Factors Affecting Patients’ Use of Electronic Personal Health Records in England: Cross-Sectional Study

Abstract

BackgroundElectronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ ePHR use is important to increase adoption rates and improve the implementation success of ePHRs.ObjectiveThis study aimed to examine factors associated with patients’ use of ePHRs in England.MethodsThe unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling.ResultsOf 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB.ConclusionsThis study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors.

Factors Affecting the Behavioral Intention to Use Standalone Electronic Personal Health Record Applications by Adults in Egypt

“…Privacy and security concerns were found to have a significant negative effect on behavioral intention to use standalone ePHR systems by adults in Egypt, this result came in consistency with several studies in literature (Pottas & Mostert-phipps, 2013;Abdekhoda et al, 2019 ;Abd-Alrazaq et al, 2019b ), the result in this research was contradicting with other studies from literature (Cocosila & Archer, 2014;Al-Sahan & Saddik, 2016) which found insignificant effect of privacy and security concerns on behavioral intention, the result indicated a small direct effect of privacy and security concerns on behavioral intention which means that privacy and security concerns are representing a barrier for standalone ePHR adoption but without a major impact, however it should be handled with care to overcome its negative effect on behavioral intention.…”

“…Perceived usefulness was found to have a significant positive effect on behavioral intention to use standalone ePHR systems by adults in Egypt and it was one of the strongest predictors in the model, this result came in consistency with other researchers from different contexts worldwide (Noblin et al, 2013;Cocosila & Archer, 2014;Yuan et al, 2015;Tavares and Oliveira, 2016;Alhammad, 2017;Hsieh et al, 2017;Dutta et al, 2018;Abd-Alrazaq et al, 2019b), this result assures the importance of perceived usefulness as a predictor of behavioral intention in the consumer health informatics context. The result also came contradicting with other studies (Chun & Hong, 2015;Koivumäki et al, 2017), they found perceived usefulness has insignificant effect on behavioral intention to adopt ePHR systems by younger adults but the situation in Egypt was different since the sample in this research had more than 75% of respondents ranging from 18 to 40 years old.…”

Patients’ Perspectives About Factors Affecting Their Use of Electronic Personal Health Records in England: Qualitative Analysis

“…The hack attacks that happened to the NHS 4 months before data collection may have exacerbated these concerns in this sample. This finding is consistent with the results of the quantitative data in the original study [ 27 ], where perceived privacy and security significantly affected patients’ intention to use Patient Online. This factor was also found in other quantitative studies [ 33 - 36 ] and qualitative studies [ 37 - 43 ].…”

“…The qualitative data provide the focus of this study. Note that the findings from the quantitative analysis of the survey data were presented in a previous paper [ 27 ]. The survey gained health research authority approval before starting data collection (The Research Ethics Committee reference number: 17/SC/0323).…”

eHealth Technology in Forensic Mental Healthcare: Recommendations for Achieving Benefits and Overcoming Barriers

“…Consequently, developers of eHealth interventions should take the skill level and preferences of patients into account to prevent a mismatch between the technology and patient. Such a mismatch might result in high levels of non-adherence (Abd-Alrazaq et al, 2019). On the one hand, it can be beneficial to further investigate how patients can be better supported in using these mostly text-based apps or websites, which are used a great deal in current practice.…”