Personal Health Records (PHRs) have the potential to engage patients with their health, increase personal empowerment, and ultimately improve health outcomes. Yet despite these potential benefits, a narrowing, a digital divide still prevents many underserved patients from meaningfully engaging with their health information online. San Francisco General Hospital (SFGH) and its associated clinics is the safety net provider to a patient population with health disparities. Our previous work has focused on PHR access and barriers to use in patients with diabetes and HIV. In this project, we hope to engage all types of patients with MYSFHEALTH. The launch of the San Francisco Health Networks' PHR MYSFHEALTH represents a unique opportunity to engage patients through training, and integrate information resources, such as MedlinePlus, at the patients' point of need. We are well positioned to offer these trainings and integrate these resources. The SFGH Barnett Briggs Medical Library provides 20 public computer terminals, computer and health literacy training for patients and a dedicated patient education librarian to assist patients. The San Francisco Public Library (SFPL) has 27 branches with public computer access, and 846 staff capable of assisting patients. We plan to leverage the SFGH and SFPL staff and facilities to apply our previous research findings to a broader range of underserved patients in San Francisco. We propose 3 specific aims:
AIM 1 : Develop curriculum to teach patients how to access their own health information in MYSFHEALTH. Curriculum will be informed by patient interviews, s, for multiple modalities (individual, groups, and online) AIM 2: Determine feasibility of curriculum through direct patient feedback and iterative design. We will conduct focus groups with patients to test the curriculum messaging and content to ensure that it resonates with our patient population and their specific needs. We will complete 3 iterations of the curriculum based on 2 rounds of patient feedback (2 focus groups per feedback round).
AIM 3 : Conduct and evaluate a small pilot evaluation. Once the curriculum is finalized, we plan to test its effectiveness with a selected population of patients at the SFGH and SFPL libraries. Specifically, we plan to test whether the curriculum improves patients': 1) self-rated mastery/confidence in using the MYSFHEALTH website, and 2) intent to register and use the PHR to manage their healthcare.

Public Health Relevance

We plan to develop and deliver a curriculum to engage underserved patients with their own health information, by means of the Personal Health Record, MYSFHEALTH. This curriculum will be based on our research findings, designed with patient input, and tested with small patient groups. We will share our findings through journal publications and sharing of the curriculum with other groups that work with patients in underserved settings.

National Institute of Health (NIH)
National Library of Medicine (NLM)
Resources Project Grant (NLM) (G08)
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Special Emphasis Panel (ZLM1-ZH-G (01))
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Vanbiervliet, Alan
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Tieu, Lina; Schillinger, Dean; Sarkar, Urmimala et al. (2017) Online patient websites for electronic health record access among vulnerable populations: portals to nowhere? J Am Med Inform Assoc 24:e47-e54
Lyles, Courtney R; Fruchterman, Jim; Youdelman, Mara et al. (2017) Legal, Practical, and Ethical Considerations for Making Online Patient Portals Accessible for All. Am J Public Health 107:1608-1611
Tieu, Lina; Sarkar, Urmimala; Schillinger, Dean et al. (2015) Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study. J Med Internet Res 17:e275