Barriers to Patient Portal Adoption Among a Bilingual Patient Population by Analysis of Survey Findings from English- and Spanish-Speaking Patients: Information Needs Study.

Background: Despite legislative action, pre-existing barriers continue to prevent patients from using patient portals. Patients, especially older people, people of color, and people with limited English proficiency continue to experience difficulty in adopting patient portals. Objective: The aim of this study was to advance understanding, explore willingness to adopt an electronic portal, and examine differences between language preferences. Methods: English- and Spanish-speaking patients (N=106) were surveyed from a community clinic regarding access to electronic devices and the internet, barriers to using a patient portal, willingness to adopt such a portal, preference mode of communication with health care providers, and preferred features in the current clinic's portal. Linear and logistic regressions were performed to predict the probability that patients would adopt the patient portal. Results: Only 65% (n=69)of participants said they envisioned themselves using a patient portal. English-speaking patients were more willing to exchange electronic information with their health care providers. Spanish-speaking patients reported language as a significant barrier to portal use. A logistic regression revealed that patients with more positive attitudes and higher perceived behavioral control are more likely to sign up and use the patient portal (Nagelkerke R2=.51, classification=90.8%, efficacy B=2.38, Wald-1=5.93, P=.02 and Exp[B]=12.44, attitude B=1.87, Wald=6.45, P=.01, Exp[B]=7.49). Conclusions: Understanding language preference differences while predicting portal use based on attitudes and perceptions empowers patients to have a more meaningful experience with their physician, potentially overcoming low health literacy-related barriers.