JMIR Publications

ABSTRACT

Background:

Diabetes self-management education/support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status.

Objective:

The purpose of this study was to evaluate the feasibility, acceptability, and preliminary efficacy of a multi-level intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving healthcare at CHCs.

Methods:

A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from two CHCs. After informed consent, participants met with a community health worker (CHW) for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function.

Results:

Twenty-six patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino/Hispanic (77%) and reported low income (86% < $40,000/year), low education (59% < high school), and no health insurance (55%). All participants had access to a Smartphone, but 91% had never accessed a health app. Baseline A1C was 8.31%. Portal activation was high; 100% of participants created a portal account and logged in within the first month. Engagement was high; 98% logged in at least twice per month in the first 3 months and 76% between 3 and 6 months. Mean (SD) participant logins per month over the first 3 months was 3.16 (SD 3.18) and 1.45 (SD 1.91) over the final 3 months. At 6 months, improvements were seen in technology confidence, digital health literacy, diabetes self-efficacy, and diabetes distress. Participant satisfaction with MAP was high as was intention to continue portal use. Barriers to clinical integration and recommendations for portal development were identified.

Conclusions:

MAP shows promise for improving health equity in portal use for T2D. Larger, controlled studies are needed to determine how best to implement MAP in complex clinical settings and to evaluate efficacy over time. Clinical Trial: NCT05180721