Qualitative Research

Improve Communications and Outreach Programs

Examining barriers and challenges in accessing services offers insights into how to address them and shape better communications, outreach, and service. In this instance, the State of Maryland operates a program designed to support the health insurance exchange for small businesses. As enrollment in health insurance has risen, uninsured populations are small pockets with unique characteristics. A communications firm engaged in the effort of communicating about health insurance with uninsured Maryland residents and small business owners tasked EurekaFacts with conducting qualitative research to help pinpoint areas where improvements could be made.

Communicating about health insurance with uninsured Maryland residents and small business owners

GMMB, an issues-based communications and consulting firm, commissioned EurekaFacts to conduct an evaluation of the barriers and challenges to enrollment in a health insurance plan for Marylanders and small business owners. The research looked at their insurance choices and enrollment in group health plans for their employees. Specifically, sampling and recruitment focused on Latino-owned small businesses.

Research Methodology

We assessed the problem from several qualitative research perspectives:

• In a series of in-depth interviews with uninsured Marylanders, including a cross-section of small business owners identified as most likely to lack health coverage, we evaluated their past health insurance experiences. Questions explored the challenges these individuals encountered with health plans, the potential impact on participant attitudes or behaviors, and then tested a series of communications materials targeted to this audience.
• The critical incident technique was used to examine participants’ health insurance experience and to recall how it influenced decision-making for their business in the past. Using this technique, we also examined how their past experiences frame their motivations and attitudes around health insurance options in the current market.
• As an analytical framework, we used the socio-demographic characteristics of the participants combined with the lens of critical incident technique to evaluate reactions to targeted messages about Maryland Health Connection (the State’s exchange marketplace) on financial assistance, help with the enrollment process, and awareness of MHC health plan options.
• The interview protocol guide used structured and open-ended questions and clarifying probes to investigate existing beliefs and attitudes about health insurance that prevent Maryland business owners from seeking information about and/or ultimately enrolling in health insurance. Secondly, questions asked whether the available insurance plan content, format, and help via multiple modes and platforms, was accessible and understood by this audience. Finally, questions asked how provisions of health plan enrollment assistance programs, information, and outreach strategies need to be customized to reach uninsured small business owners and employees.

Research Summary

The overall data revealed insights on the messages that appealed most to uninsured small business owners, what motivated them to enroll in a health plan, and the kinds of messages/language to avoid in communicating with this audience. In particular, the evaluation of the Latino small business population revealed that the framing of language around financial help requires multilingual, English to Spanish, understanding of the translation of financial terms and concepts. Terminology such as “tax credits” to offset “premiums” were difficult for participants to understand. Spanish-language participants struggled with “tax credits,” associating this with debt.

Research Impact

The findings were analyzed and presented in both a narrative report, and briefings with State of Maryland officials, health insurance industry leaders, and communications strategists. As a result of the study, communications materials were revised to explain key financial concepts using clearly understood terms and language for the small business (and Latino small business) audiences. As a follow-up to these findings, GMMB commissioned EurekaFacts with another important part of the Health Benefits Exchange, the Small Business Health Options Program (SHOP) participation survey. Insights from the SHOP survey will be used in further program enhancements and used in the 2019 enrollment.