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Lewis CC, Taba M, Allen TB, Caldwell PH, Skinner SR, Kang M, Henderson H, Bray L, Borthwick M, Collin P, McCaffery K, Scott KM. Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology. J Med Internet Res 2024; 26:e49453. [PMID: 39110967 PMCID: PMC11339585 DOI: 10.2196/49453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/24/2023] [Accepted: 05/16/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environment. Few educational resources exist to improve DHL, and few have involved adolescents during design. The co-design approach may hold utility through developing interventions with participants as design partners. OBJECTIVE This project aimed to explore the co-design approach in developing an educational resource to improve adolescents' DHL. METHODS Adolescents (12-17 years old) attended 4 interactive co-design workshops (June 2021-April 2022). Participant perspectives were gathered on DHL and the design of educational resources to improve it. Data generated were analyzed through content analysis to inform educational resource development. RESULTS In total, 27 participants from diverse backgrounds attended the workshops. Insight was gained into participants' relationship with digital health information, including acceptance of its benefits and relevance, coupled with awareness of misinformation issues, revealing areas of DHL need. Participants provided suggestions for educational resource development that incorporated the most useful aspects of digital formats to develop skills across these domains. The following 4 themes were derived from participant perspectives: ease of access to digital health information, personal and social factors that impacted use, impacts of the plethora of digital information, and anonymity offered by digital sources. Initial participant evaluation of the developed educational resource was largely positive, including useful suggestions for improvement. CONCLUSIONS Co-design elicited and translated authentic adolescent perspectives and design ideas into a functional educational resource. Insight into adolescents' DHL needs generated targeted educational resource content, with engaging formats, designs, and storylines. Co-design holds promise as an important and empowering tool for developing interventions to improve adolescents' DHL.
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Affiliation(s)
- Callum C Lewis
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Melody Taba
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tiffany B Allen
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
| | - Patrina Hy Caldwell
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- The Children's Hospital at Westmead, Westmead, Australia
| | - S Rachel Skinner
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
- The Children's Hospital at Westmead, Westmead, Australia
| | - Melissa Kang
- General Practice Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hamish Henderson
- Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, Australia
| | - Liam Bray
- Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, Australia
| | - Madeleine Borthwick
- Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, Australia
| | - Philippa Collin
- Institute for Culture and Society, Western Sydney University, Parramatta, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Karen M Scott
- Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, Australia
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Torkian S, Ebrahimi F, Shahnazi H, Rashti R, Emami M, Maracy MR. Psychometrics of the Persian version of the COVID-19-related health literacy in the Iranian population. Front Public Health 2023; 10:1085861. [PMID: 36703837 PMCID: PMC9873230 DOI: 10.3389/fpubh.2022.1085861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Background Since the occurrence of the COVID-19 pandemic, information dissemination has increased rapidly. Promoting health literacy is currently crucial to prepare people to respond quickly to situations, such as the COVID-19 pandemic. Due to the importance of health literacy in this critical situation, we are looking for a questionnaire to measure COVID-19 health literacy. The COVID-19 Germany Health Literacy Questionnaire (HLS-COVID-Q22) is an excellent tool, so the study aimed to create a cultural validity of this questionnaire for the Iranian population. Methods In this validation study, 880 samples were enrolled using a convenient sampling method. The questionnaire was translated through a backward forwarding procedure. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were employed for Persian version validity. McDonald's omega (Ω), Cronbach's alpha, and average inter-item correlation (AIC) coefficients were assessed for reliability. Results Using EFA on the random half sample (n = 440), the EFA indicated that the scale had four factors: accessing, understanding, appraising, and applying health-related information in the COVID-19 pandemic context, which explained 59.3% of the total variance. CFA was used for the sample's second part (n = 440) to evaluate the goodness of fit of the four-factor solution. CFA showed the model fit. All indices RMSEA = 0.067, CFI = 0.934, IFI = 0.934, PCFI = 0.772, PNFI = 0.747, and CMIN/DF = 2.972 confirmed the model fit. The convergent validity of the HLS-COVID-Q22 was confirmed. McDonald's omega and Cronbach's alpha were very good (α and Ω >0.80). Conclusion The Persian version of the HLS-COVID-Q22 had acceptable psychometric properties and is applicable to measure COVID-19 health literacy.
