Table 2.

Characteristics of studies with aggregated Asian American data.

Study	Objective	Research design	Sample population/ level of Chinese American granularity and location	Focus	Relevant results
Ahlers-Schmidt and Nguyen (2013) [37]	To obtain parents’ feedback and intention to use patient portals for their children’s health records and concerns post the facilitated learning session	Quantitative (cross-sectional, survey)	Parents of patients. (N=65) White (n=26, 40%); Hispanic (n=14, 22%); Asian (n=9, 14%); African American (n=6, 9%); Mixed/other race (n=8, 12%) Location: Kansas	University of Kansas Pediatric Clinic’s eClinical Works, an electronic medical record with a patient portal	Most parents did not know about the patient portal before the study demonstration. Parents expressed that patient portal was simple to use after demonstration. Parents liked portal functions such as viewing lab results and medical records; disliked need to make separate accounts for each child and the lack of a symptom checker function.
Dalrymple et al (2018) [38]	To assess parents’ use of the internet for health information and parents’ awareness of digital health technologies to obtain health information Screening questions assess parents’ level of health literacy and interest in use of patient portals	Quantitative (cross-sectional, survey) Study tool: 26-question paper and pencil survey adapted from interview protocol designed from previous study	Total sample population of parents or adult caregivers of children and adolescents, N=270 Asian (1.9%); American Indian/Alaska Native (1.5%); Black/African American (38.1%); Hispanic/Latino (13.7%); Native Hawaiian/Pacific Islander (0.4%); White (40.7%); more than one race/ethnicity (4.4%); and Other (1.5%) Location: Unspecified large metropolitan area in eastern United States	Internet and patient portal	Most patients reported having access to the internet and using the internet to seek general and health information. Respondents expressed enthusiasm and interest in using a patient portal if it were available from their health care provider.
Foster and Krasowski (2019) [39]	To assess patient portal usage by EDa patients at an academic medical center using patient portal activation rates and rates of accessing diagnostic test results on patient portals	Quantitative (retrospective cohort, EHRb, and administrative data)	25,361 unique ED patients identified via EHR patient portal records Asian (n=451); African American/Black (n=2,254); White (n=20,637); Hispanic/Latino (n=1257); Other (n=762) Location: Iowa	UIHCc patient portal (MyChart), connected to EPIC EHR system	Highest rates of using the patient portal to view laboratory and radiology results were observed for younger female, proxies, Asian, and White patients. Activation rates were highest for Asian and White patients. Disparities were observed among teenagers, older adults, African American/Black, and Hispanic/Latino patients.
Goel et al (2011) [12]	To examine the enrollment in and use of patient portal at an academic medical center by race/ethnicity, gender, and age	Quantitative (cross-sectional, EHR and administrative data) Study tool: patients’ use of EHR-based advice function and request for refills	Patients enrolled in the patient portal system, N=7088 Asian (n=142, 2%); White (n=3472, 49%); Black (n=1063, 15%); Latino (n=284, 4%); Other (n=851, 12%); Missing race/ethnicity (n=1347, 19%) Location: Chicago	Northwestern Medical Faculty Foundation’s EHR patient portal	Significant disparities in patient portal enrollment by race/ethnicity were observed, but not by age or gender. White patients (74%) were more likely to enroll in patient portals compared to Black (55%), Latino (64%), and Asian (66%) patients. When adjusted for variables (eg, age, gender, income, education, and provider effects), the disparity between Asian and White patients was no longer statistically significant.
Graetz et al (2016) [40]	To assess sociodemograp hic disparities in patient portal use	Quantitative (cross-sectional, survey) Study tool: Administered paper-based survey mailed to participants; survey measures internet access, secure email use, care preference, sociodemographics, and health characteristics	Total study participants from KPNCd, N=1041 White (n=617, 59.3%); Asian (n=145, 13.9%); Black (n=122, 11.7%), and Hispanic (n=12812.3%) Location: Northern California	Internet and email	Asian and Black respondents were more likely to rarely or never to use the internet (45.4% and 45.6%, respectively) compared to their White respondents. Asian participants (78%) preferred in-person care over telephone care compared to White patients (64%).
Ketterer et al (2013) [41]	To identify predictors of patient portal enrollment and activation among a pediatric primary care population	Quantitative (cross-sectional, EHR and administrative data) Study tool: primary care database, and enrollment in and use of a patient portal	Total sample population N=84,015 Black (n=35,286, 42%); Asian (n=2520, 3%); White (n=35,286, 42%); Hispanic (n=10,082, 12%); Other (n=9242, 11%); and Unknown (n=1680, 2%). Location: Delaware	Patient portal site, MyNemours	Adjusted odds of portal enrollment were lower for Asian respondents compared to White respondents. Once enrolled, there was no difference in portal activation between Asian respondents and White respondents. Study suggested language concordance as a major barrier.
Lyles et al (2013) [42]	To understand how patient-provider relationships influence patients’ use of online patient portals and secure messaging	Quantitative (cross-sectional, survey)	Surveyed patients DISTANCEe Black (23%); Latino (16%); East Asian (ie, Chinese, Japanese, Korean, or Vietnamese) (10%); Filipino 12%); and Other (6%) Location: Northern California	KPNC’s internet-based patient portal, kp.org	White and Latino individuals with higher trust in the providers were more likely to register on the patient portal. There was no relationship between trust in provider and patient portal use for Asian respondents.
