Impact of Patient-Clinical Team Secure Messaging on Communication Patterns and Patient Experience: Randomized...

Area of Science:

• Health Informatics
• Patient Engagement
• Digital Health Interventions

Background:

• Secure messaging (SM) is recommended for continuous care but faces low patient adoption.
• The Veterans Health Administration (VHA) sought to increase patient use of SM via their online portal, My HealtheVet (MHV).

Purpose of the Study:

• To test the effectiveness of a multicomponent Supported Adoption Program (SAP) in increasing patient engagement with SM.
• To evaluate the impact of the SAP and SM adoption on perceived provider autonomy support and communication.
• To identify patient-reported barriers to SM adoption.

Main Methods:

• A multisite, randomized encouragement design trial involving 1195 VHA patients who had MHV accounts but had not used SM.
• Intervention group received the SAP (educational materials, proactive SM, motivational interviews); control group received usual care.
• Outcomes assessed at 9 and 21 months included SM adoption rates, perceived provider autonomy support, and communication methods.

Main Results:

• SAP recipients showed significantly higher SM adoption rates than controls at 9 and 21 months (17.0% vs 6.7% at 9 months; 23.7% vs 13.5% at 21 months).
• SAP participants reported higher perceived provider autonomy support and less telephone communication with providers.
• Key barriers included low self-efficacy, no perceived need for SM, and technical difficulties with portal login.

Conclusions:

• The multicomponent SAP successfully increased SM adoption by 10 percentage points above standard care.
• New SM adopters reported improved perceptions of provider autonomy support and reduced telephone use.
• Lower-than-anticipated adoption rates suggest that addressing barriers like perceived need for SM requires tailored interventions beyond encouragement and technical assistance.