Abstract
Purpose:
To present perceptions about using patient portals to manage HIV and sexually transmitted infection (HIV/STI) test results and to communicate with sexual partners among a 2018 nationwide sample of adolescent and young sexual minority men (YSMM) aged 15–25 years.
Methods:
Univariate and bivariate analyses were conducted on cross-sectional online survey data.
Results:
Participants gave high/moderate value to portals that provide tips for sexual health [95.1%, (1,168/1,228)], ability to locate HIV/STI testing centers [96.9%, (1,190/1,228)], and ability to order home-based HIV/STI testing [96%, (1,179/1,228)]. Perceived health-engagement and dyadic communication benefits of use was sustained at or above 94%. YSMM with a history of HIV/STI diagnosis were less willing to share online results with main (93% vs 97%;X2 = 5.13; P=0.02) and non-main (70% vs. 77%;X2 = 5.17; P=0.02) sexual partners.
Conclusions:
Patient portals represent highly acceptable spaces to deliver comprehensive sexual health services; and could support communication on HIV/STI testing with sex partners among YSMM.
Keywords: Health IT, youth, HIV, sexually transmitted infections (STIs), sexual minority men (SMM)
Young gay, bisexual, and other sexual minority men (YSMM) ages 15–25 years have the highest rates of incident human immunodeficiency virus (HIV) and Neisseria gonorrhoeae infections compared to older SMM, women, and heterosexual men.[1,2] Contributing to disparities are the suboptimal patterns of HIV and sexually transmitted infection (STI) testing and partner communication among YSMM.[3] Innovative strategies are needed to promote healthy behaviors among male youth to change the trajectory of HIV/STI epidemics among youth. Patient portals represent secure online websites that give patients 24-hour access to personal health information. Interventions using patient portals are creating new pathways to increase patient engagement.[4,5] However, there are limited data characterizing perceptions among YSMM towards the use of patient portals to engage in HIV/STI prevention behaviors. In response, we assessed perceptions on using patient portals to manage HIV/STI test results and in communication with main and non-main sexual partners among a national sample of YSMM aged 15–25 years.
Methods
The American Men’s Internet Survey (AMIS) is an annual cross-sectional online survey of United States (US) residents at least 15 years of age, self-identify as cis-gender male, and with a history of sex with a man, or identifying as gay or bisexual.[6] In 2018, a randomized subset of participants were asked questions about patient portals which were adapted from the eSHINE Study.[7] The study was conducted in compliance with federal regulations governing the protection of human subjects and the study protocol was approved by the Institutional Review Board at approved by the institutional review board at Emory University.
Participants were asked to rate the value of six patient portal features: (1) games to promote sexual health, (2) ability to order home test kits for HIV/STIs, (3) counseling and resources for people with HIV/STIs, (4) telehealth services; (5) ability to locate HIV/STI testing centers; and (6) tips or tools for managing sexual health. In addition, participants indicated perceptions about the relative advantages of using (vs. not using) patient portals related to (1) convenience, (2) supporting health awareness, and (3) supporting better health decisions (Table 1). Participants indicated their agreement with (1) likelihood of using patient portals to communicate HIV/STI results with sexual partners, (2) general improvements in communication about HIV/STIs, (3) confidence in HIV/STI testing information shared by partners, and (4) improved control over sexual health decision making.
Table 1.
