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Clinical Trial Details — Status: Completed

Administrative data

NCT number NCT02522624
Other study ID # 201407058
Secondary ID 5R01MD008808-02
Status Completed
Phase N/A
First received August 6, 2015
Last updated January 30, 2018
Start date September 2015
Est. completion date February 2016

Study information

Verified date January 2018
Source Washington University School of Medicine
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

The overall purpose of the study is to better understand how the investigators previously developed decision support (DS) tool can help people make decisions about health insurance plans available through the federal exchanges created by the Affordable Care Act (ACA). The investigators will evaluate the DS tool compared to the federal government website. The investigators will also evaluate the feasibility of disseminating this tool. There are two primary aims to be completed in this project: (1) examine the reach and effectiveness of the health insurance DS tool; and (2) collect stakeholders' feedback to improve the likelihood of implementation of the DS tool.


Description:

First, for Aim 1 part 1, the investigators will recruit 40 key stakeholders (uninsured participants, health providers, community advisors, and health policy experts) to refine the DS tool through a series of individual semi-structured interviews. Next, the investigators will use their feedback to program the DS strategies into an online DS tool. After its initial production, the tool will be pilot tested with 30 individuals to assess readability, message clarity, format, and function of the tool as well as to test the randomized trial study procedures. Then, for Aim 1 part 2, the investigators will test the DS tool in a randomized trial with 362 participants eligible for the Affordable Care Act (ACA) exchanges. Half will use the DS tool and the other half will use the federal government site to learn about the exchanges. The investigators will use computerized random assignment to assign participants to study condition, after which they will all complete the same short survey. For Aim 2, the investigators will collect 40 stakeholders' feedback on likelihood of adoption and implementation of the DS tool to plan for dissemination and implementation. Stakeholders will be asked both open-ended and closed-ended questions in order to gather feedback about delivering the DS tool. These stakeholders will be different from those who were interviewed in Aim 1 as to ensure broader applicability of the DS tool.


Recruitment information / eligibility

Status Completed
Enrollment 328
Est. completion date February 2016
Est. primary completion date February 2016
Accepts healthy volunteers Accepts Healthy Volunteers
Gender All
Age group 18 Years to 64 Years
Eligibility Inclusion Criteria:

- Must be without health insurance currently; or

- Must be enrolled in one of the ACA exchange plans in the past 1 year; and

- Must speak English

Exclusion Criteria:

- Currently has health insurance that was not provided by being enrolled in one of the ACA exchange plans in the past year

- Currently has health insurance that is provided through public insurance or private employer-based insurance

- Does not speak English

Study Design


Intervention

Behavioral:
Decision Aid (DA)
Participants will be shown (on a computer) a targeted, web-based decision aid focused on the topic of health insurance plans in addition to usual care.

Locations

Country Name City State
United States The Washington University in St. Louis School of Medicine Saint Louis Missouri

Sponsors (3)

Lead Sponsor Collaborator
Washington University School of Medicine National Institute on Minority Health and Health Disparities (NIMHD), National Institutes of Health (NIH)

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Primary Knowledge Score (% Correct) 8 questions developed in researchers' past work. Assessed health insurance knowledge. Completed immediately after reviewing Decision Aid tool, taking about 5 minutes to complete.
Primary Decision Self-efficacy The decision self-efficacy (DSE) scale measured participants' perceived ability to understand insurance info and resist unwanted decision pressure. The 6 items on the DSE scale were each rated on a 3-point scale (0=Not confident; 2=A little confident; 4=Very confident). The sum of the DSE items was divided by 6 and multiplied by 25 to obtain a score on a 0-100 scale. Higher values indicate more confidence in one's decision-making ability. Completed immediately after reviewing Decision Aid tool, taking about 5 minutes to complete.
Primary Confidence in Choice The 4-item SURE (Sure of myself; Understand information; Risk-benefit ratio; Encouragement) decisional conflict scale assessed confidence in plan choice. Each item could be answered dichotomously (1=yes; 0=no). Responses were summed and a group average was obtained. Higher SURE values indicate more confidence in choice. The scale ranged from 0-4. Completed immediately after reviewing Decision Aid tool, taking about 5 minutes to complete.
Secondary Improvements in HILM 1 (Health Insurance Literacy Measure) Assessed confidence estimating costs of care.Improvement in HILM was defined as moving from "not confident" pre-intervention to "a little confident" or "very confident" post-intervention, or from "a little confident" pre-intervention to "very confident" post-intervention. Pre-intervention and post-intervention
Secondary Improvements in HILM 2 (Health Insurance Literacy Measure) Assessed confidence understanding terms.Improvement in HILM was defined as moving from "not confident" pre-intervention to "a little confident" or "very confident" post-intervention, or from "a little confident" pre-intervention to "very confident" post-intervention. Pre-intervention and post-intervention
Secondary Intended Choice Metal Level Participants indicated the plan they would choose that day. We categorized plans by governmental classifications of metal level (catastrophic, bronze, silver, gold). Completed immediately after reviewing Decision Aid tool, taking about 5 minutes to complete.
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