scholarly journals User Interactions With Health Insurance Decision Aids: User Study With Retrospective Think-Aloud Interviews (Preprint)

2021 ◽  
Author(s):  
Wayne C W Giang ◽  
Emma Bland ◽  
Jeffrey Chen ◽  
Coralys M Colón-Morales ◽  
Michelle M Alvarado
Keyword(s):  
Health Insurance ◽  
Test Scores ◽  
Decision Aid ◽  
User Study ◽  
Decision Aids ◽  
Think Aloud ◽  
Knowledge Test ◽  
Enrollment Decisions ◽  
Health Insurance Literacy ◽  
Insurance Decisions

BACKGROUND Two barriers to effective enrollment decisions are low health insurance literacy and lack of knowledge about how to choose a plan. To remedy these issues, digital decision aids have been used to increase the knowledge of plan options and to guide the decision process. Previous research has shown that the way information is presented in a decision aid can impact consumer choice, and existing health insurance decision aids vary in their design, content, and layout. Commercial virtual benefits counselors (VBCs) are digital decision aids that provide decision support by mimicking the guidance provided by an in-person human resources (HR) counselor, whereas more traditional HR websites provide information that requires self-directed navigation through the system. However, few studies have compared how decision processes are impacted by these different methods of providing information. OBJECTIVE This study aims to examine how individuals interact with two different types of health insurance decision aids (<i>guided</i> VBCs that mimic conversations with a real HR counselor and <i>self-directed</i> HR websites that provide a broad range of detailed information) to make employer-provided health insurance decisions. METHODS In total, 16 employees from a local state university completed a user study in which they made mock employer-provided health insurance decisions using 1 of 2 systems (VBC vs HR website). Participants took part in a retrospective think-aloud interview, cued using eye-tracking data to understand decision aid interactions. In addition, pre- and postexperiment measures of literacy and knowledge and decision conflict and usability of the system were also examined. RESULTS Both the VBC and HR website had positive benefits for health insurance knowledge and literacy. Previous health insurance knowledge also impacted how individuals used decision aids. Individuals who scored lower on the pre-experiment knowledge test focused on different decision factors and were more conflicted about their final enrollment decisions than those with higher knowledge test scores. Although both decision aids resulted in similar changes in the Health Insurance Literacy Measure and knowledge test scores, perceived usability differed. Website navigation was not intuitive, and it took longer to locate information, although users appreciated that it had more details; the VBC website was easier to use but had limited information. Lower knowledge participants, in particular, found the website to be less useful and harder to use than those with higher health insurance knowledge. Finally, out-of-pocket cost estimation tools can lead to confusion when they do not highlight the factors that contribute to the cost estimate. CONCLUSIONS This study showed that health insurance decision aids help individuals improve their confidence in selecting and using health insurance plans. However, previous health insurance knowledge plays a significant role in how users interact with and benefit from decision aids, even when information is presented in different formats.

scholarly journals User interactions with health insurance decision aids: A user study with retrospective think-aloud (Preprint)

10.2196/27628 ◽  
2021 ◽  
Author(s):  
Wayne Chi Wei Giang ◽  
Emma Bland ◽  
Jeffrey Chen ◽  
Coralys Morales ◽  
Michelle M. Alvarado
Keyword(s):  
Health Insurance ◽  
User Study ◽  
Decision Aids ◽  
Think Aloud ◽  
User Interactions

scholarly journals Evaluation Of The Acceptability And Utility Of A Decision Aid For The Treatment Of Adult Depression

2021 ◽  
Author(s):  
Jenny Rogojanski
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Combined Treatment ◽  
Decisional Conflict ◽  
Health Conditions ◽  
Knowledge Test

