Respectful Patient-Provider Communication and Patient Portal Usage in Pregnant People of Color

Background: Patient-provider communication (PPC) increasingly occurs in online patient portals. Variations in portal usage might worsen communication inequities for pregnant people of color (POC), widening the digital divide. The objective of this study was to examine the relationships between respectful PPC, patient portal usage, and digital health literacy (DHL) in pregnant POC. Methods: A multimethod cross-sectional survey design was used. Ordered logistic regression was performed to determine the relationship between PPC and portal use, controlling for trimester prenatal care was initiated, insurance type, age, gestational age, and parity. The moderating effect of Digital Health Literacy Instrument (DHLI) was tested on the association between portal usage and PPC. Results: A total of 130 self-identified pregnant POC participated in the study. Participants who did not use the portal had 68% lower odds of rating higher quality PPC (odds ratio [OR] = 0.32, 95% confidence interval [CI] = 0.12-0.86, p = 0.02). Participants with public versus private insurance had 62% lower odds of rating high-quality PPC (OR = 0.38, 95% CI = 0.14-0.99, p = 0.04). For portal users, DHL moderated the association between PPC and portal use - eHealth Literacy Scale (adjusted OR [aOR] = 1.06, 95% CI = 1.01-1.12, p = 0.02) and DHLI (aOR = 2.36, 95% CI = 1.12-4.95, p = 0.02). The moderation effect of DHLI was also significant among limited portal users (aOR = 2.32, 95% CI = 1.04-5.19, p = 0.04). Conclusion: Addressing the digital divide for pregnant POC requires further investigation into portal non-users with consideration to insurance type, DHL, and social determinants of health.