Lyles et al (2016) [43]	To determine whether racial/ethnic minority patients’ use of the patient portal’s medication refill function has changed over time compared to White patients	Quantitative (EHR and administrative data) Study tool: diabetic patients’ use of EHR-based medication refill function	White (58%); Asian (10%); Latino (9%); Filipino (9%); Black (7%); and Mixed/other (9%) Location: Northern California	KPNC’s internet-based patient portal, kp.org	Asian were not less likely to exclusively use refill functions than other ethnic groups. Adherence to medication refills improved over time for all ethnic groups, but there was no significant difference between ethnicities. Usability and accessibility were identified as barriers to portal registration.
Miles et al (2016) [44]	To measure and evaluate the frequency at which patients use the patient portal to view online radiology reports	Quantitative (cross-sectional, EHR and administrative data) Study tool: patient interactions with portal features (eg, radiology, laboratory, and clinical notes) and sociodemographic factors	Asian or Pacific Islander (n=6376, 10.4%); American Indian or Alaska Native (n=522, 0.8%); Black or African American (n=3817, 6.2%); Hispanic or Latino (n=1850, 3%); White (n=44,163, 72.25); and Other/more than one race (n=675, 1.1%); and Unknown (n=3728, 6.1%) Location: Seattle, Washington	UW’sf patient portal system, UW eCare web portal	Asian respondents were more likely than White patients to view their radiology reports. Older patients, primary non-English speakers, and those with non-commercial insurance viewed reports at lower rates. Concerns identified in the study include loss of patient confidentiality, health information inaccuracy, and disruption of patient-physician relationship.
Patel et al (2011) [45]	To determine low-income, ethnically diverse consumers’ attitudes and beliefs toward HIEg and use of HIE via PHRsh and to identify factors that impact consumers’ support for providers’ use of HIE and their own personal use of PHRs	Quantitative (cross-sectional, survey) Study tool: survey adapted from previously validated national surveys. Survey was translated into Spanish, Russian, and Mandarin Chinese	BHIXi’s patients White (n=36, 74%); Asian (n=57, 28%); African American (n=20; 10%); and Other (n=56, 27%). Spoke Chinese at home (n=42, 20%) Location: New York City, New York	EHRs, internet, HIE, and PHRs	Compared to other racial/ethnic groups in the study, Asian Americans indicated lower levels of support for HIE (48%) and lower levels of potential PHR usage (67%).
Sarkar et al (2010) [46]	To examine whether use of an internet-based patient portal differed between English-speaking patients with limited health literacy and English-speaking patients with adequate health literacy	Quantitative (cross-sectional, survey) Study tool: DISTANCE study was conducted in English, Spanish, Cantonese, Mandarin, and Tagalog	Total of 14,201 surveyed participants from DISTANCE study Non-Hispanic White (n=3957, 28%); Latino (n=1923, 14%); African American (n=2899, 21%); Asian (n=1253, 9%); Filipino (n=1624, 12%); Other (n=2446, 17%) Location: Northern California	KPNC’s internet-based patient portal, kp.org	Study did not find increased risk of not signing onto the patient portal for Asian Americans compared to African American, Latino, and Filipino respondents. Asian Americans had lower rates of never using patient portal functions including lab result viewing, medication refills, email, and scheduling appointments. Health literacy was identified as a barrier to portal activity.
Sarkar et al (2011) [47]	To examine portal use habits via the frequency at which participants requested a password for the patient portal, the proportion of participants who activated their accounts by changing the default password, and the proportion of participants who login to their accounts using their personal, customized password	Quantitative (cross-sectional, EHR and administrative data ) DISTANCE study was conducted in English, Spanish, Cantonese, Mandarin, and Tagalog	Total of 14,201 surveyed participants from DISTANCE Study Non-Hispanic White (n=3957, 28%); Latino (n=1923, 14%); African American (n=2899, 21%); Asian (n=1253, 9%); Filipino (n=1624, 12%); Other (n=2446, 17%) Location: Northern California	KPNC’s internet-based patient portal, kp.org	Asian American (53%) and White (51%) participants were more likely than their African American (31%), Latino (34%), and Filipino (32) counterparts to request a password for the internet-based patient portal and to login to the patient portal after requesting a password. Older adults with less educational attainment were less likely to register and use the patient portal.
Tieu et al (2017) [48]	To measure participants’ satisfaction with use of patient portal	Mixed methods (cross-sectional, usability testing and survey) Study tool: Conducted English language performance testing and think-aloud interviews with participants and administered survey to participants	Total of 25 English-speaking (23 patients and 2 caregivers) participants. African American (n=9, 36%); White (n=6, 24%); Hispanic (n=2, 8%); Asian or Pacific Islander (n=5, 20%); and Other (n=3, 12%) Location: San Francisco, California	RFPC’sj patient portal, MYSFHEALTH	Participants with limited health literacy, including Asian and Pacific Islander patients were more likely to need assistance navigating the patient portal. Barriers to patient portal use for participants with limited health literacy include (1) lack of basic computer skills; (2) routine computer use challenges despite basic knowledge of computers; (3) difficulty reading, writing, and understanding language; and (4) difficulty understanding and applying medical information from the internet and patient portal.

^aED: emergency department.

^bEHR: electronic health record.

^cUIHC: University of Iowa Hospitals and Clinics.

^dKPNC: Kaiser Permanente Northern California.

^eDISTANCE: Diabetes Study of North California.

^fUW: University of Washington.

^gHIE: health information exchange.

^hPHRs: personal health records.

ⁱBHIX: Brooklyn Health Information Exchange.

^jRFPC: Richard H. Fine People’s Clinic.