Adding dimensions to the analysis of the quality of health information of websites returned by Google. Cluster analysis identifies patterns of websites according to their classification and the type of intervention described.

Background and aims: Most of the instruments used to assess the quality of health information on the Web (e.g. the JAMA criteria) only analyze one dimension of information quality, trustworthiness. We try to compare these characteristics with the type of treatments the website describe, whether evidence-based medicine or note, and correlate this with the established criteria. Methods: We searched Google for “migraine cure” and analyzed the first 200 websites for: 1) JAMA criteria (authorship, attribution, disclosure, currency); 2) class of websites (commercial, health portals, professional, patient groups, no-profit); and 3) type of intervention described (approved drugs, alternative medicine, food, procedures, lifestyle, drugs still at the research stage). We used hierarchical cluster analysis to assess associations between classes of websites and types of intervention described. Subgroup analysis on the first 10 websites returned was performed. Results: Google returned health portals (44%), followed by commercial websites (31%) and journalism websites (11%). The type of intervention mentioned most often was alternative medicine (55%), followed by procedures (49%), lifestyle (42%), food (41%) and approved drugs (35%). Cluster analysis indicated that health portals are more likely to describe more than one type of treatment while commercial websites most often describe only one. The average JAMA score of commercial websites was significantly lower than for health portals or journalism websites, and this was mainly due to lack of information on the authors of the text and indication of the date the information was written. Looking at the first 10 websites from Google, commercial websites are under-represented and approved drugs over-represented. Conclusions: This approach allows the appraisal of the quality of health-related information on the Internet focusing on the type of therapies/prevention methods that are shown to the patient

The Relationship of Demographics to Consumers’ Use of an Extended Range of E-Health Services

E-health usage is often studied at the level of online health portals, which is invaluable in understanding how these important portals are utilized by various health consumers. However, this approach does not provide information about usage of the underlying ehealth services, which is crucial in improving the overall success of e-health portals. In this study, we examine variations in use of 12 distinct e-health services based on five demographic factors: age, gender, race/ethnicity, income, and education. Our results highlight the need for examining usage of distinct e-health services. They also show that demographic factors can play a significant role in how these services are used. Because the results of our study provide a fine-grained picture of e-health usage, they extend those studies and observations that are based on overall use of e-health portals or personal health records. Hence, our results provide important insights for the design, development, and management of specific e-health services, which in turn can improve the overall success of e-health portals

Health Care Professionals' Experiences of Patient-Professional Communication Over Patient Portals : Systematic Review of Qualitative Studies

Background: The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals' experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care. Objective: This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals. Methods: Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals' experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute's quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers. Results: A total of 6 analytical themes concerning health care professionals' experiences of web-based patient-professional communication were identified. The themes were related to health care professionals' work, change in communication over patient portals, patients' use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles. Conclusions: Health care professionals' experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals' negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals.Peer reviewe

Examining the Impact of Design Features of Electronic Health Records Patient Portals on the Usability and Information Communication for Shared Decision Making