Perceptions about using patient portals to manage HIV/STI test results and in communication with sexual partners among a nationwide sample of adolescent and young sexual minority men aged 15–25 years (N = 1,228)
| Variables | Total N (%) | History of HIV/STI Diagnosis | Chi-square | P | |
|---|---|---|---|---|---|
| Yes (N=118) |
No (N=1,110) |
||||
| Health Engagement Beliefs | |||||
| Are a more convenient way to manage sexual health records | 0.72 | 0.396 | |||
| Strongly Agree / Agree | 1,200 (2.3) | 114 (96.6) | 1,086 (97.8) | ||
| Strongly Disagree / Disagree | 28 (97.7) | 4 (3.4) | 24 (2.2) | ||
| Encourage people to be more aware of their sexual health | 9.93 | 0.002 | |||
| Strongly Agree / Agree | 1,203 (98.0) | 111 (94.1) | 1,092 (98.4) | ||
| Strongly Disagree / Disagree | 25 (2.0) | 7 (5.9) | 18 (1.6) | ||
| Help people like me make better sexual health decisions | 4.61 | 0.032 | |||
| Strongly Agree / Agree | 1,157 (94.2) | 106 (89.8) | 1,051 (94.7) | ||
| Strongly Disagree / Disagree | 71 (5.8) | 12 (10.2) | 59 (5.3) | ||
| Sex Partner Communication Beliefs | |||||
| Likelihood of sharing electronic HIV or STI test results with a main partner | 5.13 | 0.023 | |||
| Very Likely / Likely | 1,188 (96.7) | 110 (93.2) | 1,078 (97.1) | ||
| Very Unlikely / Unlikely | 40 (3.3) | 8 (6.8) | 32 (2.9) | ||
| Likelihood of sharing electronic HIV or STI test results with non-main partner | 5.17 | 0.023 | |||
| Very Likely / Likely | 995 (77.8) | 82 (69.5) | 873 (78.6) | ||
| Very Unlikely / Unlikely | 273 (22.2) | 36 (30.5) | 237 (21.4) | ||
| Patient portal access will improve communication on HIV and other STIs | 0.74 | 0.388 | |||
| Definitely / Probably | 1,183 (96.3) | 112 (94.9) | 1,071 (96.5) | ||
| Definitely not / Probably not | 45 (3.7) | 6 (5.1) | 39 (3.5) | ||
| Patient portal access will improve my confidence in the testing information a partner shares with me | 4.85 | 0.028 | |||
| Definitely / Probably | 1,194 (97.2) | 111 (94.1) | 1,083 (97.6) | ||
| Definitely not / Probably not | 34 (2.8) | 7 (5.9) | 27 (2.4) | ||
| Patient portal access will improve control over my sexual health and decision making | 5.25 | 0.022 | |||
| Definitely / Probably | 1,195 (97.3) | 111 (94.1) | 1,084 (97.7) | ||
| Definitely not / Probably not | 33 (2.7) | 7 (5.9) | 26 (2.3) | ||
Analyses were restricted to AMIS-2018 participants aged 15–25 years. Descriptive analyses were performed for all measures. To determine access, participants were asked whether able to view their health records online, for example, with MyChart. The importance of patient portal features was defined as high or moderate value compared to low or no value. Positive beliefs were defined as strongly agreeing or agreeing compared to disagreeing or strongly disagreeing with each statement. For sexual health and communication beliefs, Chi-square tests determined agreement differences for YSMM with a history of HIV/STI diagnosis at P<.05.
Results
Of the 1,715 participants answering patient portal questions, 487 observations with “don’t know” responses on patient portal items were excluded to reduce ambiguity. Excluded observations were younger and more likely to report not knowing whether they have patient portal access. Approximately 40% of study participants reported access (Figure 1). Features of patient portals that link users with HIV/STI testing services were rated as high or moderate value by the highest proportion of participants. Games to promote sexual health were valued more among younger participants [58% (351/609) vs 52% (321/619);X2=5.14;P=0.04] – Figure 1.
Figure 1. Sample Characteristics of AMIS-2018 Respondents Ages 15–25 Years (N=1,228).
Descriptive statistics among a sample of 2018 American Men’s Internet Survey respondents aged 15–25 years, including regional composition, demographic composition, and valuation for patient portal features by age category.
Over 90% of participants agreed that access (vs. non-access) to patient portals are more convenient for managing sexual health records, would encourage people to be more aware of their sexual health, and would aid in making better sexual health decisions (Table 1). Similarly, over 90% believed that patient portals could improve their communication on HIV/STIs and would be more confident in HIV/STI testing information a partner shares with them through a patient portal. Approximately 97% and 78% of participants were willing to use patient portals to share HIV/STI test results with main and non-main sexual partners respectively. Significantly lower proportions of YSMM with a history of HIV/STI diagnosis are willing to share test results with main (93% vs 97%;X2=5.13;P=0.02) and non-main sexual partners (70% vs. 77%;X2=5.17;P=0.02). Table 1 variables did not differ by age.
Discussion
We explored perceptions of using patient portals as an innovative strategy to better engage YSMM in HIV/STI prevention and care behaviors. Our results provide significant support for the acceptability of using patient portals to deliver comprehensive resources and services for managing sexual health. Improving testing practices among YSMM is a critical component of reducing the HIV/STI burden in the United States. Patient portals that provide YSMM with resources for locating testing and ordering home test kits may improve population-level practices on urogenital and extra-genital testing.
