Health Insurance, Health Literacy, Health Services Accessibility
Conditions
Keywords
Health insurance, Health services accessibility, Decision making, Health literacy
Brief summary
The overall goal of the study is to better understand how communication strategies can help people make decisions about health insurance plans. This study aims to: * (Aim 1) Examine currently uninsured individuals' understanding of terminology and details of health insurance plans; * (Aim 2) Apply three recommended strategies for communicating information about health insurance plans; * (Aim 3) Test the effects of these strategies in a randomized experiment.
Detailed description
First, this study will examine people's understanding of health insurance plan terminology and details through qualitative interviews with 50 uninsured individuals. These responses will then lead to the development of three communication strategies to improve understanding of health insurance plans: 1) plain language, 2) plain language plus visual displays and 3) plain language plus narratives. The strategies will the be pilot tested with 30 individuals to assess readability, clarity of language, and layout. The revised communication strategies will be tested with 280 individuals in a randomized experiment. Individuals will be randomly assigned to either a plain language condition alone, a plain language + visual displays condition, and a plain language + narrative condition.
Interventions
BEHAVIORALPlain Language
BEHAVIORALPlain Language + Visuals
BEHAVIORALPlain Language + Narratives
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Washington University School of Medicine
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 64 Years
Healthy volunteers
Yes
Inclusion criteria
* Must be without health insurance currently * Must have been without health insurance at some point in the past 12 months * Must speak English
Exclusion criteria
* Currently has health insurance and has not had any lapses in coverage in the past 12 months * Does not speak English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Knowledge | 1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives) | Knowledge measures the degree at which participants understand the details about health insurance plans. Knowledge was scored on a scale from 0 to 7 based on number of correct answers to the 7 items. A higher value is considered to be a better outcome. Bivariate outcome data can be found below. |
| Uncertainty | 1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives) | A survey will be administered in order to measure participants' confidence in the features of health insurance plans that matter most to them and the insurance plan they chose of the ones presented. Confidence in choice is scored on a scale from 0 to 100, with higher scores indicating more decisional conflict/more uncertainty/less confidence in choice. Bivariate outcome data can be found below. |
| Satisfaction | 1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives) | A survey will be administered in order to measure the extent to which participants are satisfied with the information presented to them. Satisfaction was scored on a scale from 1 to 4, with higher scores indicating higher levels of satisfaction. Bivariate outcome data can be found below. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Plain Language This intervention group will receive a plain-language table describing the features and costs of health insurance plans, with definitions of health insurance terms incorporated into the table.
Plain Language | 91 |
| Plain Language + Visuals This intervention group will receive the plain-language table plus visuals that focus on specific features of the plans. Participants will be able to view the information about each health insurance feature one feature at a time, in the order they prefer.
Plain Language + Visuals | 154 |
| Plain Language + Narratives This intervention group will receive the plain language table plus narratives about how others might use and rate the insurance plans.
Plain Language + Narratives | 98 |
| Total | 343 |
Baseline characteristics
| Characteristic | Plain Language | Plain Language + Visuals | Plain Language + Narratives | Total |
|---|---|---|---|---|
| Age, Continuous | 38.9 Years STANDARD_DEVIATION 12 | 38.7 Years STANDARD_DEVIATION 11.7 | 37.8 Years STANDARD_DEVIATION 12.1 | 38.5 Years STANDARD_DEVIATION 11.8 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 2 Participants | 4 Participants | 1 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 80 Participants | 136 Participants | 88 Participants | 304 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 9 Participants | 14 Participants | 9 Participants | 32 Participants |
| Race/Ethnicity, Customized African American | 48 Participants | 87 Participants | 59 Participants | 194 Participants |
| Race/Ethnicity, Customized Not Reported | 7 Participants | 14 Participants | 9 Participants | 30 Participants |
| Race/Ethnicity, Customized Other | 5 Participants | 11 Participants | 6 Participants | 22 Participants |
| Race/Ethnicity, Customized White | 31 Participants | 42 Participants | 24 Participants | 97 Participants |
| Rapid Estimate of Adult Literacy in Medicine-SF (REALM-SF) Adequate | 52 Participants | 85 Participants | 44 Participants | 181 Participants |
| Rapid Estimate of Adult Literacy in Medicine-SF (REALM-SF) Inadequate | 6 Participants | 11 Participants | 8 Participants | 25 Participants |
| Rapid Estimate of Adult Literacy in Medicine-SF (REALM-SF) Marginal | 31 Participants | 56 Participants | 42 Participants | 129 Participants |
| Rapid Estimate of Adult Literacy in Medicine-SF (REALM-SF) Not Reported | 2 Participants | 2 Participants | 4 Participants | 8 Participants |
| Region of Enrollment United States | 91 Participants | 154 Participants | 98 Participants | 343 Participants |
| Sex: Female, Male Female | 61 Participants | 79 Participants | 63 Participants | 203 Participants |
| Sex: Female, Male Male | 30 Participants | 75 Participants | 35 Participants | 140 Participants |
| Subjective Numeracy Scale (SNS) | 4.1 Units on a scale STANDARD_DEVIATION 1.1 | 4.2 Units on a scale STANDARD_DEVIATION 1 | 3.7 Units on a scale STANDARD_DEVIATION 1.2 | 4.0 Units on a scale STANDARD_DEVIATION 1.1 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Knowledge
Knowledge measures the degree at which participants understand the details about health insurance plans. Knowledge was scored on a scale from 0 to 7 based on number of correct answers to the 7 items. A higher value is considered to be a better outcome. Bivariate outcome data can be found below.
Time frame: 1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives)
Population: Analysis is represented as mean (standard deviation) of calculated knowledge.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Plain Language | Knowledge | 6.0 Units on a scale | Standard Deviation 1.2 |
| Plain Language + Visuals | Knowledge | 5.7 Units on a scale | Standard Deviation 1.3 |
| Plain Language + Narratives | Knowledge | 5.5 Units on a scale | Standard Deviation 1.5 |
Primary
Satisfaction
A survey will be administered in order to measure the extent to which participants are satisfied with the information presented to them. Satisfaction was scored on a scale from 1 to 4, with higher scores indicating higher levels of satisfaction. Bivariate outcome data can be found below.
Time frame: 1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives)
Population: Analysis is represented as mean (standard deviation) of calculated satisfaction.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Plain Language | Satisfaction | 2.7 Units on a scale | Standard Deviation 0.5 |
| Plain Language + Visuals | Satisfaction | 2.6 Units on a scale | Standard Deviation 0.5 |
| Plain Language + Narratives | Satisfaction | 2.7 Units on a scale | Standard Deviation 0.4 |
Primary
Uncertainty
A survey will be administered in order to measure participants' confidence in the features of health insurance plans that matter most to them and the insurance plan they chose of the ones presented. Confidence in choice is scored on a scale from 0 to 100, with higher scores indicating more decisional conflict/more uncertainty/less confidence in choice. Bivariate outcome data can be found below.
Time frame: 1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives)
Population: Analysis is represented as mean (standard deviation) of calculated uncertainty.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Plain Language | Uncertainty | 9.6 Units on a scale | Standard Deviation 21.6 |
| Plain Language + Visuals | Uncertainty | 10.6 Units on a scale | Standard Deviation 23.3 |
| Plain Language + Narratives | Uncertainty | 7.2 Units on a scale | Standard Deviation 18.8 |