Lack of Diversity in Personal Health Record Evaluations with Older Adult Participants: A Systematic Review of Literature.

Laura Kneale,George Demiris

doi:10.14236/jhi.v23i4.881

Abstract

Older adults are not adopting personal health records (PHRs) at the same rates as other adult populations. Disparities in adoption rates are also reported in older adult subgroups. The variability in adoption may be because PHRs are not designed to meet older adult users. We analyzed PHR evaluation studies to examine the characteristics and perspectives of older adult study participants to identify their self-reported needs. We searched Medline, CINAHL, PsycINFO, and Embase for PHR evaluation studies that involved older adult participants. 1017 abstracts were identified, and 179 publications went through full text review. 10 publications met inclusion criteria. These publications described studies conducted in 3 countries, and evaluated 7 PHRs. Homogeneity was found in the study populations and participant opinions of the systems. Many PHR evaluations do not include diverse older adult participants. This may lead to consistency in outcomes, but it also may create gaps in identifying user needs. Additional studies, specifically targeting diverse older adult participants, are needed to gain a more comprehensive understanding of the opinions of older adults on PHRs and how these systems could benefit older adult healthcare consumers. The body of research shows that older adults are highly satisfied using PHRs. These outcomes may be generalizable because most PHR evaluation studies do not include diverse older adult participants. This lack of participant diversity may be contributing to the disparities observed in PHR adoption rates.

Highlights

Older adults are not adopting personal health records (PHRs) at the same rates as other adult populations
Personal health records (PHRs) are tools that have been designed to support patient activation by allowing consumers to access, manage and share their personal health information.[5]. Recent governmental efforts such as the Affordable Care Act (United States (US)) and the Digital Agenda for Europe (European Union) have sought to increase adoption of PHRs among healthcare consumers.[6]. These efforts have led to a rise in PHR adoption rates,[7,8] but recent studies have found that older adults are less likely to adopt PHRs than younger or middle-aged adults.[9,10,11]
Our review suggests that older adults are willing, able, and highly satisfied using PHRs

Summary

Introduction

Older adults are not adopting personal health records (PHRs) at the same rates as other adult populations. Discussion Many PHR evaluations do not include diverse older adult participants This may lead to consistency in outcomes, but it may create gaps in identifying user needs. Personal health records (PHRs) are tools that have been designed to support patient activation by allowing consumers to access, manage and share their personal health information.[5] To support increased activation, recent governmental efforts such as the Affordable Care Act (United States (US)) and the Digital Agenda for Europe (European Union) have sought to increase adoption of PHRs among healthcare consumers.[6] These efforts have led to a rise in PHR adoption rates,[7,8] but recent studies have found that older adults are less likely to adopt PHRs than younger or middle-aged adults.[9,10,11] Disparities are even more pronounced in older adult minority populations, and with older adults with lower levels of education attainment.[10,11] One reason for these disparities may be that the PHRs have not been designed to truly meet older adult needs.[12,13] This hypothesis is consistent with other research that suggests older adults adopt health information technology for different reasons than younger adults.[14]

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Results

Discussion

Conclusion