title: A cross-sectional study of barriers to personal health record use among patients attending a safety-net clinic.
abstract: BACKGROUND
  Personal health records (PHR) may improve patients' health by providing access to and context for health information. Among patients receiving care at a safety-net HIV/AIDS clinic, we examined the hypothesis that a mental health (MH) or substance use (SU) condition represents a barrier to engagement with web-based health information, as measured by consent to participate in a trial that provided access to personal (PHR) or general (non-PHR) health information portals and by completion of baseline study surveys posted there.
  
  
  METHODS
  Participants were individually trained to access and navigate individualized online accounts and to complete study surveys. In response to need, during accrual months 4 to 12 we enhanced participant training to encourage survey completion with the help of staff. Using logistic regression models, we estimated odds ratios for study participation and for survey completion by combined MH/SU status, adjusted for levels of computer competency, on-study training, and demographics.
  
  
  RESULTS
  Among 2,871 clinic patients, 70% had MH/SU conditions, with depression (38%) and methamphetamine use (17%) most commonly documented. Middle-aged patients and those with a MH/SU condition were over-represented among study participants (N = 338). Survey completion was statistically independent of MH/SU status (OR, 1.85 [95% CI, 0.93-3.66]) but tended to be higher among those with MH/SU conditions. Completion rates were low among beginner computer users, regardless of training level (<50%), but adequate among advanced users (>70%).
  
  
  CONCLUSIONS
  Among patients attending a safety-net clinic, MH/SU conditions were not barriers to engagement with web-based health information. Instead, level of computer competency was useful for identifying individuals requiring substantial computer training in order to fully participate in the study. Intensive on-study training was insufficient to enable beginner computer users to complete study surveys.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America. joan@biostat.ucsf.edu
authors.forename: Joan F
authors.initials: JF
authors.lastname: Hilton
authors.forename: Lynsey
authors.initials: L
authors.lastname: Barkoff
authors.forename: Olivia
authors.initials: O
authors.lastname: Chang
authors.forename: Lindsay
authors.initials: L
authors.lastname: Halperin
authors.forename: Neda
authors.initials: N
authors.lastname: Ratanawongsa
authors.forename: Urmimala
authors.initials: U
authors.lastname: Sarkar
authors.forename: Yan
authors.initials: Y
authors.lastname: Leykin
authors.forename: Ricardo F
authors.initials: RF
authors.lastname: Muñoz
authors.forename: David H
authors.initials: DH
authors.lastname: Thom
authors.forename: James S
authors.initials: JS
authors.lastname: Kahn
mesh_terms: D054626:Consumer Health Information / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D055991:Health Records, Personal / Q000523:psychology; D006306:Health Surveys; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000523:psychology*