Perceptions, Experiences, and Beliefs About Patient Portals Among Women With Limited English Proficiency: Multicultural Qualitative Interview Study.

Abstract

Background: Individuals in the United States with limited English proficiency (LEP) experience a disproportionate disease burden. Patient portals provide patient education, outreach, and linkage to preventive health services. While patient portals have been found to be effective in facilitating the use of preventive services, they have predominantly engaged well-educated, English-speaking, White populations. There is limited research investigating experiences and beliefs about patient portals among populations with LEP.

Objective: This study aims to explore perceptions, experiences, and beliefs about patient portals among women with LEP.

Methods: We used a qualitative semistructured interview design and recruited a purposive sample of women through diverse methods. The interview guide covered topics including experiences with patient portals, the perceived feasibility and relevance of patient portals, and perceptions of patient portals targeted toward women with LEP for health promotion. The interviews were audio recorded for verbatim transcription and analysis. Each bilingual interviewer reached data saturation after interviewing 12 (43%), 9 (32%), and 7 (25%) Korean-, Spanish-, and Swahili-speaking women, respectively, yielding a total of 28 women in the study.

Results: We identified 4 main themes that were common across all linguistic groups: perceived benefits of patient portals, perceived facilitators of patient portal use, perceived barriers to patient portal use, and preferred features and suggested improvements. Perceived benefits of patient portals had 5 subthemes: easier communication with health care providers and health systems, getting connected and staying connected with health systems, easier and efficient access to one's health records over time, staying informed of and engaged with one's health and health management, and better patient engagement in medical visits. Subthemes for perceived facilitators of patient portal use were availability of time, widespread use and availability of smartphones and the internet in the United States, family support, and parenthood. Subthemes for perceived barriers to patient portal use were limited digital literacy and limited access to technology, LEP, lack of awareness and knowledge about patient portals, and illiteracy. Finally, subthemes for preferred features and suggested improvements were expanded language access to accommodate non-English speakers, improved accessibility to health information using graphics and patient education materials, and user onboarding education and technical support. Of note, while most subthemes were shared across all 3 groups, the widespread use and availability of smartphones and the internet in the United States and illiteracy subthemes were unique to Swahili-speaking women.

Conclusions: Women with LEP recognized multiple benefits of patient portals; however, several barriers were also identified. These included limited digital literacy, restricted access to technology, LEP, and illiteracy. Barriers to patient portal use were closely tied to social determinants of health, which are commonly experienced by women with LEP. To expedite the attainment of health equity, it is important to promote access to health resources such as patient portals.