The use of the Electronic Health Records (EHR) patient portal has been shown to be effective in generating positive outcomes in patients’ healthcare, improving patient engagement and patient-provider communication. Government legislation also required proof of its meaningful use among patients by healthcare providers. Typical patient portals also include features such as health information and patient education materials. However, little research has examined the specific use of patient portals related to individuals with specific diseases such as inflammatory bowel diseases (IBDs). IBDs are life-long, not curable, chronic diseases that can impact the whole population. Individuals with IBDs may have higher needs to acquire health information from their EHR portals to properly self-manage their health conditions. The research aims of the present dissertation are to understand the online health information-seeking behaviors of a target group (IBDs) of patients, the use of EHR patient portals, and the impact of design features of EHR patient portals on the usability and information communication for shared decision making. Through this dissertation, I conducted four studies to address the above research aims. First, I identified how individuals with inflammatory bowel disease (IBD) used the internet for health information seeking, the factors impacting their use of the internet to obtain health information, and how they used the internet for health-related tasks. The purpose of this study is to get a general understanding of the online health information-seeking behaviors and to guide the study of health information presentation of EHR portals in the following research. Second, I examined what factors influenced an EHR patient portal user to believe that the portal is a valuable part of their health care. This part of the dissertation aimed to reveal the critical design factors that help design an EHR portal perceived as valuable in managing health. Third, I looked at how patients used EHR patient portals, what features of the portals facilitated their use and encouraged Shared Decision Making (SDM) and engagement in health management and what features acted as barriers to SDM and their engagement in health management. This part of my dissertation focused on a broad understanding of EHR portals usage by introducing more specific factors such as features of EHR portals. Fourth, I conducted an eye-tracking study to examine how information presentation methods and chatbots impact the use and effect of patient portals. This part of my dissertation built on the other studies within my dissertation and deepened the understanding of the influence of different EHR portal designs on their effectiveness and people’s willingness to participate in SDM. The results of this dissertation contribute to the literature of understanding the information-seeking behaviors of IBD patients and the use of portals, as well as the design considerations of how to make a suitable EHR portal to support the information-seeking needs of IBD patients. The results of this dissertation can be used to guide building proper patient education materials to support their health information needs of their specific health condition, especially for individuals with chronic diseases that require a certain amount of self-management. Meanwhile, examining artificial intelligence (AI) based chatbots use in EHR portals reveals a potential path of AI use in healthcare, such as information acquisition and patient education. Designing good usable EHR may also facilitate the process of informing patients of the advantages and disadvantages of treatment plans for their disease and, therefore, may increase their willingness to participate in SDM

The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: Updated systematic literature review

Background: Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. Objective: The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. Methods: We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. Results: Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. Conclusions: Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency

Influences on the uptake of health and wellbeing apps and curated app portals: a think aloud and interview study

Background: Health and wellbeing smartphone apps can be identified through different routes, including via curated health app portals, but little is known about people’s experiences of this. Objective: This study explored how people select health apps online and their views on curated portals. Methods: Eighteen UK-based adults were recruited and asked to verbalise their thoughts whilst searching for a health or wellbeing app online, including on two curated health app portals. This was followed by semi-structured interviews. Data were analysed using Framework Analysis, informed by the COM-B model and the Theoretical Domains Framework. Results: Searching for health and wellbeing apps online was described as a ‘minefield’. App uptake appeared to be influenced by i) capabilities (e.g. app literacy skills, health and app awareness), ii) opportunities (e.g. app aesthetics, cost and social influences) and iii) motivation (e.g. the perceived utility and accuracy of the app, and transparency about data protection). Social influences and the percieved utility of an app, in particular, were important. People were not previously aware of curated portals but found the concept appealing and likely to engender trust and address data protection concerns. While apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. Conclusions: The uptake of health and wellbeing apps appear primarily influenced by social influences and the perceived utility of the app. With curated health app portals perceived as credible, app uptake via such portals may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs. Clinical Trial: N

The Effectiveness of Australian Medical Portals: Are They Meeting the Health Consumers’ Needs?

The move to using portals to distribute medical information is supported by Australian Governments and government agencies. The recent success of ‘telemedicine’ is promising for patients and governments alike as it could provide quality care and convenience for patients and reduces the burden on the health budget for governments. The Australian Government is taking a proactive role in developing medical portals to encourage the general use of the web for the dissemination of medical information (NHIMAC, 2000). Government portals such as HealthInsite (Australian) and BetterHealth (Australian Victorian Government) encourage users to access the sites (NHIMAC, 2000).. Despite the support by governments, usability tests examining portal effectiveness indicate that many portals are not effective for users. This paper presents the results of usability testing conducted on current Australian medical portals and discusses the portals’ effectiveness from the users’ perspective. The paper also discusses current technology that could improve medical portals’ effectiveness thereby better serving the needs of the health consumer

Patient Engagement in Patient Portals in Appalachia v. Surrounding U.S. Census Regions: An Analysis of HINTS (Health Information National Trends Survey) Data, 2017–2020

