JMIR Publications

ABSTRACT

Background:

Despite evidence that use of patient portals and telehealth is associated with increased health knowledge, patient satisfaction, and preventive services use, disparities exist in awareness, adoption, and use. Populations with lower digital literacy access and skills largely overlap with the populations known to experience poor health outcomes, and these problems can be mutually exacerbating. Understanding factors and strategies specific to these populations is key to achieving digital equity and better health outcomes.

Objective:

Assess portal and telehealth experiences among residents of a minoritized and lower resource area of Dallas, Texas.

Methods:

Using an explanatory sequential design, we conducted surveys and semi-structured interviews with English- or Spanish-speaking adults. Participants were residents within a 15 ZIP Code area surrounding a community-based clinic affiliated with an academic medical and cancer center. We recruited participants via a patient portal, flyers and emails distributed by clinic and community organization partners, and in person. Surveys were offered online and on paper. We also recruited a subsample of survey participants for semi-structured interviews to expound on survey findings. Our thematic analysis assessed convergence in survey and interview findings.

Results:

Among 182 survey respondents, most were older (66% age ≥60), African American or Black (65%) and female (79%); a little over half (54%) had completed at least one telehealth appointment, and a majority (72%) had used a patient portal at least once. A majority agreed with statements such as “Using the Internet for health-related activities makes me feel actively involved with my health care” (59%) and “I find the Internet useful for monitoring my health” (58%). In interviews with 20 individuals, of whom most were older, Black, female, and had digital technology experience, seven factors were key to increased engagement in patient portals and telehealth: (1) improving patient autonomy; (2) integrating digital health technology into daily life; (3) receiving recommendations from trusted individuals; (4) appreciating the value of digital health technologies; (5) enlisting the support of care partners or peers; (6) managing severe or chronic illness; and (7) accessing test results rapidly.

Conclusions:

This study builds on previous work by confirming and contributing additional insights about factors key to technology uptake and use among underserved populations. Interventions using digital health technologies should incorporate these factors to promote digital and health equity. In the future, research should explore which clinical settings and contexts are most conducive to increasing digital technology uptake and use, and implementation should leverage partnerships with community groups.