Those developing materials about the health insurance marketplace to support health insurance decisions might consider starting with plain language tables, presenting health insurance terminology in context, and organizing information according to ways the uninsured might use and value insurance features. Individuals with limited health literacy and numeracy skills and those with lower education face unique challenges selecting health insurance and weighing tradeoffs between cost and coverage.

Health equity is a public health priority, yet little is known about commitment to health equity in health departments, especially among chronic disease prevention practitioners whose work places them at the forefront of addressing the top contributors to disparities in morbidity and mortality. A random sample of state chronic disease practitioners (N=537) was surveyed on health equity commitments, partnerships, and needed skills. A small percent of respondents worked primarily on health equity (2%) and more (9%) included health equity as one of multiple work areas. Individuals who rated their work unit’s commitment to health equity as high were more likely to engage with sectors outside of health and rate their leaders as high quality and were less likely to identify skills gaps in their work unit. Opportunities exist to more fully address health equity in state public health practice through “big P” and “little p” policies, including those regarding resource allocation and staff training.

BackgroundLittle is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States.MethodsBetween February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions).ResultsPractitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries.ConclusionsThis study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.

As a result of the Affordable Care Act, millions of previously uninsured individuals are facing the daunting task of selecting health insurance. In order to better understand how to reach the uninsured and support their health insurance decision making, this study examined where the uninsured collect information about health insurance and the extent to which they trust those sources and media. We analyzed secondary data on health insurance information-seeking behaviors collected from a survey of 343 uninsured individuals. The Internet, mail, and television were among the most frequently used media, though all 3 had low trust scores. Participants sought information from health care providers and interpersonal sources less frequently but trusted it more than they trusted the media. Age, gender, race, and education were predictors of use and trust of different media and sources of health insurance information. Findings suggest that strategies that pair health care professionals, lay health advisors, or community liaisons with the ubiquity of the Internet may be a strong approach for delivering quality health insurance information to the uninsured. Tailoring messages might also be effective at reaching specific subgroups of the uninsured.