Table 2.

Summary of qualitative umbrella review findings and Grading of Confidence in the Evidence of Qualitative Research at the Level of an Umbrella Review evaluation of qualitative evidence.

Umbrella review domain and summary of qualitative findings statement (SRa source)		Confidence in the evidence according to the CERQual-URb criteriac
Patients’ interest in the potential of portals
	Patients are interested and satisfied in using patient portals if they are easy to use and useful [15,24,33].	High
	Patients are interested in using patient portals for communication and opportunity to message providers [17,30,33].	High
Portal design and features
	Patients value information in patient portals that is easy to understand, written in lay or nonmedical language, transparent, and presented in a simple display [29,33].	High
	Patients want prescription refills, and hospitalized patients in particular want information on medication that includes dose, frequency, timing, administration, route, and side effects [29,33].	High
	Minimal navigation steps and educational information on specific laboratory results, medications, and allergies are important health equity and patient-friendly considerations [15,29,33].	Moderate
	The information within patient portals gives patients and parents a greater sense of control, involvement, understanding, and security in care planning [15,33,35].	Moderate
	Patients appreciate the scheduling function in patient portals, such as booking appointments online and scheduling, and daily planning in inpatient setting [15,29,33].	Low
System-related factors
	Guideline development, framework for governance, and compliance with regulations are important for integrating patient portals into organizational processes [24,33].	Moderate
Patient-related facilitators
	Use of patient portals is facilitated by the enhanced communication over traditional methods and positive patient-provider interactions and relationships [14,33,36].	Low
	Encouragement and instruction on patient portals offered by providers and families is a facilitator of portal use [14,29,36].	Low
Patient-related barriers
	Patient barriers to portal use and enrollment include time, limited system knowledge, lack of awareness of patient portals and related features, and doubt or lack of belief in portal benefits or value [14,17,29,36].	Moderate
	Technical barriers to portal use and enrollment include type of interface, lack of technical or computer skills or training or support or literacy, lack of computer or internet access, and forgotten passwords [14,17,24,30,31,33,35,36].	Moderate
	Unauthorized access, privacy, security, and trust or confidentiality concerns are barriers to portal use and enrollment [14,15,24,29,30,33,36].	Moderate
	Patients’ lack of desire in enrolling and using portals relates to their preferences and satisfaction with existing means of communication [14,17].	Very low
Providers’ attitudes and concerns
	Providers are concerned about liability and increases or changes in workload, and the lack of training, skills, and resources for using patient portals and prefer to have support staff screen messages [24,29,33].	Moderate
	Providers are concerned that the information contained in portals may overwhelm, cognitively overload, or increase patients’ anxiety and that patient-generated data may be inaccurate [24,29,33].	Moderate
	Providers perceive patient portals could encourage patient engagement, and secure messaging could support communication of complex information, while having concerns about impact on patient-provider relationships [24,29,33].	Low
	Providers are concerned about patient safety, privacy, and confidentiality and prefer control over access and authentication of users to protect the information in patient portals [24,33].	Low
	Lack of incentive and reimbursement may result in providers being less engaged with portals than patients may assume and instructing patients not to use [14,31].	Low
Usability-related barriers
	Usability-related barriers which result in negative experiences and use of patient portals include: reminders and messages that are unreliable, have a slow response, or may not directly reach providers, and information that is inaccurate or difficult to locate due to complex navigation, visual layout, and language [14,29-31].	Low
Patient satisfaction
	Online communication with providers outside their hours is preferred by patients and parents, as it is easier to understand, more convenient, supports accessing test results, and allows for timely and consistent responses [15,29,33,35].	Moderate
Patient safety
	Patient portals enhance efficiency and patient safety when patients find and request correction of errors, especially medication errors [17,24,33,35].	Moderate
	Patients with limited health and computer literacy value portal use, but safe and effective use may be compromised by an inability to interpret results and having to take longer to complete patient portal tasks [29-31].	Low
Behavioral effects
	Patient portals can facilitate access to medical information that can engage and empower patients to be confident in their self-management and current care [29,31,36].	Low
Service utilization effects
	Patient portals can impact provider workload by increasing number of phone calls or emails or secure messaging and length of face-to-face visits [17,24,35].	Very low
Patient-oriented outcomes
	Patient portals empower patients in shared decision making, prepare for visits, enable better expression of ideas and concerns, and encourage engagement in self-care and self-management [17,24,35].	Moderate
	Patient portals support communication, enhance discussions, and shift power relations between patients and providers [17,24,29,33,35].	Moderate
	Patient portals can improve quality of care and caregiver experience and reduce care burden [17,33].	Low

^aSR: systematic review.

^bCERQual-UR: Confidence in the Evidence from Review of Qualitative Research at the Level of an Umbrella Review.

^cIndicates the confidence in the evidence and was calculated based on methodological limitations, coherence, relevance, and adequacy. Ratings are from high, moderate, low, and very low.