Homeless-experienced patients' perspectives on improving patient portal Use

Persons who have experienced homelessness (PEHs) face profound health disparities and barriers to digital health access. Among Department of Veterans Affairs (VA) patients experiencing homelessness, only 36% (vs. 70% of all VA users) are enrolled in the VA's digital patient portal: My HealtheVet (MHV). MHV allows patients to access health information and communicate with providers.

We conducted an exploratory qualitative study to identify PEHs' perspectives on MHV engagement and inform equity-focused strategies to support portal adoption.

We conducted semi-structured interviews with 17 PEHs at VA Greater Los Angeles who enrolled in MHV and participated in the Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program, which combines housing subsidies with case management for Veterans experiencing homelessness. Interviews explored MHV enrollment, uses, barriers and facilitators to engagement, and recommendations to improve adoption. Data were analyzed using rapid qualitative methods.

PEHs valued MHV for secure messaging, medication management, and medical record access. Technical challenges, including login difficulties, hindered engagement. Housing stability in HUD-VASH facilitated MHV use via reliable technology, whereas homelessness itself was a barrier. Peer networks supported MHV adoption through knowledge exchange. Participants recommended simplifying interfaces, integrating MHV training into HUD-VASH intake, increasing technical support from VA staff, and providing devices to address gaps.

MHV utilization may improve health engagement among PEHs. However, its benefits are limited by persistent digital inequities. Targeted strategies-such as peer-led onboarding, interface simplification, and integration of MHV support within housing services-may improve uptake and promote equitable access to digital healthcare.