Using Micro-Moment Time-Line Interviews to Understand Individuals’ Health Insurance...
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Using Micro-Moment Time-Line Interviews to Understand Individuals’ Health Insurance Decision-Making Processes Emily Vardell, MLS PhD Candidate and Teaching Fellow, School of Information and Library Science, University of North Carolina at Chapel Hill Background It is a “widely perceived but poorly documented problem” 1 that many individuals lack clear understanding of their health insurance. One of the first formally proposed definitions of health insurance literacy describes it as “the extent to which consumers can make informed purchase and use decisions.” 2 For the large number of adults with lower levels of health insurance literacy, their ability to procure appropriate levels of health insurance coverage and interact with the health care system successfully may be limited, which in turn can have dire effects on individuals’ health statuses. Mary Ellen Nolan Consumer Health Librarian References 1. Loewenstein, G., Friedman, J. Y., McGill, B., Ahmad, S., Linck, S., Sinkula, S., … Volpp, K. G. (2013). Consumers’ misunderstanding of health insurance. Journal of Health Economics, 32(5), 850-62. 2. Kim, J., Braun, B., & Williams, A.D. (2013). Understanding health insurance literacy: A literature review. Family and Consumer Sciences Research Journal, 42(1), 3-13. 3. Dervin, B. (1983). An overview of sense-making research: Concepts, methods and results. Paper presented at the annual meeting of the International Communication Association, Dallas, TX, May. Common Decision-Making Strategies The following decision-making strategies were the most commonly mentioned steps during the time-line interview: • Reviewed printed insurance materials from orientation session (n = 22) • Looked for information on the state health plan website to answer a specific question (n = 13) • Estimated personal health care costs (n = 13) • Sought advice from a work colleague (n = 10) • Discussed health insurance options with a spouse/partner (n = 10) • Discussed health insurance options with a parent (n = 10) • Contacted human resources officer with a question (n = 7) • Googled health insurance term(s)/answer(s) to specific question(s) (n = 7) • Reviewed state health plan website for general information (n = 6) Example Micro-Moment Time-Lines from Interviews Spoke with colleague before orientation who recommended specific plan After orientation read through printed materials Logged into online system to enroll with printed book out to confirm plans Reviewed state health plan website Printed enrollment confirmation to double check coverage for 2016 and 2017 Talked with friend about what plan she had Talked with dad about insurance terminology (i.e., FSA, deductibles) Googled terms (i.e., FSA, CDHP) and comparison of plans Used cost calculator on the state health plan website Used drug calculator on the state health plan website Looked at Decision Guide for Open Enrollment book Talked with boyfriend about his experience with state health plan Reviewed information about out-of-pocket costs and coinsurance (scenarios were helpful) Looked for coverage of contraceptives Talked with sister who has a high deductible health plan Looked at money spent last year on physical therapy Used the state health plan online calculator to estimate costs Searched for limitations on the number of physical therapy visits per year Participant 15 Timeline Participant 19 Timeline Participant 24 Timeline Let the information sink in (“percolate”) overnight Recruitment Participants (n = 30) were recruited at new hire orientation sessions at a large, public university in the southeastern United States. Acknowledgement This project was funded by the Thomson Reuters/Medical Library Association Doctoral Fellowship. Objectives • Library and information science researchers can offer community engagement support by better understanding these knowledge gaps and addressing the unmet information needs that leave many individuals in the dark and unable to make the most appropriate health insurance choices. • This study explores the processes participants use to make health insurance decisions, focusing on an analysis of the trends found across individuals. Participants’ Characteristics • 80% of participants were female and 20% male. • 46.67% of participants were between 27-35 years old, 20% 18-26 years old, 20% 36-45 years old, 10% 46-55 years old, and 3.33% 56-64 years old. • 63.33 % of participants were white, 13.33% Black/African American, 13.33% Asian or Asian American, 6.67% Hispanic/Latino, and 3.33% American Indian. • 43.33% of participants had a Master's degree, 36.67% had a Bachelor's degree, 13.33% had a Doctoral degree, and 6.67% had some college. • 56.67% of participants were single, 36.67% were married, and 6.67% had a domestic partner. Methods This study employed Dervin’s (1983) Micro-Moment Time-Line Interview method to explore the steps that individuals take to process health insurance information and make health insurance decisions. In the Micro-Moment Time-Line Interview, the researcher asks a participant to list step-by-step all the events associated with a particular situation, writing each of the steps down on a card. Then the researcher asks the participant specific questions about each card, including “what questions he or she had, what things he/she needed to find out, learn, come to understand, unconfuse, or make sense of.” 3 Reflections on Method As a result of using the Micro- Moment Time-Line technique, participants were better able to: • Estimate the amount of time spent on the health insurance decision-making process. • Identify the helpful individuals they spoke with during their decision-making process. • Recognize the questions they had during the process and the resources they used to address them. Results Participants reflected on their techniques for reviewing the information available to them, narrowing down their choices, searching for answers to specific questions, and using available tools (e.g., online benefits calculator). Participants also spoke about discussing their health insurance coverage options with others perceived as having more experience (e.g., a parent), those with similar coverage (e.g., colleagues), and those involved in their financial decisions (e.g., a spouse). Future Work The collected data will form the foundation for the construction of a model of the health insurance decision-making process and offer insight to the library and information science community on how to support health insurance information needs. The proposed model and discussion will address understanding of health insurance concepts, how health insurance decisions are made, and the factors which impact health insurance literacy and decision-making. Implications may include the creation of new information sources or ways in which to facilitate shared decision-making for health insurance choice.
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Transcript of Using Micro-Moment Time-Line Interviews to Understand Individuals’ Health Insurance...
