JMIR Perioperative Medicine · Published 2026-01-07 · DOI 10.2196/72035
Abstract BackgroundAs electronic patient portals (EPPs) continue to gain popularity and systems transition to online tools for scheduling, communication, and telehealth, patients without access or skills to use these tools may be overlooked. ObjectiveThis study analyzed patient and neighborhood-level factors, including eHealth literacy level and the Area Deprivation Index (ADI), that may limit EPP access for orthopedic surgery. MethodsA cross-sectional, survey-based study was performed at a single urban tertiary academic medical center in the United States across foot and ankle, hand and upper extremity, and orthopedic trauma subspecialty clinics from June 21, 2022, to August 12, 2022. Survey responses (N=287) provided information on sociodemographic characteristics; barriers to EPP use and frequency of EPP use; the eHealth Literacy Scale; and the ADI, which is an address-generated national census measure of neighborhood-level disadvantage. Barriers to EPP use were inductively coded into barrier types, classified as physical access, technology discomfort, or preference. The primary outcome measure was patient-reported barriers to EPP use, which was treated as a binary outcome (1=barrier; 0=no barrier). Bivariate analyses and multivariable binary logistic regressions were performed. ResultsThe percentage of patients who self-reported barriers to EPP access was 43.2% (124/287), which related to physical access (13/124, 10.4%), technology discomfort (55/124, 44.3%), and preference (78/124, 63.0%). In the adjusted regressions, only low eHealth literacy and older age predicted barriers to EPP use (low eHealth literacy, adjusted odds ratio [AOR] 1.32, 95% CI 1.13-1.54; PPPPPP ConclusionsLow eHealth literacy was the most significant determinant of overall barriers to EPP use for orthopedic surgery, followed by older age. Neighborhood-level disadvantage as measured through the ADI had no mediating effect on patient-reported barriers to EPP use when adjusting for eHealth literacy level. While patients with physical access barriers had higher ADIs, overall, few patients reported physical access barriers compared to barriers related to technology discomfort or preference. Patient preference for EPP versus non-EPP communications should be documented. Point-of-care screening using the eHealth Literacy Scale may also identify patients who require follow-up outside of the EPP during critical perioperative periods.
Abstract from DOAJ. Public domain (CC0 1.0).
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