JMIR Publications

ABSTRACT

Background:

Personal health record systems (PHRs) have been introduced to support patient empowerment by giving individuals direct access to their personal health information and other key health system resources. MyHealthNB is a province-wide PHR in New Brunswick, Canada, that allows residents to view lab results, medication lists, immunization records, imaging reports, and a range of digital health resources. As PHRs continue to expand, it is essential to understand how PHRs like MyHealthNB impact outcomes related to patient empowerment.

Objective:

This study uses MyHealthNB as a case example to examine empowerment-related impacts of PHRs on citizens. Building on a conceptual framework linking patient enablement, empowerment, involvement, and engagement, the study is guided by two questions: (1) What perceived impacts of PHR use emerge across enablement, empowerment, involvement, engagement, and cost-related outcomes? (2) Which impacts of PHR use are most prevalent, how are they interrelated, and what characteristics predict variation in these impacts?

Methods:

An exploratory sequential mixed methods study design was employed. Phase 1 involved qualitative interviews with citizens to explore perceived impacts of using MyHealthNB, analyzed using rapid qualitative analysis. Findings informed a Phase 2 cross-sectional survey that measured MyHealthNB users’ self-reported impacts across enablement, empowerment, involvement, engagement, and cost-related outcomes. Survey data were analyzed using descriptive statistics, t-tests, mediation analysis, and multivariable linear regressions to examine impacts, impact pathways, and impact predictors.

Results:

Data from 32 interviewees and 885 survey respondents were analyzed. The qualitative analysis showed that MyHealthNB supported a progression from improved access to health information (enablement), to increased confidence (empowerment), to more active participation in health management and healthcare decisions (involvement and engagement). The survey analysis confirmed significant positive impacts across all 21 outcomes measured that spanned enablement, empowerment, involvement, engagement, and cost-related outcomes (P< .05). Mediation analysis revealed that empowerment played a key role in explaining how enablement through MyHealthNB led to increased involvement and engagement in health and healthcare behaviours. Regression models identified key predictors of MyHealthNB impacts, which included satisfaction with MyHealthNB, having a family doctor, provider support of MyHealthNB, digital literacy, and MyHealthNB use frequency.

Conclusions:

PHRs can improve outcomes related to patient empowerment, behaviour change, and health system benefits. The advantages of PHR use were most prominent when individuals had access to primary care, received support from healthcare providers, and had confidence using digital technologies. Although some users experienced stress or uncertainty from using the PHR, these responses did not detract from its overall value. To fully realize the promise of PHRs, implementers should invest in digital literacy support and strengthen primary care access and integration. Clinical Trial: N/A