JMIR Publications

ABSTRACT

Background:

Racial/ethnic minorities in the United States, particularly those with limited English proficiency (LEP), experience an unequal disease burden. One of the innovations in health care includes patient portal as an effective means to provide patient education, outreach, and linkage to preventive health services. A recent systematic review revealed that patient portal is an overall effective platform to facilitate preventive service use but that it has involved predominantly well-educated, English-speaking white populations. There is limited research investigating experiences and beliefs about patient portals among LEP population.

Objective:

To explore perceptions, experiences, and beliefs about patient portal among women with LEP.

Methods:

We used a qualitative semi-structured interview design. A purposive sample of women were recruited through diverse methods. A semi-structured interview guide covered topics including experiences with patient portal, perceived feasibility and relevance of patient portal, and perceptions of patient portal targeted towards immigrant women with LEP for health promotion interventions. Interviews were audio-recorded for verbatim transcription and analysis. Each bilingual interviewer reached data saturation after interviewing 12, 9, and 7 Korean-, Spanish-, and Swahili-speaking women, respectively, yielding 28 total women in the study.

Results:

We identified four main themes that were common across all linguistic groups: Perceived Benefits of Patient Portal, Perceived Facilitators of Patient Portal Use, Perceived Barriers to Patient Portal Use, and Preferred Features and Suggested Improvements. Perceived Benefits of Patient Portal had five subthemes including: easier communication with providers and healthcare systems, getting connected and staying connected with healthcare system, easier and efficient access to one’s own health records over time, staying informed of and engaged with one’s own health and health management, and better patient engagement in medical visits. Subthemes for Perceived Facilitators of Patient Portal Use were availability of time, widespread use and availability of smart phones and Internet in the United States, family support, and parenthood. Subthemes for Perceived Barriers to Patient Portal Use were: Limited digital literacy and/or limited access to technology, limited English proficiency, lack of awareness and knowledge about patient portal, and illiteracy. Finally, subthemes for Preferred Features and Suggested Improvements were: Expanded language access, improved accessibility to health information using graphics and patient education materials, and user onboarding education and technical support. Of note, while most subthemes were shared across all three groups, certain subthemes were particularly relevant to a certain group (e.g., widespread use and access to smart phones and internet in the United States and illiteracy subthemes for Swahili-speaking women).

Conclusions:

While enabling women with LEP to effectively communicate with providers and health systems, several barriers to patient portal use were closely linked to social determinants of health often experienced in the populations. To expedite the attainment of health equity, it is important to promote access to health resources such as patient portals. Clinical Trial: NA