Laura Kneale

Patient activation, or an individual’s willingness and ability to take actions to maintain their health and wellness, is a primary component of the patient-centered health system. Activated patients are more likely to report positive experiences with their medical providers, have better health outcomes, and spend less on healthcare services. Homebound older adults face more barriers to patient activation than their non-homebound peers. Because people who are homebound are unable to leave their homes without significant assistance, regularly accessing clinic-based medical services is difficult. In addition, as a population, homebound older adults have more chronic diseases, physical and cognitive impairments, and challenges with activities of daily living than non-homebound older adults.
The number of older adults who are homebound is on the rise, and they are a growing proportion of the older adult patient population. Therefore, more research is needed to understand how consumer health information tools can be used with this population to support activation and improve health outcomes. This dissertation explores the usability, feasibility, and preliminary effectiveness of personal health records with the homebound older adult patient population. In a series of studies, I outline the benefits of using personal health records with this population, assess how current personal health records meet the needs of homebound older adult users, and describe considerations for health systems and researchers who are interested in exploring personal health records for the homebound older adult population.
This work furthers our understanding of the application of personal health records in homebound older adult patient populations. In addition, I provide design recommendations on how future systems can better meet needs of homebound older adult users. Finally, I offer suggestions to help future researchers maximize the effectiveness of homebound older adult personal health record evaluations.