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Affiliation(s)
- Samaneh Torkian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ebrahimi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Shahnazi
- Department of Health Education and Promotion, School of Health Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Rashti
- School of Public Health, Dezful University of Medical Science, Dezful, Khuzestan, Iran
| | - Mahasti Emami
- Department of Health Education and Promotion, School of Health, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Aida A, Svensson T, Svensson AK, Chung UI, Yamauchi T. eHealth Delivery of Educational Content Using Selected Visual Methods to Improve Health Literacy on Lifestyle-Related Diseases: Literature Review. JMIR Mhealth Uhealth 2020; 8:e18316. [PMID: 33295296 PMCID: PMC7758165 DOI: 10.2196/18316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 08/07/2020] [Accepted: 11/19/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lifestyle-related diseases, such as stroke, heart disease, and diabetes, are examples of noncommunicable diseases. Noncommunicable diseases are now the leading cause of death in the world, and their major causes are lifestyle related. The number of eHealth interventions is increasing, which is expected to improve individuals' health literacy on lifestyle-related diseases. OBJECTIVE This literature review aims to identify existing literature published in the past decade on eHealth interventions aimed at improving health literacy on lifestyle-related diseases among the general population using selected visual methods, such as educational videos, films, and movies. METHODS A systematic literature search of the PubMed database was conducted in April 2019 for papers written in English and published from April 2, 2009, through April 2, 2019. A total of 538 papers were identified and screened in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Finally, 23 papers were included in this review. RESULTS The 23 papers were characterized according to study characteristics (author and year of publication, study design and region where the study was conducted, study objective, service platform, target disease and participant age, research period, outcomes, and research method); the playback time of the educational videos, films, and movies; and the evaluation of the study's impacts on health literacy. A total of 7 studies compared results using statistical methods. Of these, 5 studies reported significant positive effects of the intervention on health literacy and health-related measures (eg, physical activity, body weight). Although most of the studies included educational content aimed at improving health literacy, only 7 studies measured health literacy. In addition, only 5 studies assessed literacy using health literacy measurement tools. CONCLUSIONS This review found that the provision of educational content was satisfactory in most eHealth studies using selected visual methods, such as videos, films, and movies. These findings suggest that eHealth interventions influence people's health behaviors and that the need for this intervention is expected to increase. Despite the need to develop eHealth interventions, standardized measurement tools to evaluate health literacy are lacking. Further research is required to clarify acceptable health literacy measurements.
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Affiliation(s)
- Azusa Aida
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Thomas Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Japan
| | - Akiko Kishi Svensson
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ung-Il Chung
- Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, Tokyo, Japan.,School of Health Innovation, Kanagawa University of Human Services, Kawasaki-shi, Japan.,Clinical Biotechnology, Center for Disease Biology and Integrative Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Allison R, Hayes C, McNulty CAM, Young V. A Comprehensive Framework to Evaluate Websites: Literature Review and Development of GoodWeb. JMIR Form Res 2019; 3:e14372. [PMID: 31651406 PMCID: PMC6914275 DOI: 10.2196/14372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/24/2019] [Accepted: 08/18/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Attention is turning toward increasing the quality of websites and quality evaluation to attract new users and retain existing users. OBJECTIVE This scoping study aimed to review and define existing worldwide methodologies and techniques to evaluate websites and provide a framework of appropriate website attributes that could be applied to any future website evaluations. METHODS We systematically searched electronic databases and gray literature for studies of website evaluation. The results were exported to EndNote software, duplicates were removed, and eligible studies were identified. The results have been presented in narrative form. RESULTS A total of 69 studies met the inclusion criteria. The extracted data included type of website, aim or purpose of the study, study populations (users and experts), sample size, setting (controlled environment and remotely assessed), website attributes evaluated, process of methodology, and process of analysis. Methods of evaluation varied and included questionnaires, observed website browsing, interviews or focus groups, and Web usage analysis. Evaluations using both users and experts and controlled and remote settings are represented. Website attributes that were examined included usability or ease of use, content, design criteria, functionality, appearance, interactivity, satisfaction, and loyalty. Website evaluation methods should be tailored to the needs of specific websites and individual aims of evaluations. GoodWeb, a website evaluation guide, has been presented with a case scenario. CONCLUSIONS This scoping study supports the open debate of defining the quality of websites, and there are numerous approaches and models to evaluate it. However, as this study provides a framework of the existing literature of website evaluation, it presents a guide of options for evaluating websites, including which attributes to analyze and options for appropriate methods.
