. 2023 Feb 23;7:e42881. doi: 10.2196/42881

Table 2.

Quotes reflecting key themes related to secure messaging on the C2^a platform.

Themes	PC^b quotes	CTM^c quotes
Connection to the care team	“Over time it became a partnership between the care team and [us]. There’s an invitation there to suggest treatments or alternatives. We [were] able to be taken seriously and to start this cooperation in the care of our daughter.” PC#8 “I feel heard, and more connected because of the [NP’sd] quick response. We feel that we’re genuinely being taken care of by her, and that she’s concerned, not just about my son and the medical side, but just our family’s wellbeing in general. That definitely came through, because of [C2].” PC#23	“[With messaging on C2], it feels less formal than email so you can just send like a quick, one or two lines to the family.” CTM#3 “[With] email, the amount of detail [parents] go into might be a little bit more. With [C2], they were more direct, [showed] their concerns, and [asked] their questions.” CTM#35
Efficient communication	“It’s easier to pull up previous conversations in a message, as opposed to different emails all over the place. If I kept scrolling up [on C2] then I could see what we had talked about two months ago.” PC#26 “I found [C2 to be] an easy way to send off quick messages. I think it was more friendly or laid-back… Maybe more casual.” PC#22 “I think my favourite [C2 feature] was the messenger. To be able to contact the pediatrician directly, instead of trying to call an office, and then trying to book a time for us to be able to chat with him.” PC#54	“I would say [email and C2] are similar. And perhaps [C2] was collated, better. [Emails] can get buried with other emails but [on C2 conversations are] specific to that patient so [there is] a bit of a trail.” CTM#16 “[With] email the amount of detail they go into might be a little bit more. With [C2] I felt like [PCs] were able to be more direct, show their concerns, and ask their questions.” CTM#35 “I found that it was much quicker to get a hold of them [via C2], rather than email or calling [PCs].” CTM#27
Clinical uses of secure messaging	“I think [C2 is] a great supplement. For example, our Complex Care meetings will be twice a year. Stuff happens in the six months in between and that is where [C2] was very helpful.” PC#8 “[The community-based social worker and I] had a lot of back-and-forth based on accessibility equipment that we were having ordered and measured. [We were] able to communicate with her when she had a quick question, or if we were relaying information to her, as well as ask questions and prepare things between visits. [C2] made that piece of it easier for us.” PC#19 “It was really nice that [our NP] would [message] and say, “Hey, just checking in, how’s [son] doing?”. Had I not had this platform, I wouldn’t have told her that [for example] he’s got a cough. We would deal with it at home and if need be, we would go to the Emergency in our town. She’s more up-to-date with what was going on with him.” PC#26	“If it’s not something that’s a new onset of a certain symptom or a certain issue, then the messaging platform is fine, especially dealing with ongoing issues. When something new has happened, and you need more detail, then I can see the email or phone might be more useful.” CTM#35 “I mainly used [C2] if there was a follow-up from an [previous] issue, as a check-in but also, if they had an upcoming visit, reaching out to them just to see if there’s anything in particular that they wanted to discuss at the visit.” CTM#03 “I think [C2] allows continuity between [visits] for things that we’re trying to work on. I think this [C2] messaging] would allow [for] communication between the clinical team and the family [between appointments]. It would mean that you’re using the time between appointments.” CTM#40
Barriers to use	“The helpfulness [of C2] was limited in this study period primarily because the health care providers on my son’s [care] team didn’t accept the invitations to participate.” PC#36 “If there was a way [on C2] to, communicate with all three [HCPs] at the same time, to get the same message to all of them, that would be a benefit” PC#47 “I normally use email because it’s the most convenient. Requires me to take the fewest extra steps in order to send the message. I am usually [already] logged into my email anyway.” PC#53	“It would be nice if [C2] were, linked to [the EMRe]. It’s hard to keep track of all of the different ways that people can try to get in touch with you and it’s easy to miss [a message] if you don’t respond right away. Adding another system makes me worry that I wouldn’t be able to handle everything.” CTM#42 “My issue with using all three [forms of communication is that parent] wasn’t sure which one was the “right” way to message me. So she wouldn’t consistently use the same [form of communication].” CTM#25

