User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews

Abstract

Background Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information. Objective This study aims to examine how individuals interact with two different types of health insurance decision aids (guided VBCs that mimic conversations with a real HR counselor and self-directed HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions. Methods In total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined. Results Both the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate. Conclusions This study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats.

Codesigning a user-centred digital psychoeducational tool for youth mental well-being with families in Canada: study protocol for a sequential exploratory mixed methods study

“…Research staff will meet with youth and parents (separately) over a 1-hour session to complete the tool (virtually). Youth and Parent Priority Partners will be asked to perform tasks such as selecting responses from a menu of questions, navigating to specific sections and interacting with video content while verbally describing their thought process via think-aloud exercises 42–44. Immediately after the session we will administer an online questionnaire of the System Usability Scale, a validated 10-item questionnaire that uses a 5-point Likert scale to assess usability 45.…”

Users’ Navigation Strategy and Information Search with Health Insurance Decision Aids Using Social Network Analysis

“…After completing the enrollment task participants were asked again about their health insurance knowledge and literacy. They also completed a decision conflict scale (Légaré et al, 2010) and were asked to rate the usefulness and ease of use of the system (Giang et al, 2021). Finally, participants took part in a retrospective think-aloud interview where they explained their thoughts, goals, navigation strategies, and information they were looking for while interacting with the decision aid.…”

“…Participants were employees at a state university who were recruited from a survey conducted to study the sources of information employees used to make health insurance decisions (see Colón-Morales et al, 2021, for a detailed description of the survey procedure). The only inclusion criterion was that participants must be full-time employees to be eligible for employer-provided health insurance.…”

“…For the 91.7% of Americans who have health insurance (Keisler-Starkey & Bunch, 2022), enrollment decisions occur at least once a year to either keep their current plan or change to another plan. Of that, 54.3% are employer-insured (Keisler-Starkey & Bunch, 2022), and research has shown that these individuals often seek information from multiple sources, such as friends and family and digital tools to aid in the decision-making process (Colón-Morales et al, 2021). Digital tools particularly are a preferred source of information (Colón-Morales et al, 2021) and have benefits such as providing information directly from the health insurance provider or employer and is scalable to a large audience.…”

“…Enrolling in health insurance plans is a difficult task because of the complexity of the healthcare system (Colón-Morales et al, 2021; Fox & Kongstvedt, 2013) and the lack of health insurance knowledge (Giang et al, 2021). Enrollment decisions depend on factors such as pre-existing health conditions, income level, employment status, and plan characteristics such as premiums or co-pays (Fox & Kongstvedt, 2013; Giang et al, 2021). For the 91.7% of Americans who have health insurance (Keisler-Starkey & Bunch, 2022), enrollment decisions occur at least once a year to either keep their current plan or change to another plan.…”