Veterans Experiences Using Secure Messaging

Study Overview
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Brief Summary
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Deployment of Secure Messaging (SM) in primary care and women's clinics throughout the Veteran Health System by 2011 was an implementation priority for the Secretary and Under Secretary for Health for FY11 under the VHA T21 initiative. Secure Messaging is in early phases of implementation, this eHealth tool requires thoughtful evaluation to promote the successful implementation and dissemination of this tool. The primary aim of this project is to describe Veterans' experiences when using the SM feature on MyHealtheVet (MHV). This project has local, VISN, and national impact on the implementation and sustainability of the SM feature on MHV through its qualitative and quantitative examination of users' experiences. Findings from this research explores why Veterans choose to, or not to, use the SM feature on MHV, identify facilitators and barriers, and examine if experiences differ by health literacy or computer literacy. In addition to the interview data, findings from the usability testing and the quantitative survey findings build knowledge about Veterans' experiences using the SM feature on MyHealtheVet. These data will inform systems improvements, educational approaches, and marketing strategies to increase adoption and long-term utilization among Veterans.

Detailed Description
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Project Background: Secure Messaging is a VHA implementation priority to improve Veteran access to care. Successful deployment of Secure Messaging will support improved access to care, and improved healthcare outcomes in the Veteran population. To support these initiatives, and the successful implementation of this health informatics tools in the VHA, this project is exploring Veterans' perspectives' about adopting Secure Messaging and their experiences using Secure Messaging to inform systems improvements, educational approaches, and marketing strategies. Objectives: The primary aim of this project is to describe Veterans' experiences when using the Secure Messaging feature on My HealtheVet (MHV). This research is designed to explore why Veterans choose to, or not to, use the Secure Messaging feature on MHV, identify facilitators and barriers, and examine if experiences differ by health literacy or computer literacy. In addition to the interview data, findings from the usability testing provide user data about Veterans' skills and patterns when using Secure Messaging. This study was extended to conduct a mail-in quantitative survey evaluation of Veterans experiences, preferences, purposes and perceived facilitators and barriers for using, or not using Secure Messaging. Methods: This is a prospective mixed-methods descriptive study. In Phase One: A purposive sampling was used to identify the sample of Veterans who have been Personally Authenticated for the Secure Messaging feature on My HealtheVet. Participants were recruited from two sites (Tampa n=18, Boston n=15). Phase 1 data collection procedures included: (1) surveys; (2) In-person interviews; (3) usability testing; (4) Secure Messaging secondary data collection; and (5) telephone interviews to complete study objectives. In Phase Two: Random sampling was used to collect mail-in survey data from up to 1,000 Veteran participants who have been personally authenticated to use secure messaging. Quantitative data will be summarized using descriptive statistics to describe sample characteristics, frequency counts and proportions. Study Status: The project team has completed data collection and analysis for Phase 1 and 2. Team is currently working on publications for dissemination.

Official Title
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Veterans' Experiences Using Secure Messaging on MyHealtheVet

Conditions
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Telemedicine

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Individuals who have been Personally Authenticated for the SM feature on MHV and who use SM independent of other caregivers, and cognitive impairment that prevents use of a personal computer. Exclusion Criteria: Unable or unwilling to provide informed consent.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Purposive Sampling<br>Purposive sampling was used to identify a sample of 33 Veterans who have been Personally Authenticated for the SM feature on MHV. Participants were recruited from each site (Tampa, Boston). Women were purposively recruited to ensure females were represented in data findings. | |
| Random Sampling<br>Random sampling was used to conduct a quantitative survey with 819 veterans to explore their experiences using secure messaging. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Usability of Secure Messaging | To determine ease of use and usefulness of secure messaging. Purposive sample of 33 participants were assessed for their ability to complete the following tasks: navigate to Secure Messaging, log-in to My HealtheVet and Secure Messaging, Set user preferences, check Secure Message inbox, open and send Secure Message, Open and read Secure Message attachment. Measured as: (1) able to complete task; (2) able to complete task with some difficulty; (3) not able to complete task. | baseline | 
| Secure Messaging Use and Content Patterns | Extraction of secure messages over a three-month time frame to examine message content type, including: general, tests, medication, and appointments. | 3 months | 
| Frequency of Electronic Resource Use | Mail surveys examine Veterans frequency of electronic resource use. | baseline | 
| Reasons for Using Secure Messaging Tool on My HealtheVet | Participants reported reasons for Using Secure Messaging tool on My HealtheVet | baseline | 
| Benefits of Using Secure Messaging | Veterans report benefits of using Secure Messaging | baseline | 
| Intention to Use Secure Messaging in the Future | Veteran respondent intention to use Secure Messaging in the future | baseline | 
| Veterans That Believed Improvements to the Secure Messaging System Would Make the Tool More Useful in the Future Are Presented in the Table. | Veterans were asked to report if improvements to the secure messaging system would make the tool more useful for use in the future. | baseline | 
| Veteran Need for Education Support for My HealtheVet and Secure Messaging Use. | Veterans were asked to report if they would like to have education and support using My HealtheVet and the Secure Messaging tool. | baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Qualitative, User, Computer Interface, quantitative, survey, telemedicine