Contextualizing numeric clinical test results for gist comprehension: Implications for EHR patient portals

Patient portals to Electronic Health Record (EHR) systems are underused by older adults because of limited system usability and usefulness, including difficulty understanding numeric information. We investigated whether enhanced context for portal messages about test results improved responses to these messages, comparing verbally, graphically, and video-enhanced formats. Older adults viewed scenarios with fictitious patient profiles and messages describing results for these patients from cholesterol or diabetes screening tests indicating lower, borderline, or higher risk levels. These messages were conveyed by standard format (table of numerical test scores) or one of the enhanced formats. Verbatim and gist memory for test results, risk perception, affective response, attitude toward and intention to perform self-care behaviors, and satisfaction were measured. Verbally and video enhanced context improved older adults' gist but not verbatim memory compared to the standard format, suggesting we were successful in designing messages that highlight gist-based information. Little evidence was found for benefits related to the graphically enhanced format. Although verbally and video enhanced formats improved gist memory and message satisfaction, they had less impact on the other responses to the messages. However, these responses reflected level of risk: As risk associated with test results increased, positive affect decreased whereas negative affect, perceived risk, behavioral attitudes, and intentions increased, as predicted by behavioral change theories.