Large-Scale Survey Findings Inform Patients’ Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment

Abstract

BackgroundSecure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users’ experiences in using secure email messaging.ObjectiveTo quantitatively assess veteran patients’ experiences in using secure email messaging in a large patient sample.MethodsA cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations’ Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance.ResultsThe majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy-to-use (P≤.001) communication tool, compared with individuals with lower reported health literacy. Many respondents (n=328, 40.0%) reported that they would like to receive education and/or felt other veterans would benefit from education on how to access and use the electronic patient portal and secure messaging (n=652, 79.6%).ConclusionsSurvey findings validated qualitative findings found in previous research, such that veterans perceive secure email messaging as a useful tool for communicating with health care teams. To maximize sustained utilization of secure email messaging, marketing, education, skill building, and system modifications are needed. These findings can inform ongoing efforts to promote the sustained use of this electronic tool to support for patient-provider communication.

eHealth literacy in chronic disease patients: An item response theory analysis of the eHealth literacy scale (eHEALS)

“…Healthcare providers who are aware of their patients’ eHealth literacy skillsets can better recommend relevant health information resource or train them to use technology-based resource [9]. Improving patients’ skills using Internet-based health resources, such as interactive discussion forums and secure messaging platforms [10], may enhance patients’ health-related knowledge and self-efficacy and self-manage their chronic condition(s).…”

Exploring the Measurement Properties of the eHealth Literacy Scale (eHEALS) Among Baby Boomers: A Multinational Test of Measurement Invariance

“…The eHEALS has also been used with a wide variety of samples, including schoolchildren and adolescents [13,45,52,56,64,66,67], parents [48,69], university students [23,42], adults comprising different age groups of a wide age range [16,58,60] and adults comprising solely older generations [34,43,54], as well as veterans [46,70], patients [44,49-51,53,71], caregivers [47], and health service providers [21,59]. The scale has been used with very small (<100) sample sizes [34,42,43,45,59], as well as studies comprising several thousand respondents [48,58,60,66].…”

Patient-centered communication in digital medical encounters

“…Previous studies have shown that portals are a preferred method for contacting a physician[13], and due to the increased access and general anonymity that online communication affords, patients are more likely to clearly express their thoughts[35] and to disclose potentially embarrassing issues[36]. Our findings indicate that both patients and providers are engaging in patterns of communication via online messaging that may differ from what has traditionally occurred in face-to-face encounters.…”

“…However, in-person communication is associated with greater communication apprehension than electronic modes of communication[11]. Electronic communication can be less intimidating than in-person encounters, and studies have shown that it is now patients’ preferred method for contacting a physician[12, 13]. …”