Modifiable Factors Associated with Financial Burden: Improving Health Insurance Literacy

本申请是应特别利益通知（NOSI）而提交的。

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-21-055. The goal of the parent grant, Facilitated Oncology, R37CA255875 Technology Behavioral Intervention for Depression among Diverse Patients in Ambulatory i s to evaluate the effectiveness and the implementation of an evidence-based health : information technology (HIT) behavioral treatment for cancer patients with elevated depressive symptoms. This HIT treatment combines systematic, electronic health record-integrated screening for depressive symptoms with an individually-tailored HIT intervention to address gaps in the treatment of depression among cancer patients. Under this infrastructure, we propose to explore predictors of health insurance literacy and financial burden (FB) including the impact of out-of-pocket costs. We will develop and test the feasibility and acceptability of delivering health insurance education via the HIT platform to improve HIL in patients experiencing FB and/or low health literacy in addition to at least mild depression. Our specific aims include: (1) Identify predictors of patient-reported HIL and FB with covariates including actual and self-reported OOP costs for the previous three months and patient-reported symptoms. We hypothesize that those with higher OOP costs (either actual or self-reported), lower education level, higher levels of anxiety and/or depression, lower self-efficacy, non- English speaking, and those being treated with palliative intent will have higher perceived FB. Those with low education level, low self-efficacy, and those being treated with curative intent may have lower HIL. (2) Develop (via literature review, expert and patient input) an animated infographic, educational video (HEalth insurance Literacy Primer “HELP”) that reviews basic elements of health insurance plans. (3) Pilot the acceptability and feasibility of incorporating the “HELP” video within the parent grant's, My Cancer Support, for patients that report FB and/or low health literacy on baseline screening question and evaluate the effectiveness of the intervention on HIL at one month. We hypothesize that incorporation of the “HELP” video will be feasible and acceptable and HIL will improve immediately following an educational intervention, which will be sustained at one month. Predictors of those who improve HIL will be those that have low baseline HIL, a combination of low baseline HIL and high FB, higher education level, and higher self-efficacy.