ASPO Abstracts
The HIAYA CHAT project: Utilizing an intervention adaptation framework to inform a health insurance education program for adolescent and young adult cancer patients
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2021
Abstract Body:
Purpose: Adapting interventions to new contexts requires consideration of the needs, norms, and delivery
structures of the new setting. We report on the process of intervention adaptation to design a health insurance
education program (HIEP) for adolescent and young adult (AYA) cancer patients.
Methods: Following Movsisyan's four phase evidence-informed population heath intervention guide (Exploration,
Preparation, Implementation, Sustainability), we adapted the HIEP, originally designed for pediatric cancer
survivors, to newly diagnosed AYAs. We describe the role of stakeholders (researchers, clinicians, patient
navigators, advisory board). Data collection included interviews, surveys, and pilot testing.
Results: In 2016, during the Exploration phase, we interviewed and surveyed AYAs and identified insurance
knowledge gaps, lack of familiarity with insurance legislation, and confusion about resources for insurance and
cost concerns. In 2020, during the Preparation phase, we identified mismatches between the original pediatric and
survivorship-focused content and the insurance needs of AYAs (health literacy, out-of-pocket costs). We partnered
with two AYA patient navigators to ensure the intervention content was suitable from their perspective. Patient
interviews were performed to adapt the original pediatric content to the AYA HIEP. A health educator stakeholder
assisted in matching intervention content to AYAs literacy level. Through this step, we evaluated the capacity of
the research team, navigators, and clinical collaborators to ensure our ability to implement the intervention. In the
Implementation phase, we trained the patient navigators to pilot the intervention materials with N=2 patients and
N=4 staff. In the Sustainability phase, we will evaluate the feasibility and preliminary efficacy of the adapted HIEP
in a randomized controlled trial.
Conclusions: By engaging patients, stakeholders, and leveraging institutional resources, we identified and
preemptively addressed real-world barriers, which may improve the feasibility and efficacy of the intervention for
AYAs. Using evidence-based models to adapt and refine interventions enhances rigor and reproducibility,
implements checks and balances, and surmounts challenges of intervention rollout.
Keywords: health insurance, adolescent, young adult, intervention adaptation