Browsing by Author "Akyirem, Samuel"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    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
    (JMIR, 2025-03-25) Whittemore, Robin; Jeon, Sangchoon; Akyirem, Samuel; Chen, Helen N. C.; Lipson, Joanna; Minchala, Maritza; Wagner, Julie; Epidemiology, Richard M. Fairbanks School of Public Health
    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%
  • Thumbnail Image
    Item
    Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care Providers
    (JMIR, 2024-09-16) Akyirem, Samuel; Wagner, Julie; Chen, Helen N.; Lipson, Joanna; Minchala, Maritza; Cortez, Karina; Whittemore, Robin; Epidemiology, Richard M. Fairbanks School of Public Health
    Background: Community health centers (CHCs) are safety-net health care facilities in the United States that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underused in CHCs. In addition, little is known about the specific barriers to and facilitators of patient portal use in CHCs and strategies to address the barriers. Objective: The objectives of this qualitative study were to explore the barriers to and facilitators of the use of patient portals for managing diabetes in 2 CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance use. Methods: A qualitative description design was used. A total of 21 participants (n=13, 62% clinicians and n=8, 38% adults with T2D) were purposively and conveniently selected from 2 CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, aged ≥18 years, diagnosed with T2D ≥6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care or services for adults with T2D were eligible for this study. Semistructured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were collected between October 5, 2022, and March 16, 2023. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented. Results: Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-clinician communication. However, challenges of health and technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal. Conclusions: Adults with T2D and clinicians at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low health literacy at CHCs is a critical next step. Implementing standardized patient portal strategies to address the unique needs of patients receiving care at CHCs also has the potential to improve health equity and health outcomes associated with patient portal use.