Themes

PC^b quotes

CTM^c quotes

Connection to the care team

“Over time it became a partnership between the care team and [us]. There’s an invitation there to suggest treatments or alternatives. We [were] able to be taken seriously and to start this cooperation in the care of our daughter.” PC#8

“I feel heard, and more connected because of the [NP’sd] quick response. We feel that we’re genuinely being taken care of by her, and that she’s concerned, not just about my son and the medical side, but just our family’s wellbeing in general. That definitely came through, because of [C2].” PC#23

“[With messaging on C2], it feels less formal than email so you can just send like a quick, one or two lines to the family.” CTM#3

“[With] email, the amount of detail [parents] go into might be a little bit more. With [C2], they were more direct, [showed] their concerns, and [asked] their questions.” CTM#35

Efficient communication

“It’s easier to pull up previous conversations in a message, as opposed to different emails all over the place. If I kept scrolling up [on C2] then I could see what we had talked about two months ago.” PC#26

“I found [C2 to be] an easy way to send off quick messages. I think it was more friendly or laid-back… Maybe more casual.” PC#22

“I think my favourite [C2 feature] was the messenger. To be able to contact the pediatrician directly, instead of trying to call an office, and then trying to book a time for us to be able to chat with him.” PC#54

“I would say [email and C2] are similar. And perhaps [C2] was collated, better. [Emails] can get buried with other emails but [on C2 conversations are] specific to that patient so [there is] a bit of a trail.” CTM#16

“[With] email the amount of detail they go into might be a little bit more. With [C2] I felt like [PCs] were able to be more direct, show their concerns, and ask their questions.” CTM#35

“I found that it was much quicker to get a hold of them [via C2], rather than email or calling [PCs].” CTM#27

Clinical uses of secure messaging

“I think [C2 is] a great supplement. For example, our Complex Care meetings will be twice a year. Stuff happens in the six months in between and that is where [C2] was very helpful.” PC#8

“[The community-based social worker and I] had a lot of back-and-forth based on accessibility equipment that we were having ordered and measured. [We were] able to communicate with her when she had a quick question, or if we were relaying information to her, as well as ask questions and prepare things between visits. [C2] made that piece of it easier for us.” PC#19

“It was really nice that [our NP] would [message] and say, “Hey, just checking in, how’s [son] doing?”. Had I not had this platform, I wouldn’t have told her that [for example] he’s got a cough. We would deal with it at home and if need be, we would go to the Emergency in our town. She’s more up-to-date with what was going on with him.” PC#26

“If it’s not something that’s a new onset of a certain symptom or a certain issue, then the messaging platform is fine, especially dealing with ongoing issues. When something new has happened, and you need more detail, then I can see the email or phone might be more useful.” CTM#35

“I mainly used [C2] if there was a follow-up from an [previous] issue, as a check-in but also, if they had an upcoming visit, reaching out to them just to see if there’s anything in particular that they wanted to discuss at the visit.” CTM#03

“I think [C2] allows continuity between [visits] for things that we’re trying to work on. I think this [C2] messaging] would allow [for] communication between the clinical team and the family [between appointments]. It would mean that you’re using the time between appointments.” CTM#40

Barriers to use

“The helpfulness [of C2] was limited in this study period primarily because the health care providers on my son’s [care] team didn’t accept the invitations to participate.” PC#36

“If there was a way [on C2] to, communicate with all three [HCPs] at the same time, to get the same message to all of them, that would be a benefit” PC#47

“I normally use email because it’s the most convenient. Requires me to take the fewest extra steps in order to send the message. I am usually [already] logged into my email anyway.” PC#53

“It would be nice if [C2] were, linked to [the EMRe]. It’s hard to keep track of all of the different ways that people can try to get in touch with you and it’s easy to miss [a message] if you don’t respond right away. Adding another system makes me worry that I wouldn’t be able to handle everything.” CTM#42

“My issue with using all three [forms of communication is that parent] wasn’t sure which one was the “right” way to message me. So she wouldn’t consistently use the same [form of communication].” CTM#25

^aC2: Connecting2gether.

^bPC: parental caregiver.

^cCTM: care team member.

^dNP: nurse practitioner.

^eEMR: electronic medical record.