title: Reasons and barriers for using a patient portal: survey among patients with diabetes mellitus.
abstract: BACKGROUND
  The use of a Web portal for patients with diabetes mellitus to access their own personal health record may result in improved diabetes outcomes. However, the adoption by patients is slow. This may be caused by patient characteristics, but also by the content, layout, and promotion of the portal. Detailed knowledge about this could help increase patients' participation in Web portals.
  
  
  OBJECTIVE
  The aim was to study the opinions of patients with diabetes and identify perceived barriers to using a Web portal to optimize its use.
  
  
  METHODS
  We conducted a survey among patients with type 1 and type 2 diabetes mellitus from 62 primary care practices and 1 outpatient hospital clinic in the central area of the Netherlands who all used the same electronic health record with a Web portal. Questionnaires about patient characteristics, opinions about reasons for use or nonuse, and about portal content were sent to 1500 patients with a login and 3000 patients without a login to the Web portal. Patient groups were stratified according to login frequency. Demographic and diabetes-related variables were analyzed with multivariable regression analysis.
  
  
  RESULTS
  The total response rate was 66.63% (2391/4399); 1390 of 4399 patients (31.60%) were eligible for analysis. There were 413 regular users (login frequency more than once) and 758 nonusers (no login). Most nonusers (72.4%) stated that the main reason for not requesting a login was that they were unaware of the existence of the portal. Other barriers reported by patients were disinterest in managing their own disease (28.5%, 216/758) and feelings of inadequacy with the use of computers and Internet (11.6%, 88/758). Patients treated by a general practitioner were more frequently nonusers compared to patients treated by an internist (78.8%, 666/846 vs 28.3%, 92/325; P<.001) and more users than nonusers became aware of the Web portal through their physician (94.9%, 392/413 vs 48.8%, 102/209; P<.001). Nonusers perceived specific portal content as not as useful as regular users did, especially access to laboratory values (71.7%, 383/534 vs 92.3%, 372/403), rereading clinic visits (61.3%, 320/522 vs 89.6%, 360/402), e-messaging (52.0%, 262/504 vs 74.6%, 299/401), and uploading results to the glucose diary (45.3%, 229/506 vs 74.0%, 288/400; all P<.001).
  
  
  CONCLUSIONS
  Our study shows that unawareness of the patient portal is the main barrier of enrollment. Users and nonusers perceive the usefulness of the portal differently and do not have the same recommendations for additional functionalities. To increase patients' participation in a Web portal, the unawareness of its existence and its possibilities need to be addressed by their health care professionals.
authors.affiliation: Julius Center, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. m.c.m.ronda@umcutrecht.nl.
authors.forename: Maaike C M
authors.identifier: http://orcid.org/0000-0002-6829-6982
authors.initials: MC
authors.lastname: Ronda
authors.forename: Lioe-Ting
authors.identifier: http://orcid.org/0000-0001-7673-3743
authors.initials: LT
authors.lastname: Dijkhorst-Oei
authors.forename: Guy E H M
authors.identifier: http://orcid.org/0000-0001-5773-2614
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001292:Attitude to Computers; D001294:Attitude to Health; D003625:Data Collection; D003920:Diabetes Mellitus; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010358:Patient Participation; D011795:Surveys and Questionnaires
keywords: Internet; cross-sectional studies; diabetes mellitus; electronic health record; patient access to records; patient preference; telemedicine