Patient portals are being extensively studied as an empowering tool that securely connects patients to their physicians and allows them to access their health information to emphasize active patient engagement (1–3). Mobile apps have become an integral aspect of patient portals which integrate telemedical features to facilitate patient-physician interaction within hospital settings (2–7). By using electronic patient portals through mobile apps, patients can access their health records, communicate asynchronously with their physicians, schedule appointments, and check out health information related to their condition (2, 8–11). A systematic review of 170 studies confirmed that technology positively affects patient engagement, health outcomes, and health-related behaviors (5, 12). Furthermore, many patients reported increased self-efficacy and empowerment as they became partners in their care plan and decision-making (9, 13). Some studies also claimed that patients’ ability to access their health information and test results at their convenience significantly facilitated future in-person patient-doctor communication (9).
Several studies examined usage patterns of patient portals and identified some predictors of patient portal utilization. For example, higher use of patient portals was reported among patients living in cities compared to residents of rural areas, especially among those distant from the care provider; lower age, low socioeconomic status, and having chronic conditions were also positively related to patient portal access (14–16). Other studies suggested increased use when physicians encouraged it (17, 18). Moreover, some studies showed how usability elements (i.e., user experience, perceived usefulness, and ease of use) might be crucial to increase adherence to patient portals (8). However, more research is needed to highlight the usability of patient portals through an easy and accessible interface such as a mobile app.
Another critical factor that plays a role in accessing a patient portal is access to technology and internet connectivity. The so-called “digital divide,” which refers to the gap among different demographics and regions in access to information technology, is essential in adopting patient portals. For example, the speed of the internet is a crucial factor affecting patient portal use. In addition, the fear of information breaches and lack of confidentiality are common concerns that need to be addressed (19, 20). Despite numerous efforts to improve access to health information, difficulties in navigation as displaying the health data in small-format and complex interfaces still create a gap in understanding the health data (21). Furthermore, literacy challenges, basic and routine computer barriers related to using a search bar or navigating a website, and difficulties understanding medical terminology create a burden in using patient portals (22). A recent study on the level of eHealth literacy in Lebanon (23) showed that socioeconomic status, gender, and education were positively related to eHealth literacy. Furthermore, a study conducted among diabetic patients in Saudi Arabia showed that essential factors such as internet access, content, and language might be substantial barriers to patient portal utilization (6, 24).
While most of the evidence on patient portals comes from the Western world, little is known about the usage of such technology in developing countries, especially in the Middle East, a region that lags in the accelerated era of health informatics applications and electronic patient portals (10, 25–27). Even in some affluent countries such as the UAE, the adoption and utilization of eHealth platforms are in their early stages, requiring governments to put extra effort into encouraging user engagement and raising awareness about patient portals’ benefits (28). For example, in Lebanon, recent reports suggest high internet penetration rates (29) and widespread smartphones use (30). In addition, a previous study on user acceptance of patient portals in Lebanon reported that about half of the sampled population reported a significant intent to use the portal (24). Given that the intention to use was lower than that reported in the Western literature, the authors feared even lesser actual app utilization rates (24, 31). However, no studies investigate how users perceive these patient portals and which benefits and barriers to the use of patient portals in developing countries are dramatically scarce. Also, no studies have examined the role of mobile apps in providing access to patient portals.
This study aimed to evaluate how patients to access, utilize, and perceive the quality of a mobile app (MyChart), which provides access to the patient portal in a tertiary healthcare center. This study specifically examined factors facilitating and hampering the usage of the portal and the associations between portal use, sociodemographic characteristics, and perceived app quality.