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Health insurance and health systems literacy needs are evolving with changes to the U.S. healthcare system. Following the implementation of the Affordable Care Act, many residents in West Louisville, Kentucky, a predominantly African American community, gained health insurance coverage for the first time. A qualitative study was conducted to assess residents’ health insurance and health systems needs and to identify ways of assisting residents with navigating the healthcare system and utilizing their health insurance coverage. Twelve focus groups were conducted with a total of eighty-seven residents. Round one explored participants’ experiences with health insurance, and round two examined their health information delivery preferences. An inductive thematic analysis was performed. Participants revealed the complexity of the health insurance system, many citing difficulty understanding health insurance concepts and finding suitable healthcare providers. High costs, mistrust in the healthcare system, and perceived public-private disparities were barriers to effective health insurance utilization. Health insurance materials in their current form have limited value in translating health insurance and health systems information to the West Louisville population. Alternative forms of information delivery, such as locally accessible and culturally competent community health workers may be better received and more successfully utilized by the community.

LHL is an independent predictor of racial/ethnic disparities in health behaviors (e.g., smoking, adherence to HIV treatment), access to health care resources, and health outcomes (Al Sayah, Majumdar, Egede, & Johnson, 2015; Berkman et al., 2011; Hossain, Ehtesham, Salzman, Jenson, & Calkins, 2013; Lanning & Doyle, 2010; Mantwill, Monestel-Umaña, & Schulz, 2015; Sentell & Halpin, 2006; Stewart et al., 2015). The health care system has played a role in creating disparities in health literacy by historically failing to accommodate racial and ethnic minority populations' needs and preferences in the delivery of services and health information (Saha, Beach, & Cooper, 2008). [...]health care providers may not recognize the extent of this health literacy gap. [...]African Americans with LHL are less likely to use computers or the internet for health information (McCleary-Jones et al., 2013). [...]to reach a large number of people with LHL, online or digital health literacy interventions should incorporate features that tailor health information to individuals' health literacy needs, technical skills, health needs, as well as personal and cultural values (Bickmore & Paasche-Orlow, 2012; Hur, Lee, & Schmidt, 2015). Furthermore, a qualitative study by our research team examined health insurance literacy among 87 residents (young, middle-aged, and senior adults) of a predominantly African-American community and found that participants preferred in-person health insurance navigation delivered by culturally competent community health workers who are from or familiar with the community, trustworthy, nonjudgmental, and knowledgeable about health insurance (Ali et al., 2018).

Introduction The Democratic Republic of the Congo (DRC) had the second-highest mother-to-child HIV transmission rate in Sub-Saharan Africa at 29% in 2013, however the uptake of preventive services for mother-to-child transmission of HIV (PMTCT) remains suboptimal. This systematic review explores socio-cultural and structural factors influencing PMTCT service uptake in the DRC. Methods We conducted a search of electronic databases. The PEN-3 model was used as a framework to synthesize factors influencing PMTCT service uptake into perceptions, enablers, and nurturers. Results Sixteen studies, 14 quantitative and two qualitative, were retained. Maternal, socio-economic, structural, and cultural factors were found to influence PMTCT service uptake in the DRC. Cost, accessibility, and quality of PMTCT services were key barriers to service uptake. Integration, male partner involvement, and evolving PMTCT policies improved PMTCT service delivery and uptake. This review also revealed several socio-cultural challenges in involving male partners in PMTCT programs. Discussion Findings highlight the need to address barriers and reinforce enablers of PMTCT uptake. Creating culturally appropriate, male-friendly, and family-oriented PMTCT programs will improve service uptake in the DRC.

Depression is the leading cause of disability in the United States. African Americans are disproportionately affected owing to systemic and sociocultural factors. Stigma, denial, and inadequate knowledge on depression are significant barriers to mental help seeking. Addressing mental health literacy can improve mental health knowledge, management, and outcomes. West Louisville, a predominantly African American community, is of particular interest regarding mental health literacy given existing socioeconomic and health disparities. Boot Camp Translation (BCT), a community-based participatory research (CBPR) approach, enables the translation of medical guidelines into culturally relevant messages. To describe the use of the BCT approach in developing and implementing a culturally tailored health communication campaign designed to measurably increase referral to, and use of, services for depression in West Louisville. Using the BCT approach, a group of academics, community members, and health/public health professionals convened over 6 months to develop and implement a health communication campaign on depression. Process and outcome evaluations were conducted using quantitative and qualitative methods. Our BCT was effective in engaging stakeholders, activating community members, and designing culturally informed health communication materials on depression. Although limited, our evaluation data suggest a modest increase in the evaluation and treatment of depression in West Louisville. BCT offers a structured process for engaging stakeholders in developing culturally tailored health communication campaigns.

Background: Despite increases in the number of insured Americans, consumers continue to face barriers in accessing care. Low levels of health insurance literacy (HIL) are associated with suboptimal use of health insurance coverage. There remains a need to further contextualize the relationship between HIL and access to care, especially among insured working-class people. Objective This study was conducted to understand the pathways through which HIL affects health care decision-making and access to care in an urban working-class population. Methods: Using a qualitative descriptive approach, we conducted five focus groups with 45 adult residents of South Louisville, Kentucky. The questions explored participants' experiences of insurance enrollment, use, and health care system navigation, as well as their perceptions and needs regarding accessing health insurance information. Using inductive thematic analysis, transcripts were open coded independently by team members, a focused coding framework was agreed upon, and emergent themes were identified through constant comparison techniques. Key Results: Most participants placed high value on their insurance, considering it the most important benefit employers offer. Despite having adequate HIL, most participants expressed frustration with the amount of time and effort they spent to determine the best insurance plan, obtain covered health services, and settle claims, often with ineffective results. Despite having insurance, cost considerations influenced many participants' decisions to accept certain tests or treatments, in some cases resulting in delayed or foregone care. Conclusions: The findings of this qualitative study indicate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system. Interventions to improve HIL should include practical examples and real-life scenarios, because HIL gained from experiential narratives was the most useful in navigating the health care system.[HLRP: Health Literacy Research and Practice. 2022;6(2):e61–e69.] Plain Language Summary: By conducting focus groups with a working-class population, this study contextualizes the pathways through which HIL affects consumers' health care decision-making and access to care. Findings demonstrate that obtaining health care is strongly influenced both by the individual context of HIL knowledge, experience, and life circumstances, and by the structural context of the complex, bureaucratic, and costly health care system.