InPAct - Increasing Patient Activation by encouraging and enhancing online records access in primary care

Research question How can we improve patient online access to their GP record to enhance patient activation, care, and health outcomes? Background GP contracts in England state practices must offer patients online access to their primary care record.

Systematic reviews demonstrate that online access benefits both patients and clinicians, for example by improving patients' feelings of autonomy and increasing uptake of preventive services. Challenges include resistance from clinicians, and concerns about data security or increasing patient anxiety.

Previous research has focussed on potential benefits/problems associated with online access, how patients interact with their record, and barriers/facilitators to doing so.

There is little on patients' views, and a paucity of theory-driven work on how online health records access can best be designed and enhanced to maximise potential beneficial health impacts.

Aims and objectives The overall aim of the project is to develop and test improvements to the online patient record platform (an enhanced online portal), and to ascertain the feasibility of a trial testing the impact of this on patient activation and health outcomes. Key objectives are: To identify the issues, needs and challenges that an enhanced online portal must address.

To identify guiding principles that will steer design of the enhanced online portal. To develop and optimize platform improvements and design an intervention based on these.

To assess the feasibility of evaluating an intervention containing an enhanced online portal, in order to test if this could lead to enhanced patient activation and improved health outcomes.

Methods and timelines for delivery We will employ mixed methods, use the person-based approach (9), and adhere to MRC guidance on complex interventions (10). Timelines are laid out below.

Plan of investigation Stage 1: Planning (by month 12) To identify key issues, needs, and challenges that platform improvements must address.

This will include a review of current usage data, qualitative work with stakeholders, a synthesis of relevant evidence, and an exemplar case study.

Stage 2: Design (by month 22) To define the 'guiding principles' to help guide the design of the enhanced online portal to address the findings from stage 1, employ theoretical modelling and intervention mapping from established behaviour change techniques, and user-centred design to create personas, scenarios and use cases.

Stage 3: Development (by month 32) To develop the enhanced online portal and optimise it from a user perspective, using 'think-aloud' techniques, iterative modification, and prototype development through user-centred design.

Stage 4: Feasibility testing (by month 46) To ascertain the feasibility of testing the enhanced online portal in primary care and conduct a process evaluation (11) with patients and staff.

Anticipated Impact and Dissemination Findings will inform the development of an RCT to assess the impact of a primary care based complex intervention built around an enhanced online portal.

Findings will be disseminated via our collaborators at NHSx, presented at public engagement events, in scientific journals, conferences, distributed to relevant stakeholders, and posted on the study website.