An RCT of an Online Training for Vulnerable Patients to Use an Online Patient Portal Website

Engaging Diverse Patients in Using an Online Patient Portal

Online patient portals are becoming ubiquitous in the US. Previous research has documented substantial usability barriers, especially among patients with limited health literacy. This pilot randomized pilot trial had the goal of determining the effectiveness of an in-person training with a scalable online video-based training program to increase portal use among patients in a safety net healthcare setting.

Study Overview

• Status: Completed
• Conditions: Chronic Disease; Health Literacy; Electronic Health Records
• Intervention / Treatment: Behavioral: Take-home online training; Behavioral: In-person online training

Detailed Description

The intervention in this study was a patient portal training curriculum with simple instructions and 11 how-to videos for accessing features of an online patient portal. Using a deeply participatory approach, this curriculum was created in consultation with a patient advisory board from the San Francisco Health Network, a local Medicaid health plan. From June until October 2016, 93 patients with 1 or more chronic diseases were randomized to receive either: 1) an in-person tutorial with a trained research assistant versus 2) a link to view the videos on their own. The primary outcome was portal log-in (yes/no) between 3 and 6 months post-training, assessed through a portal administrative dashboard within the EHR. Secondary outcome included baseline and follow-up survey measures on participants' perceptions of the portal use and their care, as well as views of the web-based lessons.

• Study Type: Interventional
• Enrollment (Actual): 93
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• English-speaking as portal is only available in English
• diagnosed with at least one chronic condition

Exclusion Criteria:

• cognitive impairment
• visual impairment
• severe mental health conditions
• any circumstances that would make participation in the study difficult
• no previous email use
• self-reported usage of MYSFHEALTH

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Placebo Comparator: Take-home online training; Participants received a link to access the online tutorial videos on their own.	Behavioral: Take-home online training; We randomized patients to receive a link to access the online tutorial on their own. Participants in the take-home arm were given a paper handout with a link to the training materials and an outline of the steps for accessing the training curriculum.
Active Comparator: In-person online training; Participants received an in-person tutorial of how to use the patient portal website with a trained research assistant.	Behavioral: In-person online training; For participants randomized to the in-person training arm, a trained research assistant prompted participants to log into the learning platform and guided them in accessing the training materials for portal features that were of interest to them. The staff member provided further explanation or clarification if participants had questions about the training material.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Portal log-ins	Logging into the portal website in the 3-6 months post-training (yes/no)	3-6 months post-training

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
eHealth Literacy	The eHEALS is a measure of eHealth literacy developed to measure consumers' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. eHEALS was measured at baseline and follow-up via surveys	3-6 months post-training
Portal sign-up	Initiating sign-up process for the portal website (yes/no), as pulled from EHR chart review	3-6 months post-training
Digital literacy skills	Confidence in having skills to be able to use online portal website (scored from 1 to 0), as self-reported via baseline and follow-up surveys	3-6 months post-training

Collaborators and Investigators

• Sponsor: University of California, San Francisco
• Investigators: Principal Investigator: Courtney Lyles, PhD, University of California, San Francisco

Publications and helpful links

General Publications

• Norman CD, Skinner HA. eHEALS: The eHealth Literacy Scale. J Med Internet Res. 2006 Nov 14;8(4):e27. doi: 10.2196/jmir.8.4.e27.

Helpful Links

• Published paper summarizing trial findings - A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2015
• Primary Completion (Actual): July 31, 2017
• Study Completion (Actual): July 31, 2018

Study Registration Dates

• First Submitted: November 9, 2017
• First Submitted That Met QC Criteria: November 21, 2017
• First Posted (Actual): November 27, 2017

Study Record Updates

• Last Update Posted (Actual): April 19, 2019
• Last Update Submitted That Met QC Criteria: April 17, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Keywords: Patient Portal; Healthcare disparities; Safety net healthcare system
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Chronic Disease
• Other Study ID Numbers: 5R00HS022408-05 (U.S. AHRQ Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No