reminder functionality, alerting providers to fill or refill nonadherence, and providing side effects and interactions.
Wade-Vuturo, et al (2013) [19], United States	To explore how Ps with T2DM use and benefit from secure messaging within a patient portal	Focus group and patient survey: mixed methods	N=54; females: 65%; white: 76%; age: 57.1 (SD 8.4) years; body mass index (BMI): 34.4 (10.2); HbA1c: 7.0 (SD 1.4)	MHAV by VUMC allows Ps to access EHR data; message providers; manage appointments; assess risks; access education	HbA1c, self-reported frequency of use, benefits and barriers to use messaging	Greater use of messaging to schedule an appointment was associated with patients’ glycemic control (r=−.29, P=.04). Benefits of messaging: improved patient satisfaction, enhanced efficiency and quality of face-to-face visits, and access to care. Barriers to use messaging: negative experiences with messaging. Ps’ assumptions about providers’ opinion and instruction.
Urowitz et al (2012) [20], Canada	To evaluate the experience of Ps with T1DM or T2DM and providers using a Web-based diabetes management portal	Telephone interview and open-ended questionnaire: qualitative	Ps (n=17); females: 53%; providers (n=64)	Patient portal by the Waterloo Wellington Local Health Integration Network allows Ps to access DM education; access EHR data	Telephone interview with Ps and open-ended questionnaires with providers	17 Ps were interviewed. Facilitators of disease management: increase awareness of their disease, access to educational information, and promote behavior change. Barriers to portal use: poor usability, not useful, challenges with physician engagement, and lack of understanding. Recommendations for portal improvements: more Web-based tutorial about the portal content, improve usability.
Mayberry et al (2011) [21], United States	To examine the role of health literacy, numeracy, and computer literacy on usage of a patient Web portal (PWP) in Ps with T2DM	Focus group and patient survey: mixed methods	N=75; females: 68%; white: 47%; age: 56.9 (SD 8.8) years	MHAV by VUMC allows Ps to access DM education; access EHR data	Health literacy, numeracy, computer literacy, self-report usage of PWP and health information technology (HIT)	Lower health literacy was associated with less use of a computer for searching diabetes medications or treatments, but not usage of a PWP. Numeracy and computer literacy were not associated with PWP use. Family members’ support facilitated Ps usage of both PWP.
Bryce et al (2008) [22], United States	To rate the potential or actual usefulness of 15 features of a Web-based portal for diabetes management	Focus group and patient survey: mixed methods	Preportal group (n=21) vs portal-user group (n=18): nonwhite: 33% vs 22%; age: 53 (SD 13) vs 55 (SD 11) years	HealthTrak by University of Pittsburgh Medical Center (UPMC) allows Ps to access EMR data; schedule appointments; message providers; access education; logbooks	The study asked how the portal affected management of diabetes, Ps’ experiences in using the portal and communicating with physicians	Features rated most favorably were: calculator to estimate blood glucose control (74%), appointment reminder (74%), email to health team (74%), personal tracking logs (69%), and scheduling (69%). More patients from the preportal group than the portal-users group favored personal logs (P=.02) and opportunities to form interest groups (P=.03).
Zickmund et al (2008) [23], United States	To examine the impact of the provider-patient relationship on interest in using the patient portal	Focus group: qualitative	N=39; white: 72%; males: 52%; age: 54 (SD 12)	HealthTrak by UPMC allows Ps to access EMR data; schedule appointments; message providers; access education; logbooks	Topics included the relationships with providers, and feedback on the patient portal	Interest in the portal was linked to dissatisfaction with provider responsiveness, unable to obtain medical information, and logistical problems. Disinterest in the portal was linked to satisfaction with the provider communication, difficulty in using the portal, and fear of losing connections with providers. No patient identified email communication through the portal was helpful
Hess et al (2007) [24], United States	To assess the impact of HealthTrak on patient-provider communication during September 2004-January 2007	Focus groups: qualitative	N=39; males: 51%; white: 72%; age: 54 (SD 12) years	HealthTrak by UPMC allows Ps to access EMR data; schedule appointments; message providers; access education; logbooks	Discussion around living with diabetes, desired information about diabetes, current sources of information about diabetes, doctor-patient communication, and reaction to the portal	The number of patient visits or telephone calls received did not change, but the number of HealthTrak messages increased. Participants felt that the system enhanced communication. Having access to laboratory tests was preferred. They became frustrated when test results were not released, or messages were not answered by providers.