Introduction: Those living in the Appalachian Region face a greater number of significant health disparities than residents of other areas of the U.S. Patient portals can decrease disparities, increase health literacy, and improve health outcomes. Purpose: This study explores if those living in the Appalachian Region are offered access to and use their patient portals differently than those in the surrounding U.S. Census regions. Additionally, the study aims to determine if there was a difference in reported reasons for the non-use of patient portals. Methods: A secondary analysis was completed using data from the National Cancer Institute\u27s Health Information National Trends Survey (HINTS) (2017–2020), a nationally representative survey. Descriptive statistics and chi-square tests were used to determine differences in patient portal use between regions. Results: There was no statistically significant difference between the Appalachian and surrounding U.S. Census regions in being offered access to patient portals. However, there was a statistically significant difference (non-weighted) between regions in the use of patient portals. Common reasons for the non-use of patient portals were a preference to speak directly to the provider and the lack of perceived need to use the portal. Implications: Providers in the Appalachian Region should be aware of the non-use of patient portals. Moreover, understanding the reported reasons for non-use may help providers tailor educational materials to increase patient portal use

Patient Engagement in Patient Portals in Appalachia Versus Surrounding US Census Regions: An Analysis of HINTS (Health Information National Trends Survey) Data, 2017 - 2020

OBJECTIVE: Those living in the Appalachian regions face more significant healthcare disparities than those in the US. Patient portals can decrease disparities and increase health outcomes and health literacy. The purpose of this study was to determine if those living in the Appalachian region were offered access to and used their patient portals differently than the surrounding US Census region. Additionally, we aimed to determine if there was a difference in reported reasons for non-use of patient portals. METHODS: This was a descriptive study using data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) data (2017-2020) to determine if there is a difference in the use of patient portals in the Appalachian region compared to the surrounding US Census regions. RESULTS: There was no statistically significant difference between the Appalachian and surrounding US Census regions in being offered access to and the use of patient portals. However, when holding race constant, there was a statistically significant difference between regions in the use of patient portals for non-Hispanic whites (p = 0.0192). Common reasons for non-use of patient portals were preferred to speak directly to the provider and perceived CONCLUSIONS: Providers in the Appalachian region should be aware of the non-use of patient portals by non-Hispanic whites. Moreover, understanding the reported reasons for non-use may help providers tailor educational materials to increase the use of patient portals

Where can teens find health information? A survey of web portals designed for teen health information seekers

The Web is an important source for health information for most teens with access to the Web (Gray et al, 2005a; Kaiser, 2001). While teens are likely to turn to the Web for health information, research has indicated that their skills in locating, evaluating and using health information are weak (Hansen et al, 2003; Skinner et al, 2003, Gray et al, 2005b). This behaviour suggests that the targeted approach to finding health information that is offered by web portals would be useful to teens. A web portal is the entry point for information on the Web. It is the front end, and often the filter, that users must pass through in order to link to actual content. Unlike general search engines such as Google, content that is linked to a portal has usually been pre-selected and even created by the organization that hosts the portal, assuring some level of quality control. The underlying architecture of the portal is structured and thus offers an organized approach to exploring a specific health topic. This paper reports on an environmental scan of the Web, the purpose of which was to identify and describe portals to general health information, in English and French, designed specifically for teens. It answers two key questions. First of all, what portals exist? And secondly, what are their characteristics? The portals were analyzed through the lens of four attributes: Usability, interactivity, reliability and findability. Usability is a term that incorporates concepts of navigation, layout and design, clarity of concept and purpose, underlying architecture, in-site assistance and, for web content with text, readability. Interactivity relates to the type of interactions and level of engagement required by the user to access health information on a portal. Interaction can come in the form of a game, a quiz, a creative experience, or a communication tool such as an instant messaging board, a forum or blog. Reliability reflects the traditional values of accuracy, currency, credibility and bias, and in the web-based world, durabililty. Findability is simply the ease with which a portal can be discovered by a searcher using the search engine that is most commonly associated with the Web by young people - Google - and using terms related to teen health. Findability is an important consideration since the majority of teens begin their search for health information using search engines (CIBER, 2008; Hansen et al, 2003). The content linked to by the portals was not evaluated, nor was the portals’ efficacy as a health intervention. Teens looking for health information on the Web in English have a wide range of choices available but French-language portals are much rarer and harder to find. A majority of the portals found and reviewed originated from hospitals, associations specializing in a particular disease, and governmental agencies, suggesting that portals for teens on health related topics are generally reliable. However, only a handful of the portals reviewed were easy to find, suggesting that valuable resources for teens remain buried in the Web