Effective Communication to Improve Decision Making About Health Care Plans

NCT01986790 | Completed Results DMC

• 1 other identifier: HS020309
• Study Type: interventional
• Target: 343
• Locations: 1 country
• Sites: 1

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.

Conditions

Health Literacy; Health Insurance; Health Services Accessibility

Keywords

Health insurance; Health services accessibility; Decision making; Health literacy

Outcome Measures

Primary Outcomes (3)

• 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.

  1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives)

• 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.

  1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives)

• 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.

  1 day (Immediately following showing the participant the assigned intervention (plain language table, plain language table + visuals, or plain language table + narratives)

Study Arms (3)

Plain Language

EXPERIMENTAL

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.

Behavioral: Plain Language

Plain Language + Visuals

EXPERIMENTAL

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.

Behavioral: Plain Language + Visuals

Plain Language + Narratives

EXPERIMENTAL

This intervention group will receive the plain language table plus narratives about how others might use and rate the insurance plans.

Behavioral: Plain Language + Narratives

Interventions

Plain Language BEHAVIORAL

Plain Language

Plain Language + Visuals BEHAVIORAL

Plain Language + Visuals

Plain Language + Narratives BEHAVIORAL

Plain Language + Narratives

Eligibility Criteria

• Age: 18 Years - 64 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64)

You may qualify if:

• Must be without health insurance currently
• Must have been without health insurance at some point in the past 12 months
• Must speak English

You may not qualify if:

• Currently has health insurance and has not had any lapses in coverage in the past 12 months
• Does not speak English

Sponsors & Collaborators

• Washington University School of Medicine: lead
• Agency for Healthcare Research and Quality (AHRQ): collaborator

Study Sites (1)

The Washington University in St. Louis School of Medicine

St Louis, Missouri, 63110, United States

Location

Related Publications (19)

• Gold M, Wooldridge J. Surveying consumer satisfaction to assess managed-care quality: current practices. Health Care Financ Rev. 1995 Summer;16(4):155-73.

  PMID: 10151887 BACKGROUND

• Harris-Kojetin LD, McCormack LA, Jael EF, Sangl JA, Garfinkel SA. Creating more effective health plan quality reports for consumers: lessons from a synthesis of qualitative testing. Health Serv Res. 2001 Jul;36(3):447-76.

  PMID: 11482584 BACKGROUND

• Hibbard JH, Jewett JJ, Engelmann S, Tusler M. Can Medicare beneficiaries make informed choices? Health Aff (Millwood). 1998 Nov-Dec;17(6):181-93. doi: 10.1377/hlthaff.17.6.181.

  PMID: 9916368 BACKGROUND

• Peters E, Dieckmann N, Dixon A, Hibbard JH, Mertz CK. Less is more in presenting quality information to consumers. Med Care Res Rev. 2007 Apr;64(2):169-90. doi: 10.1177/10775587070640020301.

  PMID: 17406019 BACKGROUND

• Hibbard JH, Slovic P, Jewett JJ. Informing consumer decisions in health care: implications from decision-making research. Milbank Q. 1997;75(3):395-414. doi: 10.1111/1468-0009.00061.

  PMID: 9290635 BACKGROUND

• Knutson DJ, Kind EA, Fowles JB, Adlis S. Impact of report cards on employees: a natural experiment. Health Care Financ Rev. 1998 Fall;20(1):5-27.

  PMID: 10387425 BACKGROUND

• Scanlon DP, Chernew M, Lave JR. Consumer health plan choice: current knowledge and future directions. Annu Rev Public Health. 1997;18:507-28. doi: 10.1146/annurev.publhealth.18.1.507.

  PMID: 9143729 BACKGROUND

• Kreuter MW, Green MC, Cappella JN, Slater MD, Wise ME, Storey D, Clark EM, O'Keefe DJ, Erwin DO, Holmes K, Hinyard LJ, Houston T, Woolley S. Narrative communication in cancer prevention and control: a framework to guide research and application. Ann Behav Med. 2007 Jun;33(3):221-35. doi: 10.1007/BF02879904.

  PMID: 17600449 BACKGROUND

• McCormack LA, Uhrig JD. How does beneficiary knowledge of the Medicare program vary by type of insurance? Med Care. 2003 Aug;41(8):972-8. doi: 10.1097/00005650-200308000-00010.

  PMID: 12886176 BACKGROUND

• Hoadley J. Medicare Part D: simplifying the program and improving the value of information for beneficiaries. Issue Brief (Commonw Fund). 2008 May;39:1-15.

  PMID: 18536148 BACKGROUND

• Lubalin JS, Harris-Kojetin LD. What do consumers want and need to know in making health care choices? Med Care Res Rev. 1999;56 Suppl 1:67-102; discussion 103-12. doi: 10.1177/1077558799056001S04.

  PMID: 10354679 BACKGROUND

• Kolstad JT, Chernew ME. Quality and consumer decision making in the market for health insurance and health care services. Med Care Res Rev. 2009 Feb;66(1 Suppl):28S-52S. doi: 10.1177/1077558708325887. Epub 2008 Nov 24.

  PMID: 19029288 BACKGROUND

• Hibbard JH, Jewett JJ. Will quality report cards help consumers? Health Aff (Millwood). 1997 May-Jun;16(3):218-28. doi: 10.1377/hlthaff.16.3.218.

  PMID: 9141339 BACKGROUND

• Uhrig JD, Harris-Kojetin L, Bann C, Kuo TM. Do content and format affect older consumers' use of comparative information in a Medicare health plan choice? Results from a controlled experiment. Med Care Res Rev. 2006 Dec;63(6):701-18. doi: 10.1177/1077558706293636.

  PMID: 17099122 BACKGROUND

• Kreuter MW, Wray RJ. Tailored and targeted health communication: strategies for enhancing information relevance. Am J Health Behav. 2003 Nov-Dec;27 Suppl 3:S227-32. doi: 10.5993/ajhb.27.1.s3.6.

  PMID: 14672383 BACKGROUND

• Hinyard LJ, Kreuter MW. Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Health Educ Behav. 2007 Oct;34(5):777-92. doi: 10.1177/1090198106291963. Epub 2006 Dec 15.

  PMID: 17200094 BACKGROUND

• Hibbard JH, Peters E. Supporting informed consumer health care decisions: data presentation approaches that facilitate the use of information in choice. Annu Rev Public Health. 2003;24:413-33. doi: 10.1146/annurev.publhealth.24.100901.141005. Epub 2001 Nov 6.

  PMID: 12428034 BACKGROUND

• Politi MC, Kaphingst KA, Kreuter M, Shacham E, Lovell MC, McBride T. Knowledge of health insurance terminology and details among the uninsured. Med Care Res Rev. 2014 Feb;71(1):85-98. doi: 10.1177/1077558713505327. Epub 2013 Oct 24.

  PMID: 24163306 BACKGROUND

• Politi MC, Kaphingst KA, Liu JE, Perkins H, Furtado K, Kreuter MW, Shacham E, McBride T. A Randomized Trial Examining Three Strategies for Supporting Health Insurance Decisions among the Uninsured. Med Decis Making. 2016 Oct;36(7):911-22. doi: 10.1177/0272989X15578635. Epub 2015 Apr 3.

  PMID: 25840904 DERIVED

Results Point of Contact

• Title: Mary C. Politi, PhD
• Organization: Washington University's School of Medicine

politim@wudosis.wustl.edu

314-747-1968

Study Officials

• Mary Politi, PhD

  The Washington University in St. Louis School of Medicine

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: November 4, 2013
• First Posted: November 18, 2013
• Study Start: April 1, 2012
• Primary Completion: March 1, 2014
• Study Completion: June 1, 2014
• Last Updated: June 9, 2016
• Results First Posted: June 9, 2016

Record last verified: 2016-05

Locations

US (1)