Challenges to the adoption of patient portals in marginalized Latino populations

Background: The Health Information Technology for Economic and Clinical Health Act promotes the adoption of health information technologies (HIT) as a tool to improve individual and population health. Little is known about HIT adoption in marginalized populations.

Purpose: To explore knowledge and attitudes toward patient portals by diabetes patients at a community health clinic along the Texas-Mexico border.  

Methods: An in-person survey asked about sociodemographics, health literacy measures, and patient portal knowledge and attitudes. Interviewers also asked patients to complete a task on the clinic’s planned portal to assess website navigation skills. Correlational analysis was conducted to explore the relationship between interest in using portal and ehealth literacy. Content analysis of interviewer observations was completed to identify themes describing portal navigation.

Results: Forty-seven diabetes patients completed the surveys (91% Hispanic, 77% female, 47% with incomes <$10,000). Only 49% had a computer/laptop, 55% had Internet access at home, and 53% were current Internet users. A quarter did not know how to use a computer. Correlational analysis showed positive associations between ehealth literacy and interest in using portal (p<.05). Analysis of interviewer observations revealed (1) interest in patient portals, (2) need for demonstration, and (3) challenges including lack of computer knowledge, vision problems, and privacy/security concerns. 

Conclusion: Marginalized populations present a unique challenge to the adoption of HIT and place healthcare providers at a disadvantage when meeting “meaningful use” measures, which require an engaged, health-literate patient population. Policies should support practice settings serving marginalized communities through additional resources and health education efforts.