Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study (Preprint)

Abstract

BACKGROUND Online health technologies are increasingly being used in medical research and may be useful in addressing the HIV and sexually transmitted infection (STI) burden among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and use of new online health technologies. However, behavioral intentions to use patient portals for HIV/STI prevention and care among SMM is understudied. OBJECTIVE The goal of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for HIV/STI prevention and care among a nationwide sample of SMM. METHODS Twelve items of the American Men’s Internet Survey Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a prior study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting online access to their health records (N=1,375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach’s alpha (α) was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess goodness of fit of the final factor structure. We calculated total AMIS-PPSHI scale scores for comparisons within group categories, including age, HIV and STI diagnosis history, recency of testing, serious mental illness, and anticipated healthcare stigma. RESULTS The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α =.84). The EFA suggested three subscales: 1) Sexual health engagement and awareness (α=.87), 2) Enhancing dyadic communication (α=.87), and 3) Managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure; root mean squared error of approximation = .061, comparative fit index = .964, Tucker-Lewis index = .953, and standardized root mean squared residual = .041. The most notable differences were lower scores on the Enhanced dyadic communication subscale among people living with HIV. CONCLUSIONS The PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient-questionnaires in other settings. Scores demonstrate that patient portals are favorable IT solutions to deliver health services focused on HIV/STI prevention and care among SMM in the United States. More attention is needed to address privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV.

Behavioral Intentions to Use Patient Portals to Disclose HIV and Other Sexually Transmitted Infection Testing Histories with Sexual Partners Among U.S. Sexual Minority Men

“…Eligible criteria included U.S. residents, ≥ 15 years of age, self-identifying as cis-gender male, and reported a history of sex with a man or identifying as gay or bisexual [35,36]. In 2018, a randomized subset of participants (n = 4,687) was presented with the Patient Portal Sexual Health Instrument (PPSHI) to measure attitudes on using patient portals for HIV/STI prevention [34].…”

“…It is the "extent to which a measure predicts the answers to some other question or a result to which it ought to be related with [26,33]." The Enhancing Dyadic Communication (EDC) is a latent construct that measures the extent to which an individual believes that using patient portals to share HIV/STI testing history with sex partners enhances the dyadic exchange of test information with sex partners [34].…”