Beyond Technology Adoption: Exploring the Impact of Public Health Employees' Perceptions and Usage of Patient Portal to Advance Digital Health Equity

Abstract

BEYOND TECHNOLOGY ADOPTION: EXPLORING THE IMPACT OF PUBLIC HEALTH EMPLOYEES’ PERCEPTIONS AND USAGE OF PATIENT PORTALS TO ADVANCE DIGITAL HEALTH EQUITY By Helene Franchanita Edwards July, 2025 Director of Dissertation: Dr. Doyle Cummings Major Department: Public Health

ABSTRACT Background: Healthcare organizations have been at the forefront of health information technology (HIT), striving to promote health equity and improve access to care. The introduction of electronic health records with patient-centric access has been a game-changer, promising to elevate the quality of care and enhance patient-provider engagement. Among these technological advancements, patient portals provide individuals with secure, unrestricted access to their health information. Several studies have revealed disparities in patient portal adoption across multiple levels, including policy and governance, organizational, and individual levels, which are more pronounced among vulnerable populations who are less likely to achieve optimal health outcomes. There are limited studies assessing the technology acceptance of patient portals in safety net organizations, which provide healthcare services for vulnerable populations. In North Carolina, local health departments (LHDs) promote the health of their respective communities while also organizing and delivering healthcare services to uninsured individuals, Medicaid recipients, and other vulnerable populations. As safety net providers, LHDs play a pivotal role in promoting patient portal utilization among historically marginalized populations and those with limited English proficiency (LEP); therefore, understanding the perspectives of public health professionals on the technology acceptance of patient portals can impact universal adoption. Objective: This study aimed to identify predictors that influence the adoption of patient portals by public health professionals and their recommendations for others to use them. Methods: This quantitative cross-sectional study was conducted among local public health professionals, utilizing a 32-question survey, built in Qualtrics, based on the extended Unified Theory of Acceptance and Use of Technology-2 (UTAUT-2) model to investigate consumer acceptance of patient portals and behavioral intention to use and recommend them. Between February and April 2025, snowball convenience sampling strategies were employed to recruit local public health professionals across North Carolina. The primary theory constructs of performance expectancy, effort expectancy, social influence, and price value were considered independent variables. The dependent variables were behavioral intention to use and intention to recommend patient portals. Age, education, marital status, experience, and residence (urban or rural county) were tested as moderators between the primary theory constructs and behavioral intention to use. The three research questions and six hypotheses were analyzed using descriptive statistical analysis, bivariate analysis (ANOVA and Independent t-tests), and multivariate analysis (multiple regression analyses and Confirmatory Factor Analysis for structural equation modeling). Results: Of the 431 participants, 392 were included in the final analysis. Healthcare providers offered patient portal access to 98.7% (n = 387) of the respondents. Furthermore, 94.4% (n = 370) of the respondents reported having access to patient portals, and 90.8% (n = 356) used their portals within the last 12 months. Performance expectancy (β = .548, C.R. = 11.050, p < 0.001), effort expectancy (β = .303, C.R. = 7.088, p < 0.001), social influence (β = 0.066, C.R. = 2.021, p < 0.043), and price value (β = 0.100, C.R. = 2.905, p < 0.004) were the influential drivers of behavioral intention to use (R2 = 85.3%). Age (β = 0.949, p = 0.008), education (β = 0.959, p = 0.019), experience (β = 0.919, p = 0.007), and residence (β = 0.959, p = 0.029) had moderating effects on the independent variables of the adapted UTAUT-2 model. In addition, behavioral intention to use (β = 0.864, p < 0.001) had a statistically significant impact on intention to recommend (R2 = 74.7%). Conclusion: This study confirmed the valuable impact of healthcare providers promoting patient portals to their patients. Furthermore, performance expectancy, effort expectancy, social influence, and price value were statistically significant predictors of public health professionals’ behavioral intention to use patient portals. Behavioral intention to use and frequency of use of patient portals were statistically significant influential drivers of the intention to recommend patient portals to others. The study’s results suggest that local health departments should focus on strategies associated with these factors to expand health information technology policies, thereby improving population health and reducing barriers to the adoption of patient portals. Future research should be conducted in other contexts and explore additional predictors to develop effective interventions that encourage the adoption and sustained use of patient portals in advancing digital health equity.