Mary C Politi1, Kimberly A Kaphingst1, Jingxia Esther Liu1, Hannah Perkins1, Karishma Furtado1,2, Matthew W Kreuter2, Enbal Shacham3, Timothy McBride2. 1. Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO (MCP, KAK, JEL, HP, KF) 2. Washington University in St. Louis, George Warren Brown School of Social Work, St. Louis, MO (KF, MWK, TM) 3. Department of Behavioral Science and Health Education, St. Louis University College for Public Health and Social Justice, St. Louis, MO (ES)
Abstract
BACKGROUND: The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. METHODS:Participants (N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice. RESULTS: Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall ([Formula: see text] = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual (P = 0.04) and visual to narrative (P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices ([Formula: see text] = 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004). CONCLUSIONS: Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.
RCT Entities:
BACKGROUND: The Affordable Care Act allows uninsured individuals to select health insurance from numerous private plans, a challenging decision-making process. This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. METHODS:Participants (N = 343) from urban, suburban, and rural areas were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. We administered measures assessing knowledge (true/false responses about key features of health insurance), confidence in choices (uncertainty subscale of the Decisional Conflict Scale), satisfaction (items from the Health Information National Trends Survey), preferences for insurance features (measured on a Likert scale from not at all important to very important), and plan choice. RESULTS: Although we did not find significant differences in knowledge, confidence in choice, or satisfaction across condition, participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features. In addition, those with adequate health literacy skills as measured by the Rapid Estimate of Adult Literacy in Medicine-Short Form (REALM-SF) had higher knowledge overall ([Formula: see text] = 6.1 v. 4.8, P < 0.001) and preferred the plain language table to the visual (P = 0.04) and visual to narrative (P = 0.0002) conditions, while those with inadequate health literacy skills showed no preference for study condition. A similar pattern was seen for those with higher subjective numeracy skills and higher versus lower education with regard to health insurance knowledge. Individuals with higher income felt less confident in their choices ([Formula: see text] = 28.7 v. 10.0, where higher numbers indicate less confidence/more uncertainty; P = 0.004). CONCLUSIONS: Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.
Authors: A J Housten; K Furtado; K A Kaphingst; C Kebodeaux; T McBride; B Cusanno; M C Politi Journal: BMC Health Serv Res Date: 2016-11-08 Impact factor: 2.655
Authors: Mary C Politi; Marie D Kuzemchak; Jingxia Liu; Abigail R Barker; Ellen Peters; Peter A Ubel; Kimberly A Kaphingst; Timothy McBride; Matthew W Kreuter; Enbal Shacham; Sydney E Philpott Journal: MDM Policy Pract Date: 2016-11-16
Authors: Aubri S Hoffman; Karen R Sepucha; Purva Abhyankar; Stacey Sheridan; Hilary Bekker; Annie LeBlanc; Carrie Levin; Mary Ropka; Victoria Shaffer; Dawn Stacey; Peep Stalmeier; Ha Vo; Celia Wills; Richard Thomson Journal: BMJ Qual Saf Date: 2018-02-21 Impact factor: 7.418
Authors: Mary C Politi; Abigail R Barker; Kimberly A Kaphingst; Timothy McBride; Enbal Shacham; Carey S Kebodeaux Journal: BMC Health Serv Res Date: 2016-02-16 Impact factor: 2.655