Date of Award

December 2014

Degree Type


Degree Name

Doctor of Philosophy



First Advisor

Karen H. Morin

Committee Members

Yvonne Lucero, Sally Lundeen, Amy Coenen, Timothy Patrick


Message, Messaging, Nursing, PHR, Secure, Technology





Claudia S. Derman

The University of Wisconsin-Milwaukee, 2014

Under the Supervision of Professor Karen H. Morin, PhD, RN, ANEF, FAAN

The purpose of this study was to describe the topics discussed using secure messaging (SM), the pattern of use of SM, and whether the themes discussed and/or the pattern of use varied based on gender and age of the SM user. Secure messaging is an example of a technology that focuses on patient-centered communication. Secure messaging allows patients to communicate with their clinicians using the Internet and at their convenience, while maintaining the privacy of the information exchanged. Secure messages, if approved by the patient, may also be written by family members or significant others for the patient. By its nature, the use of SM is indicative of an individual's involvement in their healthcare, utilizing self-management skills. Few studies were found that reported on the content of messages written by patients or their families. No studies were found that reviewed the topics patients write about in these secure messages nor were studies found that tracked the number of messages written by patients and relating to the days and time that were most utilized.

A review of 1200 secure messages written by veterans and their caregivers was undertaken to determine what information was contained within the secure messages. The 1200 messages contained 1720 themes that were grouped using content analysis to yield a total of ten topics. The day of week and the time of day of messages were additionally reviewed by gender and age of the individual. Messages written by friends of family members were reviewed and compared to those written by patients.

The topic most addressed as that of medications, with more than one-third of the 1720 themes within messages relating to medications. Veterans aged 55 to 64 years were the greatest users of the SM system followed closely by those between the ages of 65 to 74. Men wrote most frequently about medications while women wrote more themes related to the topics of complaints and concerns and consultations with specialists.

Pattern of use of relative to time of day and day of the week was also reviewed in subset of the sample (n= 600). The most common time frame during which messages were sent was between 9:00 a.m. and 6 p.m., accounting for more than 70% of all messages. Tuesdays and Thursdays were the most often utilized days of week for SM.

The implications of this study include revisiting how MyHealtheVet is configured to enhance the veteran's ability to communicate effectively and appropriately with healthcare providers. It is possible that participants employed SM rather than other identified means to contact providers as they were assured of a response within a defined period of time. Findings have implications for users, clinicians, hospital administrators, and technical staff. The purposes of SM can be revisited with users, clinicians may wish to consider alternative strategies, and administrators may wish to revisit the current structure in terms of identifying a method to sort the information contained in SM.