Age at diagnosis and insurance literacy influence engagement in an insurance literacy educational program for adolescents and young adults with cancer: Results from the HIAYA CHAT pilot study

Authors: Chevrier A, Kaddas HK, Mann K, Waters AR, Perez GK, Park ER, Vaca Lopez PL, Warner EL, Ray N, Allen K, Tsukamoto T, Fair D, Lewis M, Haaland B, Kirchhoff AC

Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2023

Abstract Body:
Purpose: Interventions are needed to help cancer patients navigate care and reduce financial toxicity. Relatedly, there is a need to understand who engages in these programs. We report on factors associated with completion of a virtual 4-session health insurance literacy education program designed for adolescent and young adult (AYA) cancer patients. Methods: AYA patients between the ages of 18-39, <1 year from diagnosis, were recruited from clinical sites in Utah to participate. AYAs completed a baseline survey prior to randomization that included items on demographics, health insurance literacy (confidence using insurance/health insurance terms; 22 items ranging 9-33, >23 to denote high literacy), and financial toxicity (COmprehensive Score for Financial Toxicity; 11 items ranging 0-44, <22 to denote financial toxicity). Intervention sessions were delivered over Zoom every other week, lasting ~45 minutes each. Among intervention participants (N=45), we examined factors (diagnosis age, insurance policy holder status, insurance literacy, financial toxicity, time from diagnosis) related to completion of 4 sessions using Fisher's exact tests. We fit a multivariable logistic regression to examine associations of these factors with the outcome (completion of 4 sessions vs. 0-3). Results: Participants were 62.2% female, 55.5% their own insurance policy holder, and 14.0% Hispanic. The overall number of sessions completed was 0 (24.4%), 1 (6.7%), 2 (4.4%), 3 (0.0%), and 4 (65.0%). In univariate comparisons, younger AYAs (N=17, age 18-25) were less likely to complete 4 sessions than older AYAs (N=28; age 26-39) (50.0% vs 70.0%, p=0.06). More of the older AYAs had high baseline health insurance literacy scores than younger AYAs (64.0% vs. 35.3%, p=0.07). In the multivariable model, AYAs with higher baseline insurance literacy were less likely to complete all 4 sessions (Odds Ratio [OR]=0.12, 95% CI 0.02- 0.90 vs. low literacy). Yet, older AYAs remained more likely to complete all 4 sessions than younger AYAs (OR=6.49, 95% CI 1.00-40.97). Conclusions: AYAs who engaged fully in an insurance literacy program were older and had lower health insurance literacy. Tailored interventions that address differences by age and literacy levels may increase engagement and impact.

Keywords: health insurance, educational intervention, young adults