Using Micro-Moment Time-Line Interviews to Understand Individuals’ Health Insurance Decision-Making Processes
Emily Vardell, MLS
PhD Candidate and Teaching Fellow, School of Information and Library Science, University of North Carolina at Chapel Hill
Background
It is a “widely perceived but poorly documented problem”1 that many individuals lack clear understanding of their health insurance. One of the first formally proposed definitions of health insurance literacy describes it as “the extent to which consumers can make informed purchase and use decisions.”2 For the large number of adults with lower levels of health insurance literacy, their ability to procure appropriate levels of health insurance coverage and interact with the health care system successfully may be limited, which in turn can have dire effects on individuals’ health statuses.
Mary Ellen NolanConsumer Health Librarian
References
1. Loewenstein, G., Friedman, J. Y., McGill, B., Ahmad, S., Linck, S., Sinkula, S., … Volpp, K. G. (2013). Consumers’ misunderstanding of health insurance. Journal of Health Economics, 32(5), 850-62.
2. Kim, J., Braun, B., & Williams, A.D. (2013). Understanding health insurance literacy: A literature review. Family and Consumer Sciences Research Journal, 42(1), 3-13.
3. Dervin, B. (1983). An overview of sense-making research: Concepts, methods and results. Paper presented at the annual meeting of the International Communication Association, Dallas, TX, May.
Common Decision-Making Strategies
The following decision-making strategies were the most commonly mentioned steps during the time-line interview:
• Reviewed printed insurance materials from orientation session (n = 22)
• Looked for information on the state health plan website to answer a specific question (n = 13)
• Estimated personal health care costs (n = 13)
• Sought advice from a work colleague (n = 10)
• Discussed health insurance options with a spouse/partner (n = 10)
• Discussed health insurance options with a parent (n = 10)
• Contacted human resources officer with a question (n = 7)
• Googled health insurance term(s)/answer(s) to specific question(s) (n = 7)
• Reviewed state health plan website for general information (n = 6)
Example Micro-Moment Time-Lines from Interviews
Spoke with colleague before orientation who recommended specific plan
After orientation read through printed materials
Logged into online system to enroll with printed book out to confirm plans
Reviewed state health plan website
Printed enrollment confirmation to double check coverage for 2016 and 2017
Talked with friend about what plan she had
Talked with dad about insurance terminology (i.e., FSA, deductibles)
Googled terms (i.e., FSA, CDHP) and comparison of plans
Used cost calculator on the state health plan website
Used drug calculator on the state health plan website
Looked at Decision Guide for Open Enrollment book
Talked with boyfriend about his experience with state health plan
Reviewed information about out-of-pocket costs and coinsurance (scenarios were helpful)
Looked for coverage of contraceptives
Talked with sister who has a high deductible health plan
Looked at money spent last year on physical therapy
Used the state health plan online calculator to estimate costs
Searched for limitations on the number of physical therapy visits per year
Participant 15 Timeline
Participant 19 Timeline
Participant 24 Timeline
Let the information sink in (“percolate”) overnight
Recruitment
Participants (n = 30) were recruited at new hire orientation sessions at a large, public university in the southeastern United States.
Acknowledgement
This project was funded by the Thomson Reuters/Medical Library Association Doctoral Fellowship.
Objectives
• Library and information science researchers can offer community engagement support by better understanding these knowledge gaps and addressing the unmet information needs that leave many individuals in the dark and unable to make the most appropriate health insurance choices.
• This study explores the processes participants use to make health insurance decisions, focusing on an analysis of the trends found across individuals.
Participants’ Characteristics
• 80% of participants were femaleand 20% male.
• 46.67% of participants were between 27-35 years old, 20% 18-26 years old, 20% 36-45 years old, 10% 46-55 years old, and 3.33% 56-64 years old.
• 63.33 % of participants were white, 13.33% Black/African American, 13.33% Asian or Asian American, 6.67% Hispanic/Latino, and 3.33% American Indian.
• 43.33% of participants had a Master's degree, 36.67% had a Bachelor's degree, 13.33% had a Doctoral degree, and 6.67% had some college.
• 56.67% of participants were single, 36.67% were married, and 6.67% had a domestic partner.
Methods
This study employed Dervin’s (1983) Micro-Moment Time-Line Interview method to explore the steps that individuals take to process health insurance information and make health insurance decisions. In the Micro-Moment Time-Line Interview, the researcher asks a participant to list step-by-step all the events associated with a particular situation, writing each of the steps down on a card. Then the researcher asks the participant specific questions about each card, including “what questions he or she had, what things he/she needed to find out, learn, come to understand, unconfuse, or make sense of.”3
Reflections on Method
As a result of using the Micro-Moment Time-Line technique, participants were better able to:
• Estimate the amount of time spent on the health insurance decision-making process.
• Identify the helpful individuals they spoke with during their decision-making process.
• Recognize the questions they had during the process and the resources they used to address them.
Results
Participants reflected on their techniques for reviewing the information available to them, narrowing down their choices, searching for answers to specific questions, and using available tools (e.g., online benefits calculator).
Participants also spoke about discussing their health insurance coverage options with others perceived as having more experience (e.g., a parent), those with similar coverage (e.g., colleagues), and those involved in their financial decisions (e.g., a spouse).
Future Work
The collected data will form the foundation for the construction of a model of the health insurance decision-making process and offer insight to the library and information science community on how to support health insurance information needs. The proposed model and discussion will address understanding of health insurance concepts, how health insurance decisions are made, and the factors which impact health insurance literacy and decision-making. Implications may include the creation of new information sources or ways in which to facilitate shared decision-making for health insurance choice.
