Powerful audiences are linked to health information avoidance: Results from two surveys

OBJECTIVE

We examined the extent to which community members avoid medical information that they may very much want, yet fear that others may use to harm them.

METHODS

In two online studies, we surveyed participants (N = 659) about their experiences with insurer and employer harm, past avoidance of medical information, intentions to avoid medical information, and reasons for avoiding medical information. Study 2 was a conceptual replication of Study 1 with some minor variations.

RESULTS

Several key findings emerged. 1) Although reports of past audience harm were relatively rare, reports of past avoidance were common, both for audience reasons and resource reasons. 2) Participants who were younger and who reported avoiding medical tests in the past (for audience or resource reasons) generally reported greater intentions to avoid health information in the future. 3) Participants reported that receiving unfavorable medical test results would elicit more harm from financially powerful audiences (health insurers and employers) than from interpersonally powerful audiences (close friends/family and others). 4) Participants indicated that the prospect of harm from an audience (i.e., negative effects on insurance coverage) rather than the prospect of bad news would dissuade them from seeking a medical test. Finally, 5) Participants reported that they were most inclined to avoid testing for medical conditions that were untreatable, unimportant, embarrassing/stigmatizing, or expensive.

CONCLUSIONS

Findings demonstrate that people are concerned with audience perceptions of their health and these concerns may adversely affect decision making and behavior.

An audience research study to disseminate evidence about comprehensive state mental health parity legislation to US State policymakers: protocol

BACKGROUND

A large proportion of the US population has limited access to mental health treatments because insurance providers limit the utilization of mental health services in ways that are more restrictive than for physical health services. Comprehensive state mental health parity legislation (C-SMHPL) is an evidence-based policy intervention that enhances mental health insurance coverage and improves access to care. Implementation of C-SMHPL, however, is limited. State policymakers have the exclusive authority to implement C-SMHPL, but sparse guidance exists to inform the design of strategies to disseminate evidence about C-SMHPL, and more broadly, evidence-based treatments and mental illness, to this audience. The aims of this exploratory audience research study are to (1) characterize US State policymakers' knowledge and attitudes about C-SMHPL and identify individual- and state-level attributes associated with support for C-SMHPL; and (2) integrate quantitative and qualitative data to develop a conceptual framework to disseminate evidence about C-SMHPL, evidence-based treatments, and mental illness to US State policymakers.

METHODS

The study uses a multi-level (policymaker, state), mixed method (QUAN→qual) approach and is guided by Kingdon's Multiple Streams Framework, adapted to incorporate constructs from Aarons' Model of Evidence-Based Implementation in Public Sectors. A multi-modal survey (telephone, post-mail, e-mail) of 600 US State policymakers (500 legislative, 100 administrative) will be conducted and responses will be linked to state-level variables. The survey will span domains such as support for C-SMHPL, knowledge and attitudes about C-SMHPL and evidence-based treatments, mental illness stigma, and research dissemination preferences. State-level variables will measure factors associated with C-SMHPL implementation, such as economic climate and political environment. Multi-level regression will determine the relative strength of individual- and state-level variables on policymaker support for C-SMHPL. Informed by survey results, semi-structured interviews will be conducted with approximately 50 US State policymakers to elaborate upon quantitative findings. Then, using a systematic process, quantitative and qualitative data will be integrated and a US State policymaker-focused C-SMHPL dissemination framework will be developed.

DISCUSSION

Study results will provide the foundation for hypothesis-driven, experimental studies testing the effects of different dissemination strategies on state policymakers' support for, and implementation of, evidence-based mental health policy interventions.