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Patient Portal Adoption Barriers in a Safety-Net Clinic: A Mixed-Methods Study With National Comparison
Solomon Kim1, Leah Bourgan1, Lawrence Chen1
1College of Medicine, California Northstate University, Elk Grove, CA, USA.
The Permanente Journal
|July 24, 2026
Summary
Patient portal adoption is significantly lower in safety-net clinics due to system usability and trust issues, not health literacy. Tailored strategies are crucial for equitable digital health access.
Area of Science:
- Digital Health Equity
- Health Informatics
- Health Services Research
Background:
- Patient portals are key for healthcare communication but face adoption disparities in underserved populations.
- Existing strategies often overlook unique barriers in safety-net settings.
Purpose of the Study:
- To investigate patient portal adoption barriers in a safety-net setting.
- To compare adoption mechanisms between safety-net and national populations.
Main Methods:
- Mixed-methods study at a student-run free clinic (112 patients, 42 practitioners).
- Exploratory cluster analysis of patient engagement patterns.
- Semistructured interviews and logistic regression for comparative analysis.
Main Results:
- Local portal adoption (22.3%) was substantially lower than national rates (66.1%).
- Barriers identified were system usability and trust, not health literacy.
- Predictive models performed poorly locally, indicating different adoption drivers.
Conclusions:
- Equitable digital health requires community-specific assessments.
- System-level factors, not individual deficits, likely drive low adoption in underserved groups.
- Tailored interventions are needed for safety-net settings.
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