The ability to access, manage, and understand personal health information enables individuals to become better consumers and participate more fully in making health care decisions. The development of electronic health records and the availability of patient portals for accessing personal health records, coupled with myriad health information via the internet (eHealth), have provided the potential for electronic personal health information management (ePHIM). However, great variability exists in access to eHealth information for components of the US population. Despite continuing efforts, this digital divide remains for rural, minority and low-income communities. Limited access for ePHIM contributes to the health disparities experienced by these populations. The goal of this project is to improve the ability of low-income African American, American Indian, Latino, and white older adults living in rural and urban communities to use information technology applications for ePHIM. The project's conceptual framework combines the Technology Acceptance Model and the person- environmental interaction model. It uses a community-based participatory partnership of Wake Forest School of Medicine and its Outpatient Department Medicine Clinic, with Community Partners HealthNet, a network of 18 clinics serving 25 rural North Carolina counties, to achieve 3 specific aims: (1) document the ePHIM experience, knowledge, perceived needs, and perceived risks of low-income African American, American Indian, Latino, and white older adults living in rural and urban communities~ (2) delineate the actual use of ePHIM by low-income African American, American Indian, Latino, and white older adults living in rural and urban communities~ and (3) delineate differences in perception, belief and experience in using ePHIM between patients and caregivers who use versus those who do not use ePHIM. This project is significant because it will delineate disparities in ePHIM by working with two networks of clinics (Community Partners HealthNet~ Outpatient Department Medicine Clinic/Wake Forest Baptist Health) that provides care to rural and urban, low- income, and minority patients. Working with these networks, this project will implement in-depth and longitudinal research that will delineate the factors affecting ePHIM use among vulnerable elders. This project is innovative. (1) It will use qualitative data collection techniques within a community-based participatory research framework to assess the motives and barriers to patients' and caregivers' ePHIM among rural as well as urban, low-income, older adult, and minority communities. (2) It emphasizes the importance of including caregivers, particularly for older adults, in understanding the use of ePHIM. (3) It will use these qualitative methods to assess the perceptions of health care providers and IT providers about the potential use of ePHIM. (4) It will use these qualitative methods to determine the factors that facilitated and limited the use of ePHIM by comparing high / expert, medium, and low users. (5) It will document the actual pattern of ePHIM use among older adults and their caregivers over a one-year period. (6) It will explore the association of ePHIM use and chronic disease management among older adults.

R01HS021679

2013-07-01

2019-06-30