TY  - JOUR
AU  - Whittemore, Robin
AU  - Jeon, Sangchoon
AU  - Akyirem, Samuel
AU  - Chen, Helen N C
AU  - Lipson, Joanna
AU  - Minchala, Maritza
AU  - Wagner, Julie
PY  - 2025
DA  - 2025/3/25
TI  - Multilevel Intervention to Increase Patient Portal Use in Adults With Type 2 Diabetes Who Access Health Care at Community Health Centers: Single Arm, Pre-Post Pilot Study
JO  - JMIR Form Res
SP  - e67293
VL  - 9
KW  - patient portal
KW  - mobile phone
KW  - diabetes
KW  - community health center
KW  - adults
KW  - diabetic
KW  - DM
KW  - diabetes mellitus
KW  - Type 2 diabetes
KW  - T2D
KW  - community health centers
KW  - CHCs
KW  - pilot study
KW  - feasibility
KW  - self-management
KW  - glycemic control
KW  - patient portals
KW  - social determinants of health
KW  - primary outcome
KW  - digital health
KW  - digital health literacy
KW  - health technology
KW  - health technologies
KW  - psychosocial
KW  - efficacy
AB  - Background: Diabetes self-management education and support (DSMS) delivered via patient portals significantly improves glycemic control. Yet, disparities in patient portal use persist. Community health centers (CHCs) deliver care to anyone who needs it, regardless of income or insurance status. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a multilevel intervention to increase access and use of portals (MAP) among people with type 2 diabetes (T2D) receiving health care at CHCs. Methods: A within-subjects, pre-post design was used. Adults with T2D who were portal naive were recruited from 2 CHCs. After informed consent, participants met with a community health worker for referrals for social determinants of health, provision of a tablet with cell service, and individualized training on use of the tablet and portal. Next, a nurse met individually with participants to develop a DSMS plan and then communicated with patients via the portal at least twice weekly during the first 3 months and weekly for the latter 3 months. Data were collected at baseline, 3 months and 6 months. The primary outcome was patient activation and engagement with the portal. Secondary outcomes included technology attitudes, digital health literacy, health-related outcomes and psychosocial function. Results: In total, 26 patients were eligible, 23 received the intervention, and one was lost to follow up. The sample was predominately Latino or Hispanic (17/22, 77%) and reported low income (19/22, 86%< US $40,000/year), low education (13/22, 59% <high school), and no health insurance (12/22, 55%). All participants had access to a Smartphone, but 91% (20/22) had never accessed a health app. The baseline hemoglobin A1c level was 8.31%. Portal activation was high; 100% (22/22) of participants created a portal account and logged in within the first month. Mean participant logins per week over the first 3 months was 3.16 (SD 1.55) and 1.45 (SD 0.93) over the final 3 months; mean logins per month over the first 3 months was 12.65 (SD 6.21) and 5.79 (SD 3.74) over last 3 months. Engagement was high; 96% (20/21) logged in at least twice per month in the first 3 months and 76% (16/21) between 3 and 6 months. At 6 months, improvements were seen in technology confidence, digital health literacy, diabetes self-efficacy, and diabetes distress. Participant satisfaction with MAP was high as was intention to continue portal use. Barriers to clinical integration and recommendations for portal development were identified. Conclusions: MAP shows promise for improving health equity in portal use for T2D. Larger, controlled studies are needed to determine how best to implement MAP in complex clinical settings and to evaluate efficacy over time. Trial Registration: ClinicalTrials.gov NCT05180721; https://clinicaltrials.gov/study/NCT05180721 
SN  - 2561-326X
UR  - https://formative.jmir.org/2025/1/e67293
UR  - https://doi.org/10.2196/67293
UR  - http://www.ncbi.nlm.nih.gov/pubmed/40131327
DO  - 10.2196/67293
ID  - info:doi/10.2196/67293
ER  -