Decision aids communicate the best available evidence on treatment options to patients in order to facilitate informed decision-making. Research suggests that decision aids improve patients’ treatment knowledge, reduce decisional conflict, and promote more active decision-making. Despite evidence of the utility of decision aids in physical health conditions, they are both understudied and rarely used for mental health problems. The present study evaluated the acceptability and utility of a decision aid for the treatment of depression and its relationship to participants' knowledge and decision-making. Undergraduate students ( Participants completed a follow-up knowledge test, along with a series of questionnaires assessing acceptability of the decision aid and other variables of interest (e.g., decisional conflict, preparation for decision-making). One month later, participants completed the knowledge test for the third time. Overall, a majority of participants rated the decision aid as highly acceptable and useful. There was a significant increase in participants’ knowledge of depression treatment from prior to reading to after reading the decision aid. Although participants’ knowledge scores decreased slightly at the 1-month follow-up, they were still significantly higher than their baseline scores. The hypothesis that participants’ treatment choice would be influenced by the order in which treatment options were presented to them within the decision aid was partially supported. However, this effect was eliminated when the few participants who selected the “no treatment” option were excluded, as well as when participants were given the additional option of selecting a combined treatment (i.e., medication and psychotherapy). This is one of the few studies aimed at expanding the use of decision aids to mental health conditions. Future research should evaluate the utility of this decision aid with a clinical sample. Additionally, the methodology used in this study can be translated to the evaluation of other decision aids.

Benefits Communications Survey: employees want more direction

2018 ◽  
Vol 17 (2) ◽  
pp. 99-102
Author(s):  
Justyn Harkin
Keyword(s):  
Health Insurance ◽  
Working Hours ◽  
Full Time ◽  
Employee Communication ◽  
Enrollment Decisions ◽  
Communication Preferences ◽  
Content Type ◽  
Related Stress ◽  
Insurance Decisions ◽  
Communication Material

Purpose The purpose of 2017 ALEX® Benefits Communication Survey is to explore what employees think of the ways their companies talk to them about their benefits. Specifically, the survey focuses on whether employees understand the benefits communication material that is put in front of them, and it tries to provide insights on how employers can help employees improve their ability to make informed decisions about their healthcare options. Design/methodology/approach The survey was conducted online from February 24 to March 17, 2017, by Harris Poll on behalf of Jellyvision. It included 2,043 US adults (ages 18+) who were employed full-time, eligible for company-provided benefits and did not currently have health insurance through Medicare, Medicaid or the VA. Data were weighted where necessary by age, gender, race/ethnicity, region, education, income, marital status, household size and propensity to be online for aligning them with their actual proportions in the population. Results of this research were compared with Jellyvision’s April 2016 survey of 2,105 employed adults. Findings Of the employees whose companies offer health insurance benefits, approximately half (49 per cent) say making health insurance decisions is “always very stressful” for them, and 55 per cent say that they would like help from their employer when choosing a plan. One in five employees (21 per cent) say they often regret the benefit choices they make during open enrollment. Further, while 89 per cent say they generally understand their options, only 59 per cent can actually identify the different elements involved in the full cost of their health care. In terms of communication preferences, 65 per cent of employees prefer to look over benefit enrollment instructions outside of working hours. Originality/value Jellyvision commissioned this study to provide employers with valuable insights about how employees process and respond to benefit communications. The data can help employers understand the sources of enrollment-related stress and critical gaps in health insurance and benefits knowledge, which can lead to poor decision-making and regret among employees. The survey also reveals employee communication preferences, which employers can use to optimize their content, drive engagement, and empower employees to make more informed benefit enrollment decisions.

scholarly journals Evaluation Of The Acceptability And Utility Of A Decision Aid For The Treatment Of Adult Depression

2021 ◽  
Author(s):  
Jenny Rogojanski
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Decision Aid ◽  
Decision Aids ◽  
Treatment Options ◽  
Combined Treatment ◽  
Decisional Conflict ◽  
Health Conditions ◽  
Knowledge Test

Decision aids communicate the best available evidence on treatment options to patients in order to facilitate informed decision-making. Research suggests that decision aids improve patients’ treatment knowledge, reduce decisional conflict, and promote more active decision-making. Despite evidence of the utility of decision aids in physical health conditions, they are both understudied and rarely used for mental health problems. The present study evaluated the acceptability and utility of a decision aid for the treatment of depression and its relationship to participants' knowledge and decision-making. Undergraduate students ( Participants completed a follow-up knowledge test, along with a series of questionnaires assessing acceptability of the decision aid and other variables of interest (e.g., decisional conflict, preparation for decision-making). One month later, participants completed the knowledge test for the third time. Overall, a majority of participants rated the decision aid as highly acceptable and useful. There was a significant increase in participants’ knowledge of depression treatment from prior to reading to after reading the decision aid. Although participants’ knowledge scores decreased slightly at the 1-month follow-up, they were still significantly higher than their baseline scores. The hypothesis that participants’ treatment choice would be influenced by the order in which treatment options were presented to them within the decision aid was partially supported. However, this effect was eliminated when the few participants who selected the “no treatment” option were excluded, as well as when participants were given the additional option of selecting a combined treatment (i.e., medication and psychotherapy). This is one of the few studies aimed at expanding the use of decision aids to mental health conditions. Future research should evaluate the utility of this decision aid with a clinical sample. Additionally, the methodology used in this study can be translated to the evaluation of other decision aids.

