Activated by Few, Used by Fewer: Closing the Patient Portal Gap for Older, Spanish-Speaking Patients at a Border Clinic, With Evidence on Who Uses Portals and Why
[Student Name]
University of Phoenix
DNP/715: Information Systems and Health Care Delivery Technology
Week 6 Assignment
[Instructor Name]
[Date]
The clinic and figures are composites written for a model paper.
I am a family nurse practitioner at a community clinic in a Texas border city, serving about 11,000 patients, 68% of whom prefer Spanish. Our portal lets patients see results, message clinicians, request refills and join video visits. Since we introduced video visits during the pandemic, portal access determines who can use them. A report showed that 41% of our English-preferring patients had activated portal accounts, compared with 12% of Spanish-preferring patients, and only 4% of Spanish-preferring patients over 65. This paper explains the gap and designs a response.
What a Similar Population Showed
Ancker et al. (2011) studied portal adoption over two years in a network of community health centers serving predominantly low-income patients. Only 16% of patients received an access code; of those, 60% activated accounts and 49% used them two or more times. Patients who were white, female, younger, English-speaking and insured were more likely to receive access codes, and English language and insurance were associated with repeat use. Racial disparities were small but persisted after adjustment.
Our Gap Starts Upstream
Like the clinics Ancker et al. (2011) studied, our gap begins before patients choose whether to use the portal: staff offer activation codes less often to Spanish-speaking and older patients. A review of 200 visit records found that activation was offered at 58% of visits with English-preferring patients and 21% with Spanish-preferring patients. Staff explained that they assumed older Spanish-speaking patients would not want it.
What Influences Engagement
Irizarry et al. (2015), in a state-of-the-science review of 120 studies, found that patients' interest and ability to use portals were strongly influenced by age, ethnicity, education, health literacy, health status and caregiver role, and that health care delivery factors, mainly provider endorsement and portal usability, also contributed. They called for research on specific populations and contexts.
Staff assumed older Spanish-speaking patients did not want the portal, so they never offered it, and the data then seemed to prove them right.
Usability in Spanish
Our portal has a Spanish interface, but results, visit summaries and clinician messages appear in English. For a Spanish-speaking patient, a laboratory result labeled only in English is not accessible even if the login works.
Infrastructure
A survey of 150 Spanish-preferring patients over 50 found that 62% had a smartphone, 23% had home broadband and 41% relied on limited prepaid data. Rodriguez et al. (2022) argue that digital inclusion, meaning access to devices, broadband and digital skills, should be treated as part of health care, and that health systems and policymakers should invest in digital infrastructure alongside clinical services to prevent digital tools from widening disparities.
Health Literacy
Many of our older patients completed only primary school. Portal screens use terms such as "encounter," "result pending" and "proxy," which confuse readers of any language. Plain-language labels and short video instructions in Spanish, played on the clinic's waiting-room screen, can make the portal easier to understand.
Why Video Visits Raise the Stakes
During the pandemic, video visits became a main route to care. Patients without portal access had to use telephone visits, which limit examination and visual education. If video visits remain an option, unequal portal access becomes unequal access to a form of care, not just to a convenience.
Staff Beliefs
Staff assumptions were the first barrier. In a brief session, I shared the offer-rate data by language and invited staff to discuss why the gap existed. Several were surprised; one medical assistant said she had stopped offering the portal after two older patients declined. Showing staff their own data, without blame, opened the door to change.
Designing the Response
The program addresses each level. Staff: every patient is offered activation at check-in, with a script in both languages, and offer rates are tracked by language. Support: a bilingual digital navigator, a community health worker trained in portal use, helps patients activate accounts on their own phones and practice sending a message. Usability: we will request Spanish visit summaries and plain-language result explanations from the vendor, and clinicians will reply in the patient's language. Infrastructure: the navigator helps eligible patients enroll in federal and local low-cost internet programs, and the clinic offers free Wi-Fi and a private room for video visits.
Messaging Load
Increasing portal use will increase message volume. Our nurses already answer about 300 portal messages a day. The program includes a message triage protocol and a bilingual nurse who handles Spanish messages, so that expanding access does not overwhelm staff or delay replies.
Family Caregivers
Many older patients rely on adult children. Proxy access, with the patient's consent, lets a caregiver manage messages and appointments. Irizarry et al. (2015) identified caregiver role as a factor in engagement; proxy access builds on it.
Privacy Concerns
Some patients worry that online accounts expose their information or immigration status. The navigator explains in Spanish what the portal contains, who can see it and that the clinic does not share information with immigration authorities. Addressing fear directly is part of digital inclusion.
Provider Endorsement
Clinicians will mention the portal during visits, for example saying, "I'll send your results through the portal, and my nurse can help you set it up." Provider endorsement was one of the delivery factors associated with engagement (Irizarry et al., 2015).
Pilot First
The navigator will start at one site for three months. If activation among Spanish-preferring patients rises and patients report the portal as useful, the program will expand to the other two sites. A pilot lets us refine scripts and training before larger investment.
Measures
Measures include activation offer rates by language and age, activation rates, repeat use, video visit completion and patient-reported ease of use. The primary target is doubling activation among Spanish-preferring patients within a year, with a secondary target of raising video visit completion among patients over 65 by half.
Community Partners
The local library offers free computer classes, and a church near our largest site runs a senior program. Partnering with both to offer portal workshops in Spanish extends support beyond the clinic and meets patients where they already gather.
Not Everyone Will Want It
Some patients will prefer phone calls. The goal is informed choice, not universal use, and staff will record a patient's preference so it is respected at every later visit. Telephone access must remain equally good so that portal users are not advantaged in getting appointments or refills.
Conclusion
Portal activation at our clinic was three times higher among English-preferring patients, and the gap began with who was offered access. Evidence from a similar population, a review of engagement factors and the case for digital inclusion explain the pattern. A program addressing staff offers, navigator support, Spanish usability, caregiver proxies and internet access targets each barrier, with measures to show whether the gap narrows.
References
Ancker, J. S., Barrón, Y., Rockoff, M. L., Hauser, D., Pichardo, M., Szerencsy, A., & Calman, N. (2011). Use of an electronic patient portal among disadvantaged populations. Journal of General Internal Medicine, 26(10), 1117-1123. https://doi.org/10.1007/s11606-011-1749-y
Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: A state of the science review. Journal of Medical Internet Research, 17(6), Article e148. https://doi.org/10.2196/jmir.4255
Rodriguez, J. A., Shachar, C., & Bates, D. W. (2022). Digital inclusion as health care: Supporting health care equity with digital-infrastructure initiatives. New England Journal of Medicine, 386(12), 1101-1103. https://doi.org/10.1056/NEJMp2115646
How this DNP 715 Week 6 example is structured
The DNP/715 Week 6 work usually addresses telehealth and patient-facing technologies. This paper measures who uses a patient technology and who does not, explains the gap with evidence and designs an intervention that addresses personal, system and infrastructure barriers. Students search this week as DNP 715 Week 6, DNP715 Wk 6 or DNP/715 Wk 6; all three are the same assignment.
DNP/715 Week 6 questions, answered
What does DNP/715 Week 6 usually ask for?
Many sections ask students to evaluate telehealth or patient-facing technologies such as portals, remote monitoring or video visits, including effectiveness, access and equity.
Who uses patient portals?
Studies show that portal use is influenced by age, race, ethnicity, language, education, health literacy and insurance, and that provider endorsement and portal usability also matter.
What is digital inclusion?
Ensuring that people have the devices, internet access and skills needed to use digital health tools, which some health leaders argue should be treated as part of health care rather than a separate issue.
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