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Affiliation(s)
| | | | | | - Vicki Young
- Public Health England, Gloucester, United Kingdom
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New technologies, new disparities: The intersection of electronic health and digital health literacy. Int J Cardiol 2019; 292:280-282. [PMID: 31171391 DOI: 10.1016/j.ijcard.2019.05.066] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022]
Abstract
Mobile health, or mHealth, is the implementation of digital health services with mobile and wearable devices, and has ample potential to enhance self-management of chronic conditions, especially cardiovascular risk factors (e.g., blood pressure control and supporting tobacco cessation and physical activity). It remains ambiguous, however, whether such technologies can improve cardiovascular outcomes. More importantly, mHealth carries the additional challenge of digital health literacy, which demands particular skills complementary to general and health literacy. Populations at risk for limited health literacy are similarly vulnerable to having challenges with digital health literacy. We identify such challenges and outline solutions to improve access to digital health services and their use for individuals with limited digital health literacy. We present an 18-point "Digital Universal Precautions" as a mandate for health care organizations committed towards addressing and facilitating eHealth literacy. As health care institutions increasingly advance mHealth through delivery of on-line material and patient portals, they face the challenge of ensuring that digital health services and content are available to all patients.
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Patel MR, Israel BA, Song PXK, Hao W, TerHaar L, Tariq M, Lichtenstein R. Insuring Good Health: Outcomes and Acceptability of a Participatory Health Insurance Literacy Intervention in Diverse Urban Communities. HEALTH EDUCATION & BEHAVIOR 2019; 46:494-505. [PMID: 30786753 DOI: 10.1177/1090198119831060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The U.S. uninsured rate has dropped significantly since the passage of the Affordable Care Act (ACA), yet insurance coverage remains lower in historically marginalized communities than in the overall population. New consumer engagement approaches that involve these populations are needed. The purpose of this study was to evaluate the effectiveness of the Insuring Good Health Intervention, a website and video series designed to improve engagement with health insurance and ACA reforms. The study was designed and implemented using a community-based participatory research approach. METHOD We conducted a lagged-control cluster randomized controlled trial to evaluate Insuring Good Health with racially and ethnically diverse adults seeking services in medically underserved areas within the Detroit, Michigan metropolitan area. Outcomes were assessed at baseline and at 6 and 9 months postintervention, and including self-efficacy, knowledge, beliefs, and intention to seek help with insurance navigation and care. RESULTS Among 243 participants, mean age was 43.4 ( SD = 13) years, and all participants met federal guidelines for poverty. The study had an 86% response rate at 9-month follow-up ( n = 209). Compared with the lagged-control group, intervention participants had more positive beliefs concerning preventive care (estimate 0.51, standard error 0.16; p < .01), and intention to seek help with insurance navigation and care (estimate 0.43, standard error 0.17; p < .001) at 9-month follow-up. Hispanic participants benefitted the most from the intervention, including improved knowledge of health insurance eligibility over 9 months compared with other racial/ethnic groups (estimate -0.97, standard error 0.40, p < .01). DISCUSSION Insuring Good Health was associated with increased intention to seek help with insurance navigation and care, and improved beliefs around preventive care. CONCLUSIONS Insuring Good Health has the potential to be an important consumer engagement tool to reduce disparities in health insurance coverage and care seeking.
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Affiliation(s)
- Minal R Patel
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Barbara A Israel
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Peter X K Song
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Wei Hao
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lindsay TerHaar
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Madiha Tariq
- 2 Arab Community Center for Economic and Social Services, Dearborn, MI, USA
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Rogers J, Silva S, Benatar S, Briceno ACL. Family Planning Confidential: A Qualitative Research Study on the Implications of the Affordable Care Act. J Adolesc Health 2018; 63:773-778. [PMID: 30262409 DOI: 10.1016/j.jadohealth.2018.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/24/2018] [Accepted: 06/26/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE A cornerstone of the Title X program is guaranteed access to confidential family planning services regardless of patients' ability to pay. This is particularly important for adolescents and young adults. The Patient Protection and Affordable Care Act (ACA) expanded health insurance access for thousands of individuals. But, billing third-party payers for family planning services can result in the generation of explanations of benefits and other communications to the policy holder that may compromise confidentiality for covered dependents. METHODS The research team facilitated 12 focus groups with 62 Title X clients in 5 states and conducted interviews with 91 health center key informants in 10 states. Transcripts were coded using NVivo version 10.0. Researchers used deductive coding and grounded theory to search for themes. RESULTS Clients expressed confusion about the difference between confidential services from their health center versus confidential communications from their health insurance plan. Health center staff also highlighted confidentiality issues that may arise from ACA insurance expansion and revealed that clients overall do not understand how health insurance works, particularly younger clients and those that were newly covered under the ACA. CONCLUSIONS Many Title X supported health centers will continue not to bill insurance if there are concerns regarding confidentiality, especially with their adolescent and young adult clients. Despite additional revenue sources that have emerged since the passage of the ACA, Title X funding may remain critical for clients who need safe, affordable, and confidential care.
