Effective Communication to Improve Decision Making About Health Care Plans

Study Overview
=================
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.

Official Title
-----------------
Effective Communication to Improve Decision Making About Health Care Plans

Conditions
-----------------
Health Literacy, Health Insurance, Health Services Accessibility

Intervention / Treatment
-----------------
* Behavioral: Plain Language
* Behavioral: Plain Language + Visuals
* Behavioral: Plain Language + Narratives


Participation Criteria
=================
Eligibility Criteria
-----------------
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

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Plain Language<br>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<br> <br> |
| Experimental: Plain Language + Visuals<br>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<br> <br> |
| Experimental: Plain Language + Narratives<br>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<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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) | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Health literacy, Health insurance, Health services accessibility, Decision making