JMIR Publications

ABSTRACT

Background:

Patient-accessible electronic health records (PAEHRs) are now available population-wide in several countries, but research on age has largely compared broad "younger" and "older" categories or examined single age groups in isolation, and has emphasized whether people access their records rather than why. Fine-grained evidence on how motivations for reading differ across the life course is lacking.

Objective:

This study examined how reasons for accessing a national PAEHR differ across nine age groups among Swedish users, and how encouragement to read and self-rated health are associated with those reasons.

Methods:

We conducted a cross-sectional analysis of Swedish responses to the NORDeHEALTH 2022 Patient Survey. The 83-item questionnaire was embedded in Journalen, Sweden's national PAEHR, and completed after electronic authentication by users aged 15+ over 3 weeks (January 23 to February 13, 2022). Only complete responses were analyzed (estimated response rate 1.2%). Eleven reasons for reading, each rated on a 5-point scale, were analyzed using three-way factorial ANOVA (age group × encouragement × self-rated health), with polynomial contrasts testing linear trends across age.

Results:

Of 13,008 respondents, 8,754 (67.30%) were women and 6,505 (50.01%) were aged ≥55 years. In the analytical sample of 12,686, age was associated with all 11 reasons for reading. The largest age effect was for curiosity (F8,12650=127.99; P<.001), which declined linearly with age (20-24 years: mean 4.42, SD 1.00; ≥85 years: mean 2.60, SD 1.58). Younger respondents also scored higher on checking for inaccuracies (F8,12650=20.24; P<.001) and to share with friends (F8,12650=20.26; P<.001). Oldest respondents scored highest on obtaining an overview (F8,12650=25.64; P<.001), understanding their health issue (F8,12650=21.16; P<.001), preparing for visits (F8,12650=19.82; P<.001), and with the youngest group, sharing with relatives (F8,12650=12.04; P<.001). For the remaining reasons, age effects were small relative to those of encouragement and health. Encouragement was most strongly associated with sharing with relatives (F1,12650=258.63; P<.001) and following up on visits (F1,12650=182.92; P<.001), but not with checking for inaccuracies (P=.73). Poorer self-rated health was most strongly associated with uncertainty about receiving the right care (F1,12650=557.05; P<.001) and suspected inaccuracies (F1,12650=536.84; P<.001).

Conclusions:

Age, encouragement and self-rated health were associated with why people read their records. Older users read primarily to understand and manage their health; younger users out of curiosity or to detect errors. Actively prompting patients to read records, and designing for the concerns of those in poorer health, may matter more than age-tailoring alone.