Factors impacting electronic patient-generated data use in safety-net systems: a qualitative study

Area of Science:

• Implementation Science
• Health Informatics
• Patient-Centered Care

Background:

• Electronic patient-generated data (PGD) offers potential benefits for chronic disease management.
• Safety-net systems face unique challenges in adopting new health technologies.
• Understanding patient and clinician perspectives is crucial for successful implementation.

Purpose of the Study:

• To identify barriers and facilitators to electronic PGD use in safety-net settings.
• To explore patient and clinician perceptions of PGD implementation.
• To inform strategies for integrating PGD into safety-net care.

Main Methods:

• Conducted 43 semi-structured interviews with patients and clinicians.
• Observed 15 patient-clinician interactions in an urban safety-net system.
• Utilized thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR) and Behavior Change Wheel (BCW).

Main Results:

• Key barriers included capability (knowledge), motivation (data sharing preferences, attitudes toward digital tools, privacy), and opportunity (social support).
• Non-English speakers raised concerns about burdening others.
• Clinicians identified resource availability and implementation processes as additional barriers.

Conclusions:

• Addressing capability, motivation, and opportunity barriers is essential for successful electronic PGD implementation in safety-net systems.
• Systemic factors at patient, clinician, health system, and policy levels must be considered to overcome adoption barriers.
• Failure to address these factors will perpetuate challenges, particularly in under-resourced settings.