Health Education Specialists' Knowledge, Attitudes, and Perceptions of the Patient Protection and Affordable Care Act

A Cross-Sectional Study on the Affordable Care Act from the Perspective of People Living with HIV: The Interplay between Knowledge, Stigma, Trust, and Attitudes

Background

Many AIDS Drug Assistance Programs (ADAPs) purchased Affordable Care Act (ACA) Qualified Health Plans (QHPs) for low-income people living with HIV (PLWH). To date, little has been published about PLWH's perspective on the ACA. We explored ACA knowledge, HIV stigma, trust in the healthcare system, and ACA attitudes among PLWH with ADAP-funded QHPs in Virginia.

Methods

Participants were surveyed about demographic characteristics, ACA knowledge, HIV stigma, trust in various healthcare and government entities, and attitudes toward the ACA. Descriptive statistics were used. We assessed for associations (1) between baseline characteristics and correct ACA knowledge, HIV-related stigma, trust, and ACA attitudes and (2) between correct ACA knowledge and the following data: sources of ACA knowledge, HIV stigma, and trust.

Results

Participants (n = 53) were a vulnerable population based on the assessment of social determinants of health, and 30% had correct ACA knowledge. Almost three-fourths of participants used HIV clinic case managers for ACA information. Participants who used websites for ACA information had correct ACA knowledge more often compared to those that did not (71% vs. 15%; p = 0.001). Those with correct ACA knowledge had lower stigma scores compared to those without correct ACA knowledge (93.8; SD: 15.4 vs. 108; SD: 20.3; p = 0.01). Participants trusted HIV clinicians more than general clinicians and insurance companies. No association was found between having correct ACA knowledge and endorsing having enough information about the ACA to understand how it will impact their HIV care.

Conclusions

Websites imparted accurate ACA information. HIV clinic case managers were the most used source, and HIV clinicians were a trusted source of information. HIV clinicians and case managers should consider disseminating information about the ACA and its impact on HIV care delivery via internet videos. Lack of internet and stigma are a threat to PLWH gaining actionable healthcare information.

Health Educator Perspectives on Seeking Medicaid Reimbursement in Indiana

Health education is a growing field. However, there is confusion about the role delineation of health education specialists (HES) and other health education (HE) providers. Additionally, recent reimbursement opportunities allow employers to bill for HE services but offer confusing language regarding eligible service-providing professionals. This study surveyed health educators in Indiana to assess knowledge, attitudes, and perceived abilities to bill Medicaid and other insurers for HE services. Using a cross-sectional research design, an original 22-item Web-based questionnaire was developed and distributed to all Certified Health Education Specialist/Master Certified Health Education Specialist (CHES/MCHES) practitioners residing in Indiana. Additional respondents were recruited using a snowball technique, as original respondents asked to share the survey with colleagues. A final data set of 61 respondents was analyzed. All respondents' organizations provided HE services, with the majority indicating they do not charge and do not bill for HE services. Additionally, 60% of the respondents agreed that HES should be reimbursed for services, and the vast majority believed reimbursement to be important for the field. With recent reimbursement opportunities for HE and preventative health services, it is important that HES advocate for the profession and for potential reimbursement opportunities, such as Medicaid, to enhance the field and support HES jobs.

Health Education Careers in a Post-Health Reform Era

Since enactment of the Patient Protection and Affordable Care Act in 2010, health education specialists (HES) have made important contributions in implementing the law's provisions at the individual, family, and population levels. Using their health education competencies and subcompetencies, HES are improving public understanding of health insurance literacy and enrollment options, conducting community health needs assessments required of nonprofit hospitals, modifying policies or systems to improve access to health screenings and preventive health services, strengthening clinical and community linkages, and working with employee benefit plans. In addition to educating stakeholders about their complementary training and roles with respect to clinical providers, HES must keep abreast of rapid changes catalyzed by the Affordable Care Act in terms of health standards, payment models, government regulations, statistics, and business practices. For continued career growth, HES must continually acquire new knowledge and skills, access and analyze data, and develop interprofessional partnerships that meet the evolving needs of employers as the nation pursues health for all.