Socioeconomic and behavioural factors associated with access to and use of patient Electronic Health Records: a cross-sectional analysis of four European countries.

Abstract

Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to a lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of individuals’ electronic health records (EHR): motivations, intentions and physical access to patients EHR.Methods: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). First, exploratory factor analysis was performed to group items derived from the UTAUT model. Next, we applied linear and logistic regressions controlling for country-level heterogeneity, health and sociodemographic factors.Results: A total of 829 individuals aged over 18 completed the questionnaire. We found evidence of socioeconomic inequalities in the access to and use of EHR. Education and income played a significant role in individual’s desire to access their EHR. Being older than 65 years, and migrant, were negatively related to the desire to access EHR. An income gradient was found in having a physical access to EHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use EHR. In fully adjusted model testing the contribution of UTAUT-derived factors, individuals who perceived EHRs to be useful and had the necessary digital skills were more inclined to use their EHR regularly. Social support and lack of anxiety in using technology were strong predictors of regular use of EHR.Conclusion: The findings highlight the importance of considering all stages in the use of EHR (desire, physical access, and regular use), while paying special attention to migrants and people with lower socioeconomic backgrounds who may not be able to exploit the potential of EHRs. As EHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could lead to increases in health equity.

Promoting Self-determined and Informed use of Personal Health Records (PHR) among Older Adults: Assessment of Attitudes Towards the PHR and Requirements for an eLearning Platform

“…At the same time, little knowledge about it was evident among the participants, who reported di culties in gathering adequate information about the German version of the PHR. Although the study by Paccoud et al found that individuals aged 65 or older are associated with a lower desire to use the PHR, this was not found to be the case in the population of the study presented here (17). All the participants in this study reported wanting to use the PHR after its release.…”

Access to an Electronic Health Record: A Polish National Survey

“…Although there are not many similar recent studies from other countries, comparing the situation related to willingness to access EHRs is crucial. Referring to the publication by Paccoud, Baumann et al from 2020, based on surveys conducted in Luxembourg, Belgium, France, and Germany, on average, 82.6% of respondents were interested in accessing EHRs compared to 63.7% in our study [ 75 ]. It is worth mentioning that although we do not have such data from Poland due to a lack of implementation of EHRs so far, in Luxembourg, Belgium, France, and Germany, only 7.5% of respondents actually have access to EHRs, and only 3.5% intend to use EHRs regularly [ 75 ].…”

“…Referring to the publication by Paccoud, Baumann et al from 2020, based on surveys conducted in Luxembourg, Belgium, France, and Germany, on average, 82.6% of respondents were interested in accessing EHRs compared to 63.7% in our study [ 75 ]. It is worth mentioning that although we do not have such data from Poland due to a lack of implementation of EHRs so far, in Luxembourg, Belgium, France, and Germany, only 7.5% of respondents actually have access to EHRs, and only 3.5% intend to use EHRs regularly [ 75 ]. In Western countries, as in Poland, the interest in access to EHRs is positively correlated with a higher education level, and negatively correlated with older age.…”

“…In Western countries, as in Poland, the interest in access to EHRs is positively correlated with a higher education level, and negatively correlated with older age. In Western countries, women have expressed greater interest in access to EHRs, while in Poland, men were a bit more interested [ 75 ]. The general interest in access to EHRs is lower in Poland than in Western countries.…”