171 - Health Insurance Literacy and Self-Efficacy in Adolescents and Young Adults with Chronic Conditions: A Cross-Specialty Study

Publication Number: 1160.171

LUCIO E. ORTEGA MARTINEZ, Rady Children's Hospital San Diego, SAN DIEGO, CA, United States; Jose A. Silva Sepulveda, Rady Children's Hospital San Diego, San Diego, CA, United States; SUSAN A.. PHILLIPS, Rady Children's Hospital San Diego, San Diego, CA, United States; JEANNIE S. HUANG, University of California San Diego, La Jolla, CA, United States

Background: Health insurance literacy is critical for adolescents and young adults (AYA) with chronic conditions to ensure continuity of care during the transition from pediatric to adult healthcare. Limited knowledge and self-efficacy in navigating insurance coverage can lead to care disruptions and poor outcomes in chronic conditions including chronic cardiac conditions (CCC), type 1 diabetes (T1D), and inflammatory bowel disease (IBD).

Objective: To assess health insurance knowledge and self-efficacy among AYA with chronic conditions across specialties and examine associations with demographic characteristics.

Design/Methods: A cross-sectional study was conducted from June 2022 to August 2023 at a pediatric tertiary-care center. Youth aged 15 years and older with CCC, T1D, and IBD were recruited for participation. Participants completed the Kaiser Family Foundation Health Insurance Knowledge Survey (10 questions evaluating basic health insurance concepts, summarily graded as % correct) and the Health Insurance Literacy Measure (HILM, 21 items, rated on a scale of 1 to 4 with greater scores indicating greater confidence) to evaluate health insurance self-efficacy, respectively. Demographic factors (age, gender, race, ethnicity, insurance type) were analyzed using distribution analyses. Participant survey responses were analyzed by demographic groupings using Wilcoxon rank sum tests using a significance level of P<.05.

Results: 75 AYA with chronic conditions participated, including 25 with CCC, 25 with IBD, and 25 with T1D. The overall median age was 18 years, 52.1% female, 52.7% were white, and 40% were covered by government insurance. Demographics did not differ across conditions (Table 1). Median health insurance knowledge scores were universally low (30-40% correct, Table 2) across conditions (P=0.92). Health insurance self-efficacy was moderate (median: 2.5-2.8 out of 4) across groups, with non-Hispanic AYA reporting higher total self-efficacy (P=0.03) and confidence in choosing plans (P=0.005) than Hispanic AYA (Table 3). Otherwise, no significant differences were found by condition, gender, race, or insurance type.

Conclusion(s): AYA with chronic conditions exhibit limited health insurance knowledge and moderate self-efficacy, with ethnic disparities highlighting the need for culturally tailored interventions.

Table 1. Demographics by Disease Condition
*One participant declined to answer M=male, F=female, NB=non-binary, H=Hispanic, NH=non-Hispanic, W=white, NW=non-white.

Table 2. Health Insurance Knowledge and Self-Efficacy


Table 3. Health Insurance Knowledge and Self-Efficacy by Gender, Race, Ethnicity, and Health Insurance Type