Research Spotlight: Enhancing Health Insurance Literacy in Childhood Cancer Survivors

Elyse R. Park, PhD, MPH an investigator in the Department of Psychiatry and Medicine at Massachusetts General Hospital, and Director of the Health Promotion Resiliency Intervention Research (HPRIR) Center, is the lead author of a recently published study in the Journal of Oncology Practice, Health Insurance Navigation Tools Intervention: A Pilot Trial Within the Childhood Cancer Survivor Study.

Karen Kuhlthau, PhD, chief and director of General Academic Pediatrics at Mass General for Children, is senior author.

What Question Were You Investigating?

Childhood cancer survivors (CCS) are at increased risk for underinsurance and health insurance–related financial burden.

Interventions targeting health insurance literacy (HIL) are needed to improve the ability of CCS to understand and use health insurance.

Our recent study aimed to test if a health insurance navigation program (Health Insurance Navigation Tools (HINT)) is feasible and acceptable to deliver to a cohort of childhood cancer survivors.

We also aimed to identify the benefits of participating in the program compared to enhanced usual care on enhancing health insurance literacy, which may ultimately reduce financial burden among survivors.

What Methods or Approach Did You Use?

This multiphase randomized controlled trial was conducted within the national Childhood Cancer Survivor Study (CCSS) cohort.

The study enrolled 82 childhood cancer survivors with low baseline health insurance literacy (HIL) scores and limited knowledge of Affordable Care Act.

The intervention consisted of four sessions delivered by a patient navigator via Zoom and a corresponding electronic booklet that the team designed.

Our trial design is unique because it is the first trial (that we are aware of) using a digitally delivered health insurance navigation to improve HIL and health outcomes in childhood cancer survivors.

What Did You Find?

Results support the feasibility and acceptability of a virtual health insurance navigation program targeted for childhood survivors.

 Additionally, participants randomized to the intervention showed signals of improvements in health insurance literacy, familiarity with health insurance reform, knowledge of ACA provisions, psychological financial hardship, and health insurance satisfaction compared to the control group.

What are the Implications?

A health insurance navigation program for this population is essential, as CCS are at increased risk for early, high cumulative burden of chronic health conditions and shortened lifespans, which is exacerbated by the complexity of navigating and managing health care and insurance in the United States.

What are the Next Steps?

Currently, with funding from the NCI, we are conducting a Type 1 hybrid effectiveness-implementation trial to test HINT-S (synchronous navigator sessions), HINT-A (4 prerecorded, asynchronous navigator sessions, which has the potential to be more cost-effective and scalable), and enhanced usual care to promote health insurance literacy, as well as improving downstream financial hardship and out-of-pocket costs (target sample size=520).

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.