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Affiliation(s)
| | - Sandra Silva
- Altarum Institute, Washington, District of Columbia
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McCullough K, Dalstrom M. I am insured but how do I use my coverage: Lessons from the front lines of Medicaid reform. Public Health Nurs 2018; 35:568-573. [DOI: 10.1111/phn.12525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sawyer AN, Kwitowski MA, Benotsch EG. Are You Covered? Associations Between Patient Protection and Affordable Care Act Knowledge and Preventive Reproductive Service Use. Am J Health Promot 2017; 32:906-915. [PMID: 29121792 DOI: 10.1177/0890117117736091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Sexual and reproductive health conditions (eg, infections, cancers) represent public health concerns for American women. The present study examined how knowledge of the Patient Protection and Affordable Care Act (PPACA) relates to receipt of preventive reproductive health services among women. DESIGN Cross-sectional online survey. SETTING Online questionnaires were completed via Amazon Mechanical Turk, a crowdsourcing website where individuals complete web-based tasks for compensation. PARTICIPANTS Cisgendered women aged 18 to 44 years (N = 1083) from across the United States. MEASURES Participants completed online questionnaires assessing demographics, insurance status, preventive service use, and knowledge of PPACA provisions. ANALYSIS Chi-squares showed that receipt of well-woman, pelvic, and breast examinations, as well as pap smears, was related to insurance coverage, with those not having coverage at all during the previous year having significantly lower rates of use. Hierarchical logistic regressions determined the independent relationship between PPACA knowledge and use of health services after controlling for demographic factors and insurance status. RESULTS Knowledge of PPACA provisions was associated with receiving well-woman, pelvic, and breast examinations, human papillomavirus vaccination, and sexually transmitted infections testing, after controlling for these factors. Results indicate that expanding knowledge about health-care legislation may be beneficial in increasing preventive reproductive health service use among women. CONCLUSION Current findings provide support for increasing resources for outreach and education of the general population about the provisions and benefits of health-care legislation, as well as personal health coverage plans.
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Affiliation(s)
- Ashlee N Sawyer
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Melissa A Kwitowski
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Eric G Benotsch
- 1 Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Bessett D, Prager J, Havard J, Murphy DJ, Agénor M, Foster AM. Barriers to contraceptive access after health care reform: experiences of young adults in Massachusetts. Womens Health Issues 2015; 25:91-6. [PMID: 25630846 DOI: 10.1016/j.whi.2014.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/24/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore how Massachusetts' 2006 health insurance reforms affected access to sexual and reproductive health (SRH) services for young adults. STUDY DESIGN We conducted 11 focus group discussions across Massachusetts with 89 women and men aged 18 to 26 in 2009. RESULTS Most young adults' primary interaction with the health system was for contraceptive and other SRH services, although they knew little about these services. Overall, health insurance literacy was low. Parents were primary decision makers in health insurance choices or assisted their adult children in choosing a plan. Ten percent of our sample was uninsured at the time of the discussion; a lack of knowledge about provisions in Chapter 58 rather than calculated risk analysis characterized periods of uninsurance. The dynamics of being transitionally uninsured, moving between health plans, and moving from a location defined by insurance companies as the coverage area limited consistent access to contraception. Notably, staying on parents' insurance through extended dependency, a provision unique to the post-reform context, had implications for confidentiality and access. CONCLUSIONS Young adults' access to and utilization of contraceptive services in the post-reform period were challenged by unanticipated barriers related to information and privacy. The experience in Massachusetts offers instructive lessons for the implementation of national health care reform. Young adult-targeted efforts should address the challenges of health service utilization unique to this population.
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Affiliation(s)
- Danielle Bessett
- Department of Sociology, University of Cincinnati, Cincinnati, Ohio.
| | | | - Julia Havard
- Ibis Reproductive Health, Cambridge, Massachusetts
| | | | | | - Angel M Foster
- Ibis Reproductive Health, Cambridge, Massachusetts; Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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