Twelve participants ranged in age from 29 to 78 years; approximately 66.66% (n=8) were males, and 58% had graduated from high school. Most of the participating patients used computers and the internet 1/2 to 1 h per week (n=4, 33.33%) (Table 1).
Table1: General characteristics of the users
Demographic Items
|
Frequency (%)
|
Gender
|
Male
Female
|
8(66.66%)
4(33.33%)
|
Age group (year)
|
<30
30-50
50-70
>70
|
1(8.33%)
3(25.00%)
6(50.00%)
2(16.66%)
|
Education Level
|
8th grade or less
High school graduate
4 year college
>4 year college
|
2(16.66%)
7(58.33%)
2(16.66%)
1(8.33%)
|
Computer & Internet usage
|
Never
<1/2 h/week
1/2 to 1 h per week
1-3 h per week
3-7 h per week
>7 h/wee
|
1(8.33%)
2(16.66%)
4(33.33%)
3(25.00%)
1(8.33%)
1(8.33%)
|
We identified 2 main themes: “practical worth” and “use free of effort”. Each of the themes comprised five and three subthemes, respectively, and 23 categories, which are displayed in Table 2.
Table2: Patient prespective about usability and usefulness of CKDPHRs
Main themes
|
Sub thems
|
Main categories
|
Practical worth
|
Personal Health Management
|
-Improve my self management
-Tailor to my need
-Improve underatanding of medical condition
- Improve greater control over health outcome
|
Personal Health Adherence
|
-Improve follow up and visit
-Improve medication adherence
-Improve preventive care
|
Personal Decision Support
|
-Improve choise lifestyle support
-Improve treatment education support
|
Personal Information Management
|
-Improve acuracy &validity of health information
-Improve portability of patient records
-improve access health information
- improve update health information
|
Communication Management
|
-Improve secure messaging and consult with health providers
-Improve medication refill
-Improve timely information sharing
|
Use free of effort
|
Error Handling
|
-Error prevention
- Good error massage
|
Subjectively Pleasing
|
-Good design
- Consistency
- Clarity of messages
-User friendly
|
Feasibility of recall
|
- Recognition rather than recall
|
“Practical worth” is about the quality of having utility and especially the applicability of PHRs to encourage patients to actively engage with them. There are five related subthemes: personal health management, personal health adherence, personal decision support, personal information management and communication management.
Personal health management: Patients reported improvements in their ability to self-manage their healthcare and greater control over health outcomes as a result of using PHRs, with an emphasis on tailoring to needs.
"I feel that I have great control over my treatment process after working with PHRs, and it has become easier for me to understand my health condition" (P9).
“I think using PHRs and their features, such as health dashboards, personal settings, health calendars and reminders, can help me manage my health, but it still needs to be more customized” (p12).
Personal health adherence: Most of the patients stated that PHR helps to improve medication adherence, follow-up and preventive care.
“I'm older and often forget about taking my medication; PHRs have made my job easier by providing reminders and alerts for me (P5).
Personal decision support: Four patients stated that they viewed the PHR as a method for improving lifestyle and education.
“PHR is very informative; I use educational and interpretive information with confidence because it was obtained under the supervision of my physician (p12).
Personal information management: Most of the participants stated that CKDPHR patients have unprecedented access to medical histories and clinical tracking information.
“This is the first time that I saw a wide range of information relevant to my health and wellbeing integrate” (P2).
Other interviewees said the following:
“I believed that access to more complete and accurate information would help effective manage and control of disease” (P5).
Communication management: Many dialogs from patients showed that they would value the opportunity to improve communication with their health provider via PHRs, for example, via a secure messaging function.
“I consult and ask questions from physicians about my care plan without the need for face-to-face appointments.”
The second main theme explored in the present study was “use free of effort”, which contains three subthemes: error handling, feasibility of recall and subjectively pleasing.
Error handling: Users believe that systems should make as few errors as possible when using a computer system.
Feasibility of recall: This subtheme refers to when once users have learned the work with systems and with which quickly they can perform the tasks. One patient said:
“After training by Administration, “It was very easy to learn how to use this system. I think I learned to work with different parts of the system very quickly” (patient 4).
Subjectively pleasing: Participants in the study said that they would be willing to use the system daily.
“This system can do all the things I think I would need for disease management and will I recommend it to my friends” (patient 1).
Additionally, some of the patients reported that some parts of the PHR had medical words and concepts that were difficult to understand. For example, participants had to read and interpret abbreviations, medical words and test results such as the glomerular filtration rate (GFR).