# Privacy Fact Sheets for Mitigating Disease-Related Privacy Concerns and Facilitating Equal Access to the Electronic Health Record: Randomized Controlled Trial

## TL;DR

This study shows that providing privacy fact sheets can reduce privacy concerns and encourage people to upload health records, especially for stigmatized diseases.

## Contribution

The study introduces privacy fact sheets as a novel transparency tool to mitigate privacy concerns and increase EHR adoption.

## Key findings

- Privacy fact sheets significantly increased the likelihood of uploading health records.
- The effect was strongest for stigmatized diseases.
- Privacy fact sheets were most beneficial for users with high privacy risk perceptions.

## Abstract

The German electronic health record (EHR) aims to enhance patient care and reduce costs, but users often worry about data privacy and security. To mitigate disease-related privacy concerns, for instance, surrounding stigmatized diseases, we test the effect of privacy fact sheets (PFSs)—a concise but comprehensive transparency feature designed to increase users’ perceived control over their data—on increasing EHR use in a simulated online study.

The study aimed to investigate whether displaying a PFS shortly before upload decisions must be made mitigates disease-related privacy concerns and makes uploads more likely.

In an online survey study, 393 German participants from the recruitment platform Prolific were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and time course (TC; acute vs chronic). They were then asked to decide whether to upload the report to an EHR click dummy, while we systematically varied the presentation of privacy information (PFS vs no PFS). Participants were randomly (single-blinded) assigned to one of the 2×2×2 conditions (stigma, TC, privacy information).

All 393 participants were randomly assigned to one of the following groups: low, acute, no PFS (n=52, 13.2%); low, chronic, no PFS (n=45, 11.5%); high, acute, no PFS (n=46, 11.7%); high, chronic, no PFS (n=55, 14%); low, acute, PFS (n=44, 11.2%); low, chronic, PFS (n=41, 10.4%); high, acute, PFS (n=56, 14.2%); and high, chronic, PFS (n=54, 13.7%). The results show that, in general, upload behavior is negatively influenced by disease-related stigma (odds ratio [OR] 0.130; P<.001) and positively influenced when a PFS is given (OR 4.527; P<.001). This increase was particularly pronounced for stigmatized diseases (OR 5.952; P=.006), but independent of the TC of the diseases.

Our results demonstrate that PFSs may help to increase EHR uploads in people interacting with a realistic EHR click dummy, by mitigating privacy concerns in scenarios involving stigmatized diseases. Results further indicate that a PFS is mainly relevant and effective for people with increased privacy risk perceptions, whereas they neither benefit nor hurt others. Thus, implementing PFSs may increase the likelihood that users who perceive high privacy risks when confronted with sensitive or stigmatized health information decide to upload their data to the EHR, ultimately increasing digital health equity.