Appendix Table 4.
Studies of Barriers to Portal Use
| Study, Year (Reference) | Design (Sample Size)* | Setting and Population | Intervention | Participant Concerns and Desires |
|---|---|---|---|---|
| Studies assessing patient experiences | ||||
| Colorafi et al, 2018 (62) | 40 patients Quantitative Survey Qualitative Visit observation Interviews |
Older adults from 2 urban cardiac clinics in Arizona | Discussion of AVS | Digital literacy and access Privacy and security |
| Giardina et al, 2015 (64) | Qualitative Interviews (n = 13) |
Patients and caregivers in the Houston VA system | Discussion of abnormal test results | Support to interpret medical information Timeliness of information |
| Gerard et al, 2017 (63) | Qualitative Open-ended responses within online platform (n = 260) |
Primary care patients at an academic hospital system in Boston | Discussion of visit note and care plan | Want to contribute own data and share data with others |
| Haun et al, 2017 (65) | Qualitative (n = 48) Focus groups Simulations |
Patients and caregivers from the VA health systems in Bedford, Massachusetts, and Tampa, Florida | Discussion of the overall VA HIT system | New features Virtual visits Better functionality and standardization Security and privacy More education and training needed |
| Hefner et al, 2019 (71) | Qualitative Three focus groups (n = 17) |
Patients with a cardiopulmonary condition at a large academic medical center in the Midwest | Discussion of experiences using portal secure messaging | Digital literacy/access More education/training needed Concern about provider engagement |
| Irizarry et al, 2017 (66) | Quantitative Surveys (n = 100) Qualitative 4 focus groups (n = 23) |
Community-based sample in Pittsburgh with varying health literacy and portal use experience | Discussion on overall portal interest and usefulness | Digital literacy and access Preference for in-person communication More education/training needed |
| Kim and Fadem, 2018 (69) | Qualitative Focus groups (n = 17) |
Convenience sample of older adults in New Jersey | Discussion on overall portal interest and specific features | Preference for in-person communication More education/training needed Concern about provider engagement |
| Mishuris et al, 2015 (67) |
n = 19 Qualitative In-depth interviews Quantitative Survey |
Home-based primary care patients, caregivers, and staff in the Boston VA system | Discussion on overall portal interest and usefulness | Digital literacy and access More education/training needed Satisfied with current care delivery methods Want to share data with others |
| Price-Haywood et al, 2017 (72) | Quantitative Cross-sectional survey (n = 247) |
Older adults with hypertension or diabetes at a large, integrated health delivery system | Discussion on overall interest and experiences with portals | Digital literacy/access Need for simpler interface Need for increased awareness |
| Sadasivaiah et al, 2019 (70) | Mixed methods (n = 16 507) Overall interest in portal registration (yes/no) Documentation and coding of specific reasons for noninterest |
Inpatients at a large public hospital in San Francisco | Specific documentation of interest and noninterest in portal use documented in the EHR among nurses | Low interest Digital literacy and access Physical or mental barriers Security and privacy |
| Tieu et al, 2015 (68) | Qualitative In-depth interviews (n = 16) |
Patients and caregivers in the San Francisco safety-net system | Discussion on overall portal interest and usefulness | Digital literacy and access Health literacy Security and privacy Preference for in-person communication Want to share data with others Better functionality and standardization |
| Studies assessing patient and provider experiences | ||||
| Alpert et al, 2018 (56) | Qualitative Interviews (35 patients and 13 oncologists) |
National Cancer Center in central Virginia | Participants provide feedback about portal usefulness and communication practices | Digital literacy and access Health literacy |
| Black et al, 2015 (57) | Qualitative Interviews (10 patients) 6 focus groups (21 patients and 13 providers) |
Asthma clinics in urban Philadelphia | Participants review AVS features and portal | More education/training needed Better functionality and standardization Digital access and literacy |
| Ochoa et al, 2017 (58) | Quantitative Surveys (400 patients and 59 providers) |
Safety-net health care system in Los Angeles | Participants provide feedback about portal adoption | Digital access and literacy (among a subset) Limited interest from providers |
| O’Leary et al, 2016 (59) | Qualitative Interviews (18 patients) 3 focus groups (21 providers) |
Large academic hospital in Chicago | Participants provide feedback about portal usefulness | Digital access and literacy Need for new features |
| Pillemer et al, 2016 (60) | Quantitative Use data Surveys (n = 6368) Qualitative Interviews (13 patients) |
Large, integrated delivery system in Western Pennsylvania | Participants provide feedback about their experience with the portal | Increased patient anxiety |
| Sieck et al, 2017 (61) | Qualitative Interviews (29 patients and 13 providers) |
Primary care offices at a large academic medical center in Ohio | Participants provide feedback about portal usefulness | More education and training are needed |
AVS = after-visit summary; EHR = electronic health record; HIT = health information technology; VA = Veterans Affairs.
*
Unless otherwise specified, sample sizes are the number of patients.