Social Determinants and the Use of Personal Health Records

Individuals can gain health benefits when using Internet-based personal health records (PHRs) connected to doctors’ electronic health records (EHRs) because such connections facilitate access to health information, communication with one’s physician, and enhanced patient-physician shared decision-making about treatments (Kaelber et al., 2008). Individuals’ uses of the PHRs are also critical to creating a reliable health information infrastructure within the public health sector and improving the healthcare system (Tang et al., 2006). However, PHR adoption rates are low although many non-PHR users have stated their intentions to use PHRs (Fox & Duggan, 2013), suggesting an intention-behavior gap in individuals’ PHR adoption behaviors. However, no studies have examined where this intention-behavior gap may exist.

Methods

To identify potential moderating factors (e.g., age, gender, education, household income, race/ethnicity, health insurance, regular sources of care, healthcare service use) that may contribute to the gap between intention (=interval level) and actual use (=binary), we analyzed the Health Information National Trends Survey data on U.S. adults (18+) using structural equation modeling (SEM). Individuals who used a computer to access the Internet or communicate via e-mail and gave valid answers to all of the study variables were subsampled (unweighted N=4,078).

Results

The binary analysis results showed that only 14.3% of the Internet users reported that they used their PHRs to keep track of the care that they received, see their test results, schedule medical appointments, or conduct other health-related activities. Controlling for healthcare needs as well as the subjective norm on, attitude toward, and behavioral control for PHRs, the SEM identified gender, health insurance, and regular sources of care to be moderating factors. Specifically, being female (p<0.1) had a positive association to intention; however, it had a negative association to actual use. Having health insurance (p<0.01) and regular sources of care (p<0.05) had negative associations with intention; however, they had positive associations with actual use (p<0.05 and p<0.001, respectively). Meanwhile, education and employment were not related significantly with intention. However, with respect to actual use, education (p<0.001) had a positive association, while employment (p<0.01) had a negative association. Although age had a negative association with intention to use (p<0.001), it had no significant association with actual use. Meanwhile, doctor visits had no association with intention to use, but did have a strong positive association with actual use (p<0.001).

Conclusion

The results implied that the interactions among these social determinants created the location of the intention-behavior gap. PHRs could be the most necessary for individuals who are uninsured and lack regular sources of care because they can better maintain their health by obtaining their medical records through their PHRs; track their medical and treatment histories; and, in turn, maintain their health and/or chronic conditions. Hence, these moderating factors, along with the factors that had significant associations with actual PHRs use, suggest that healthcare practitioner and policymakers’ efforts toward increasing PHR use should focus on female adults who have jobs, but who lack healthcare accessibility and have lower educational levels. These efforts should also focus on older adults.