背景:健康的数字决定因素(DDoH),包括获得技术工具,数字健康素养,和互联网接入,作为健康的障碍独立发挥作用。在大多数医疗保健系统中,DDoH的评估并不是常规的,尽管解决DDoH可能有助于减轻不同的健康结果和数字鸿沟。
目的:评估DDoH个体水平因素对患者入组和使用患者入口的影响。
方法:多模态,根据电子病历中记录的首选模式和语言,对11,424人进行了横断面调查。基于技术接受模型,纳入患者入口和使用患者入口的意向是我们感兴趣的结局.评估感知有用性和易用性以确定结构效度,探索性调查包括个体水平的DDoH,包括互联网和设备访问,技术支持的可用性,医疗复杂性和症状负担,个人与医疗系统的关系,数字健康素养。计数(n)和比例(%)用于描述反应类别,并报告未调整和调整的比值比。
结果:这项研究包括1,850名受访者(11,424名被邀请;回应率为16.2%),其中大多数是女性(58.3%),白色(77.2%),平均年龄为63岁。在验证技术接受模型时,感知易用性的度量(即,使用病人入口需要大量的脑力,患者门户将非常容易使用)和感知的有用性(即,患者门户与提供者发送和接收消息的有用性,安排约会,补充药物)与患者入口的登记和使用意图呈正相关。在调整后的模型中,除了数字健康素养的构建之外,感知的易用性和感知的有用性构建,了解互联网上可用的卫生资源(aOR=3.5,95%CI1.8-6.6),入口易用性(AOR=2.8,95%CI1.6,5.0),和门户有用性(aOR=2.4,95%CI1.4,4.2)与患者门户登记显著相关.与患者门户登记和使用意图相关的其他因素包括舒适地阅读和说英语,报告使用互联网上网或发送/接收电子邮件,家庭互联网接入,以及对技术设备的访问(计算机,平板电脑,智能手机,等。).
结论:评估和解决个人水平的DDoH,包括数字健康素养,获得数字工具和技术,以及对患者之间关系方面的支持,社会支持系统,医疗保健提供者可以帮助减轻和减少健康方面的差距。通过集中努力评估和解决个人水平的DDoH,我们有机会改善数字驱动的医疗保健交付成果,如访问和体验,以及结构结果,例如在算法中建立的偏见,这些算法在社区中具有不完整的表示形式。
背景:
BACKGROUND: Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide.
OBJECTIVE: This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal.
METHODS: We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported.
RESULTS: This study included 1850 respondents (11,424 invited, 16.2% response rate), who were mostly female (1048/1850, 56.6%) and White (1240/1850, 67%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95% CI 1.8-6.6), portal ease of use (aOR 2.8, 95% CI 1.6-5), and portal usefulness (aOR 2.4, 95% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc).
CONCLUSIONS: Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities.