A Partnership Approach to Enhance Health Care Literacy
Condition: Insurance, Health
Study type: Interventional

Summary: 
      With the help of local focus groups, the investigators are designing and testing a website to
      help urban people have better access to health care through understanding their insurance
      options better. They hypothesize that once individuals engage with the website and go through
      all of its modules, they will: 1) become more informed consumers of the ACA and its health
      insurance options; 2) enroll in an insurance plan; and 3) better leverage the benefits of
      their existing plans."
    

Detailed description: 
      The Affordable Care Act (ACA) has afforded millions of Americans with both greater access to
      and greater affordability of health insurance and its associated benefits. However, limited
      resources have been devoted for effective ACA outreach and enrollment - especially in states
      that did not create their own health insurance exchanges such as Michigan. Federally
      Qualified Health Centers (FQHCs) in Detroit are vital to meeting the health and medical care
      needs of the local community. However, they face long-term sustainability challenges,
      particularly related to their financial capacity, which can be augmented by increasing the
      number of insured patients that they serve.

      The goal of the proposed project is to establish a new community-based participatory research
      (CBPR) partnership aimed at enhancing health care literacy of community residents of Detroit
      as it relates to the implementation of the ACA, through the design, implementation and
      evaluation of the effectiveness of an intervention trial. In accordance with the principles
      of CBPR, a Steering Committee will be established, involving four FQHCs and social service
      agencies working in Detroit, four community partner organizations, and academic members of
      the research team. The investigators will first conduct 9 focus groups with Detroit residents
      who use the local FQHCs and social service agencies and 1 focus group with health care
      navigators in order to inform the development of the e-Health intervention and better
      ascertain the healthcare literacy challenges residents face accessing information about the
      ACA. The investigators propose to develop and evaluate a healthcare literacy, e-Health
      intervention embedded with short, culturally and locally-tailored videos informed by behavior
      change principles that will teach patients/families about: the importance and benefits of
      health insurance, ACA coverage provisions and local insurance options available to them, the
      specifics of the new law and how it affects them, and how to navigate local systems and
      resources to obtain and maintain health insurance. They will recruit 240 patients/families
      seen at 4 local-area FQHC and social service sites to examine whether patient use of the
      website increases health care literacy and encourages individuals to enroll in health
      insurance plans. They will employ a randomized cross-over lagged research design where 120
      patient/families seen at 2 FQHC and social service sites will be approached to use the
      website. The investigators will also identify 120 patients/families seen at 2 other sites who
      will serve as a lagged control group in the first segment of the study. Both the 120
      intervention patients/families and the lagged control patient/families will be asked to
      complete a questionnaire about the ACA and other pertinent issues at the onset of the study.
      Six months later, they will again survey the patients in both groups (using the same survey
      instrument) to see whether any differences between the groups can be detected after 6 months.
      At that time, the 100 patient/families in the lagged control group will then be given the
      website (treatment) and they will follow them for 3 months. The investigators hypothesize
      that once individuals engage with the website and go through all of its modules, they will:
      1) become more informed consumers of the ACA and its health insurance options; 2) enroll in
      an insurance plan; and 3) better leverage the benefits of their existing plans.
    

Intervention name(s): E-health website
Intervention type(s): Behavioral
Intervention description(s): e-Health website embedded with short, culturally and locally-tailored videos informed by behavior change principles that will teach patients/families about: the importance and benefits of health insurance, ACA coverage provisions and local insurance options available to them, the specifics of the new law and how it affects them, and how to navigate local systems and resources to obtain and maintain health insurance.
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: health care navigation; health literacy; Affordable Care Act