Recommendations to Address Barriers to Patient Portal Use Among Persons with Diabetes Seeking Care at Community Health Centers: A Qualitative Study (Preprint)

BACKGROUND Community Health Centers (CHCs) are safety-net healthcare facilities in the US that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underutilized in CHCs. Additionally, little is known about the specific barriers and facilitators to patient portal use in CHCs as well as strategies to address the barriers. OBJECTIVE The objective of this qualitative study was to explore the barriers and facilitators of the use of patient portals for managing diabetes in two CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance usage METHODS A qualitative description design was used. Twenty-one participants (13 clinicians and 8 adults with T2D) were purposively and conveniently selected from two CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, ≥18 years old, diagnosed with T2D ≥ 6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care/services for adults with T2D were eligible for this study. Semi-structured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented. RESULTS Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-provider communication. However, challenges of health/technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal. CONCLUSIONS Adults with T2D and providers at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low literacy and implementing standardized patient portal use strategies to address the unique needs of patients receiving care at CHCs have potential to improve health equity and health outcomes associated with patient portal use.