Investigating Barriers to Effective Use by Patients of the VA’s Personal Health Record
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Abstract
Background. Personal Health Records (PHRs) are computer applications that contain a variety of tools designed to help patients access, track, understand, and manage their healthcare information. My HealtheVet (MHV), the Veterans Administration’s (VA) patient portal, enables veterans who have completed an authentication process to access their medical information online as well as an array of powerful health-management tools. For example, within the Track Health function (THF) of MHV, one of MHV’s eight major categories, patients can monitor various measures (e.g., blood pressure and blood sugar) with options to edit, delete, or add new and information and to display information in tabular or graphical formats. Such functionalities, however, are likely to be challenging to use, especially by older veterans and users with inadequate health literacy, and in fact a recent survey found that most of this PHR’s functionalities are largely unused. We report on two studies designed to better understand some of the barriers to effective use of MHV.
Methods. All study participants were VA patients. Study 1 included 28 veterans recruited in two age groups, < 65 and ≥ 65 years of age, who were non-users of MHV. They were administered instruments that measured computer/internet proficiency, health literacy, numeracy ability, and graph literacy, given facilitator-guided demonstrations of each of MHS’s main features and also explored MHV on their own, and completed a Perceived Usefulness and Usability of MHV Questionnaire followed by an exit interview. Study 2 included 40 Veterans, all authenticated users of MHV, who were recruited into these same age groups and administered the same instruments, as well as one related to degree of actual use of each of the MHV categories. They then performed 13 MHV tasks (populated by fictitious patient data) representing all eight major MHV categories (e.g., Create a graph of your blood sugar measurements over the past year. Would you say that, overall, your blood sugar went up, stayed about the same, or decreased?). Overall and individual MHV category task performance scores were computed.
Results. Older users performed significantly more poorly on critical functionalities (such as the THF) than their younger counterparts despite reporting similar degrees of usage of all categories. Age, health literacy, numeracy ability, and graph literacy all significantly differentiated the 19 lower performers from the 21 higher performers. Regression analysis indicated that even after controlling for computer/internet proficiency and comorbidity, health literacy and graph literacy significantly impacted the performance scores of the Study 2 participants. Study 1 participants provided significantly higher ratings of the usefulness and usability of MHV than their Study 2 counterparts, but reported significantly lower computer/internet proficiency.
Conclusions. Veterans with low computer proficiency skills, older MHV users, and users with low health literacy, numeracy ability, and graph literacy skills may be at a disadvantage in attaining the health-management benefits that this patient portal can offer. Translation of these findings into strategies for instruction and design are important for supporting MHV redesign efforts planned by the VA, and should provide insights into design of other PHRs as well.
Methods. All study participants were VA patients. Study 1 included 28 veterans recruited in two age groups, < 65 and ≥ 65 years of age, who were non-users of MHV. They were administered instruments that measured computer/internet proficiency, health literacy, numeracy ability, and graph literacy, given facilitator-guided demonstrations of each of MHS’s main features and also explored MHV on their own, and completed a Perceived Usefulness and Usability of MHV Questionnaire followed by an exit interview. Study 2 included 40 Veterans, all authenticated users of MHV, who were recruited into these same age groups and administered the same instruments, as well as one related to degree of actual use of each of the MHV categories. They then performed 13 MHV tasks (populated by fictitious patient data) representing all eight major MHV categories (e.g., Create a graph of your blood sugar measurements over the past year. Would you say that, overall, your blood sugar went up, stayed about the same, or decreased?). Overall and individual MHV category task performance scores were computed.
Results. Older users performed significantly more poorly on critical functionalities (such as the THF) than their younger counterparts despite reporting similar degrees of usage of all categories. Age, health literacy, numeracy ability, and graph literacy all significantly differentiated the 19 lower performers from the 21 higher performers. Regression analysis indicated that even after controlling for computer/internet proficiency and comorbidity, health literacy and graph literacy significantly impacted the performance scores of the Study 2 participants. Study 1 participants provided significantly higher ratings of the usefulness and usability of MHV than their Study 2 counterparts, but reported significantly lower computer/internet proficiency.
Conclusions. Veterans with low computer proficiency skills, older MHV users, and users with low health literacy, numeracy ability, and graph literacy skills may be at a disadvantage in attaining the health-management benefits that this patient portal can offer. Translation of these findings into strategies for instruction and design are important for supporting MHV redesign efforts planned by the VA, and should provide insights into design of other PHRs as well.
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