JMIR Publications

ABSTRACT

Background:

Informal caregivers, or “care partners”, provide critical support to care recipients when managing their healthcare. Veterans’ Health Administration (VHA) priorities identify caregivers as a vital resource in supporting veterans’ care management. The Veteran Delegation Tool (VDT) is VHA’s HIPAA compliant solution for veterans’ care partners to co-manage veterans’ healthcare through VHA’s electronic health portal. To support a user-centric VDT development, Human Centered Design (HCD) approaches are needed to examine end user experiences to inform enhancements to promote uptake and sustained use.

Objective:

The objective of this prospective descriptive quality improvement project was to use a HCD process to examine: (1) VDT user perceptions about the tool to co-manage healthcare; (2) VDT user practical experiences using VDT.

Methods:

This HCD project was conducted within the context of a four-phase approach: Frame; Discover; Design and Deliver. First, the Frame Phase, was conducted to design the protocol and prepare the VDT system for testing. Next, in the Discover Phase, semi-structured interviews, follow-up interviews, and user testing examined VDT benefits, facilitators, and barriers. Discover Phase data informed the Design and Deliver Phases, which are currently underway.

Results:

Veterans (n=24), care partners (n=21), and individuals who represented dual roles (n=9), including veteran/care partner (n=4), veteran/clinical provider (n=2), care partner/provider (n=3), participated in the Discover Phase, semi-structured interviews. A subsample (n=6) participated in the Discover Phase, follow-up interviews and user testing. Analysis of semi-structured interviews across both phases indicated convergence on respondents’ perceptions of perceived VDT benefits, facilitators, barriers, and recommendations. Perceived benefits included: (1) authorized access; (2) co-management of healthcare needs online; (3) communication with clinical team; and (4) access to resources and ease of burden. Reported perceived barriers included: (1) benefits of VDT not recognized; (2) technical literacy access issues; (3) increased stress or burden on care partners; and (4) personal health information (PHI) security. Participants reported experiences across four VDT activity domains: (1) upgrade to My HealtheVet Premium account; (2) VDT registration; (3) VDT Sign-in; and (4) VDT utilization. User testing demonstrated users’ challenges to register, navigate, and use VDT. Datasets informed the development of VDT enhancements and recommendations.

Conclusions:

Care partners need access to electronic health portals to assist with health care management. VDT is VHA’s solution to provide HIPAA compliant access to allow communication and information exchange between designates, veterans, and clinical care teams to co-manage veterans’ care. In general, users value the potential use and benefits of VDT, but access and navigation improvements are needed to ensure uptake and sustained use. Future efforts need to iteratively evaluate the Human Centered phases, Design and Delivery of VDT to target audiences. Continued efforts to understand and respond to care partners needs when caring for care recipients are warranted.