"Really hard to navigate": A qualitative study of motivators, barriers, and supports of adolescent-clinician communication on patient portals.

Abstract

Purpose: To understand how patient portals can support adolescent sexual and reproductive health (SRH) care needs and to identify factors impacting use of patient portals for adolescent-clinician communication.

Methods: We conducted semi-structured interviews with adolescents, parents/guardians, and primary care providers (PCPs) by video or phone. Interview guides explored experiences with adolescent healthcare-seeking generally and SRH care specifically, as well as perspectives regarding adolescent portal use. Interviews were recorded, transcribed, and deidentified. Interviewer summaries written after each interview noted key themes that informed analysis. The analysis team collaboratively coded transcripts. Codes were synthesized into analytic memos, which were refined to develop results.

Results: We interviewed 31 people from one health system: 10 adolescents 14-17 years old and 10 parents/guardians of adolescents aged 14-17, and 11 primary care providers (PCPs). A motivator of portal use shared by all participants included convenience of use. Clinicians and parents/guardians also viewed portals as a tool to support adolescent independence and improve quality of care. Barriers shared by all participants included lack of adolescent portal uptake and dissatisfaction with functionality. Clinicians and adolescents raised concerns about confidentiality while parents and clinicians raised concerns about safety of care. Supports shared by all participants included encouragement and guidance from trusted adults, while adolescents and clinicians described the reinforcing nature of positive care experiences using the portal.

Discussion: Through the perspectives of adolescents, parents/guardians, and clinicians, we elucidated key factors that may influence adolescent portal use for SRH care needs. We identified critical intervention targets for future research.