Respectful Communication and Patient Portal Usage in Pregnant People of Color

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Project Summary Pregnant people of color consistently report poor communication, being dismissed, ignored, discriminated against and disrespected. Racially-based mistreatment contributes to worse experiences and increased labor interventions. Improvements in patient-provider communication (PPC) are urgently needed in prenatal care. With the increasing numbers of digital modalities, such as the patient portal, it is essential to examine the impact of these digital tools on PPC. Patient portals have emerged as an effective and valuable strategy to improve PPC providers in the general population. Research on patient portal usage in the general population, including in pregnant people, demonstrates lower portal usage in communities of color creating the digital divide. One aspect of this divide is digital health literacy (DHL). Few studies have examined DHL in pregnancy in the U.S. No study has examined the relationship between PPC, patient portal usage and DHL in pregnant people of color. With the persistent perinatal health inequities and the rapid integration of digital health tools, the time is now to better understand patient-provider communication, patient portal usage and digital health literacy in pregnant people of color. The long-term goal of the proposed research is to improve respect and quality in perinatal care through the creation of an inclusive, culturally relevant digital health intervention to address PPC for pregnant people of color. The specific aims are: Aim 1 - quantify the relationships between patient-provider communication, patient portal usage and digital health literacy in pregnant people of color; and Aim 2 - identify the facilitators and barriers to optimal digital communication in pregnant people of color. This multimethod study will recruit 130 self-identified pregnant people of color from an urban safety net hospital. Survey data will be collected on demographic and clinical information, as well as participant perceptions of PPC in pregnancy, patient portal usage and digital health literacy. Exploratory qualitative questions will be posed at the end of the survey to inquire about facilitators and barriers to optimal digital patient-provider communication. For Aim 1, regression analysis will examine the associations among respectful patient-provider communication, digital health literacy and patient portal usage in pregnant people of color, after controlling for covariates. In Aim 2, thematic analysis will be applied to understand how optimal communication develops through patient portal utilization by individual experiences of the participants. This research is significant because it proposes to examine a potentially modifiable influence on PPC, a public health priority. This study addresses the NINR’s research lenses to advance health equity and social determinants of health research. Without data on how patient-provider communication within the patient portal and utilization barriers faced by pregnant people of color, the benefit of this digital modality will be inequitable and disparities exacerbated.