title: Large-Scale Survey Findings Inform Patients' Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment.
abstract: BACKGROUND
  Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users' experiences in using secure email messaging.
  
  
  OBJECTIVE
  To quantitatively assess veteran patients' experiences in using secure email messaging in a large patient sample.
  
  
  METHODS
  A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations' Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance.
  
  
  RESULTS
  The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy-to-use (P≤.001) communication tool, compared with individuals with lower reported health literacy. Many respondents (n=328, 40.0%) reported that they would like to receive education and/or felt other veterans would benefit from education on how to access and use the electronic patient portal and secure messaging (n=652, 79.6%).
  
  
  CONCLUSIONS
  Survey findings validated qualitative findings found in previous research, such that veterans perceive secure email messaging as a useful tool for communicating with health care teams. To maximize sustained utilization of secure email messaging, marketing, education, skill building, and system modifications are needed. These findings can inform ongoing efforts to promote the sustained use of this electronic tool to support for patient-provider communication.
authors.affiliation: Veterans Health Administration, HSR&D Center of Innovation on Disability and Rehabilitation Research, Tampa, FL, United States. joliehaun@gmail.com.
authors.forename: Jolie N
authors.identifier: http://orcid.org/0000-0003-4075-3763
authors.initials: JN
authors.lastname: Haun
authors.forename: Nitin R
authors.identifier: http://orcid.org/0000-0001-6263-8075
authors.initials: NR
authors.lastname: Patel
authors.forename: Jason D
authors.identifier: http://orcid.org/0000-0002-1610-0431
authors.initials: JD
authors.lastname: Lind
authors.forename: Nicole
authors.identifier: http://orcid.org/0000-0001-8423-6237
authors.initials: N
authors.lastname: Antinori
mesh_terms: D000328:Adult; D000368:Aged; D003142:Communication; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D012648:Self Care; D011795:Surveys and Questionnaires; D014481:United States; D014728:Veterans
keywords: Internet communication tools; cross-sectional survey; email; veterans