Acceptability of online based interventions for improving HIV medication adherence, testing, and HIV/STI knowledge is well-documented.[7,8] Decreased likelihood to share results among YSMM living with HIV or prior STI diagnosis is an indicator that STIs, particularly HIV, remain highly stigmatized conditions. Disclosure of HIV status can impact numerous psycho-social outcomes and motivates how a person approaches or avoids sharing an HIV diagnosis with others.[8] Standards are needed to ensure patient portals are private, secure, and not diminish autonomous control over personal health information.[7,8] Patient portals may be additionally designed to mitigate both stigma and adverse consequences of HIV disclosure. Specifically, by addressing factors such as alleviation of inhibition to avoid talking about HIV, social support, and changing social information about HIV.[9] Furthermore, these portals can serve as a conduit to scientifically accurate information about prevention, medicinal innovations, and care. Finally, patient portals could cue health behaviors and enhance self-efficacy to encourage testing through videos modeling health behaviors and providing methods to reduce stress and anxiety associated with talking about HIV and other STIs.
Taken together, these findings suggest that patient portal awareness and access may be significantly lower among adolescent minors. Middle and high school may be an optimal time to promote patient portal education and engagement. One concern, however, is that patient portal systems generate statements visible to parents and guardians detailing health services that minors may want to keep confidential. Laws vary from state to state, however confidentiality is generally assumed for health services to which minors can legally consent, such as, screening and treatment for STIs.[10] As such, patient portals are recommended to include confidential adolescent-specific modules consistent with privacy protections for minors.[10] Furthermore, modules may include functions for youth to safely report physical or sexual abuse, including state-specific categorizations of statutory rape which clinicians are mandated to report. These issues underscore the need for adolescent, parental, and clinician input on the design and implementation of patient portals to optimize sexual health and well-being in youth. [5]
Implications and Contributions.
This study explores perceptions on using patient portals to support HIV/STI prevention and management among a national sample of YSMM. Given the high acceptability described here, future studies can evaluate optimal implementation strategies for sexual health patient portal interventions across the US.
Acknowledgements
This work was supported by grants from the MAC AIDS Fund and by the National Institutes of Health [P30AI050409]–the Emory Center for AIDS Research and the Johns Hopkins Bloomberg School of Public Health Center for Public Health and Human Rights [5R01MH110358–03]. KJ’s efforts were supported in part by 2T32AI102623–06, R25MH08362, & T32DA007292.
List of Abbreviations
- CDC
Centers for Disease Control and Prevention
- HER
Electronic health record
- HIV
Human immunodeficiency virus
- STI
Sexually transmitted infections
- YMSM
Young men who have sex with men
Footnotes
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Disclosure
The authors have no conflicts of interest to disclose.
REFERENCES
- [1].Centers for Disease Control and Prevention (CDC). HIV Surveillance Report: Diagnoses of HIV Infection in the United States and Dependent Areas, 2017. 2018.
- [2].CDC. Sexually Transmitted Disease Surveillance 2017. 2018. Atlanta: U.S. Department of Health and Human Services. [Google Scholar]
- [3].Liu A, Coleman K, Bojan K, et al. Developing a Mobile App (LYNX) to Support Linkage to HIV/Sexually Transmitted Infection Testing and Pre-Exposure Prophylaxis for Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc. 2019;8(1):e10659. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [4].Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011;34(9):1934–1942 [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Ramsey A, Lanzo E, Huston-Paterson H, Tomaszewski K, Trent M. Increasing Patient Portal Usage: Preliminary Outcomes From the MyChart Genius Project. Journal of Adolescent Health. 2018;62:29–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [6].Sanchez TH, Sineath RC, Kahle EM, Tregear SJ, PS S The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: Protocol and Key Indicators Report 2013. JMIR Public Health Surveill. 2015;1(1):e3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [7].Jackman K-M, Hightow-Weidman L, Poteat T, Wirtz AL, Kane J, Baral S. Evaluating psychometric determinants of willingness to adopt sexual health patient portal services among Black college students: A mixed-methods approach. Journal of American College Health. 2019. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].Holloway I, Winder TJ, Lea CH III, Tan D, Boyd D, Novak DT. Technology Use and Preferences for Mobile Phone–Based HIV Prevention and Treatment Among Black Young Men Who Have Sex With Men: Exploratory Research. JMIR mHealth and uHealth. 2017;5:e46. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Chaudoir SR, Fisher JD, Simoni JM. Understanding HIV disclosure: A review and application of the Disclosure Processes Model. Social Science and Medicine. 2011;72:1618–1629. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [10].The American College of Obstetricians and Gynecologists (ACOG). ACOG Committee Opinion no. 599: Adolescent confidentiality and electronic health records. Obstet Gynecol. 2014;123:1148–1150. [DOI] [PubMed] [Google Scholar]