Toward Normalizing Inclusive Design by Uncovering Patient Experiences of a Web Portal in a Dental Hospital: Mixed Methods Study

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Abstract
Background: Patient portals can improve care delivery and the efficient use of health care resources. Barriers to uptake can hinder the realization of expected benefits for health services and patients, particularly for older adults (≥65 y) and those who are culturally and linguistically diverse (CALD). Objective: This study aimed to evaluate the usability and overall patient experience of a patient portal, particularly for CALD and older adults. Methods: A mixed methods study at a dental hospital was performed including a patient experience survey that was administered before (2111 patients) and after (2445 patients) portal implementation to all patients, semistructured interviews (18 patients), and a usability survey (235 patients) that was administered to all patients who had registered to use the portal and had an appointment at the clinic. Also, we conducted a scenario-based usability evaluation (17 patients) with CALD and people. Results: The patient experience survey revealed that the portal had no impact on the ease of changing appointments when the clinic with the portal (Wilcoxon z=−1.62; P=.05) was compared with clinics without the portal in the same hospital (z=−1.54; P=.06). For the usability survey, >82% were completed by patients and 18% by carers, and 47.3% of respondents were older adults (≥65 years old). The majority spoke English (n=191, 81.3%), while others preferred to speak other languages (n=44, 18.7%) and were identified as CALD. Adult participants (18‐64 years old) reported that the portal was easy to use and simple. However, design problems, including inadequate incorporation of inclusivity, were found to more often limit usability for older (≥65) and CALD people. The overall Simplified System Usability Scale (SUS) mean score was 63.3 (95% CI 60.9‐65.7). Adult participants reflected higher SUS scores than older participants (F=10.4; P=.001). Interview results revealed how the portal was used and barriers to its uptake. Barriers related to poor usability and gaps in the implementation approach (eg, limited awareness of the purpose of the portal). Usability evaluations indicated that all participants could log in with the one-time password (OTP), but most were assisted. Only 3 of 17 participants were able to send a message to the clinic. Other usability problems identified were focused on display, content, layout, functionality, and navigation categories. Conclusions: The use of inclusive design principles when designing patient portals is necessary for successfully engaging all patients. Our study highlights the importance of normalizing inclusive designs in patient portals to ensure that priority populations, such as older and CALD people, are not marginalized by design. We provide recommendations to guide future design and implementation of patient portals.

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