Usability research for an NHS patient-facing portal

A digital solution with an adoption problem

An NHS primary care organisation had deployed a patient-facing portal allowing patients to book appointments, request repeat prescriptions, and access elements of their health record. Adoption was lower than projected, with usage concentrated among a demographic that didn't reflect the practice population - younger, more digitally confident, and lower in overall healthcare need than the patients whose engagement would have the greatest impact on service demand.

The organisation needed to understand whether the adoption problem was primarily a communication and awareness issue - in which case the solution was better promotion - or whether there were usability and accessibility barriers that were preventing people from completing key tasks even when they tried. Getting this diagnosis wrong would mean investing in the wrong intervention.

A secondary concern was accessibility: the practice population included a high proportion of older patients and patients with limited English, and the development team had limited visibility into how these groups experienced the portal.

Testing across the full range of the patient population

Participation Studio recruited participants in two cohorts. The first comprised patients who had already used the portal - providing a baseline understanding of the experience for people who had overcome initial barriers. The second comprised patients registered with the practice who had not used the portal despite being aware of it - the population whose non-adoption the research most needed to explain.

In-person sessions were prioritised for older participants and those with lower digital confidence, with remote sessions used for participants who were comfortable with the format. In-person testing allowed a more naturalistic assessment of how participants approached an unfamiliar digital interface - including the decisions they made before they even started, such as whether to use a phone or a computer and whether to ask for help.

Sessions tested three core tasks: booking a routine appointment, requesting a repeat prescription, and finding information in the health record. Task selection was driven by what the organisation most needed patients to use independently - not the full feature set.

What the research involved

Usability barriers, not awareness gaps

Registration was the single largest barrier. The process required a linkage code that had been sent by post and that most participants had either not retained or not received. Several participants had started registration before and abandoned it at this point - their prior failure had created a belief that the system didn't work, which they were now bringing into the research session.

The appointment booking journey asked patients to select a clinical reason before seeing any available slots. For patients with multiple conditions, this decision was unclear; for patients who didn't know whether their issue was "routine" or "urgent", it was anxiety-inducing. Several participants abandoned at this step to call the practice instead - precisely the behaviour the portal was designed to reduce.

Accessibility findings focused on text size, contrast, and the visual hierarchy of action elements, with specific issues affecting participants who used accessibility settings on their devices. These weren't cosmetic issues - they were preventing task completion for a population with disproportionately high healthcare need.

A prioritised remediation plan