KRiskSM: A Computerized Decision Aid for Client Acceptance and Continuance Risk Assessments

2002 ◽  
Vol 21 (2) ◽  
pp. 97-113 ◽  
Author(s):  
Timothy B. Bell ◽  
Jean C. Bedard ◽  
Karla M. Johnstone ◽  
Edward F. Smith
Keyword(s):  
Risk Management ◽  
Quality Control ◽  
Decision Aid ◽  
Audit Quality ◽  
Decision Aids ◽  
Risk Assessments ◽  
Innovative Technology ◽  
Full Potential ◽  
Business Risk ◽  
Client Acceptance

This paper describes the development and implementation of KRisk, an innovative technology-enabled auditor decision aid for making client acceptance and continuance risk assessments. KRisk, developed and designed by KPMG LLP, is part of the firm's audit quality control and risk management processes. In this paper, we discuss the environmental and technological forces that affect auditor business risk management. We also describe important aspects of the development, functionality, and implementation of KRisk. We discuss possible impediments to realizing the full potential of decision aids that have been reported in prior auditing research, and describe how KRisk and related audit quality control procedures implemented at KPMG were designed to overcome such impediments. Also, we present some ideas for scholarly research dealing with auditor business risk management issues, and issues related to the design and use of decision aids in general.

The Effects of Decision Aid Orientation on Risk Factor Identification and Audit Test Planning

2002 ◽  
Vol 21 (2) ◽  
pp. 39-56 ◽  
Author(s):  
Jean C. Bedard ◽  
Lynford E. Graham
Keyword(s):  
Risk Factors ◽  
Risk Management ◽  
Decision Aid ◽  
Decision Aids ◽  
Management Strategies ◽  
Risk Identification ◽  
Matched Pair ◽  
Audit Planning ◽  
Audit Firms ◽  
Risk Management Strategies

In auditing, risk management involves identifying client facts or issues that may affect engagement risk, and planning evidence-gathering strategies accordingly. The purpose of this paper is to examine whether auditors' identification of risk factors and planning of audit tests is affected by decision aid orientation, i.e., a “negative” focus wherein client risk and its consequences are emphasized, or a “positive” focus where such factors are not emphasized. Specifically, we expect that auditors will identify more risk factors using a negatively oriented risk identification decision aid, but only when engagement risk is relatively high. We address this issue in the context of auditors' knowledge of actual clients, manipulating decision aid orientation as negative or positive in a matched-pair design. Results show that auditors using the negative decision aid orientation identify more risk factors than do those using a positive orientation, for their higher-risk clients. We also find that decisions to apply substantive tests are more directly linked to specific risk factors identified than to direct risk assessments. Further, our results show that auditors with repeat engagement experience with the client identify more risk factors. The findings of this study imply that audit firms may improve their risk management strategies through simple changes in the design of decision aids used to support audit planning.

Decision Aids for Generating Analytical Review Alternatives: The Impact of Goal Framing and Audit-Risk Level

2002 ◽  
Vol 14 (1) ◽  
pp. 157-177 ◽  
Author(s):  
Jennifer M. Mueller ◽  
John C. Anderson
Keyword(s):  
High Risk ◽  
Cognitive Load ◽  
Information Search ◽  
Decision Aid ◽  
Decision Aids ◽  
Risk Level ◽  
Audit Risk ◽  
Goal Framing ◽  
Analytical Review ◽  
The Impact

An auditor generating potential explanations for an unusual variance in analytical review may utilize a decision aid, which provides many explanations. However, circumstances of budgetary constraints and limited cognitive load deter an auditor from using a lengthy list of explanations in an information search. A two-way between-subjects design was created to investigate the effects of two complementary approaches to trimming down the lengthy list on the number of remaining explanations carried forward into an information search. These two approaches, which represent the same goal (reducing the list) but framed differently, are found to result in a significantly different number of remaining explanations, in both low- and high-risk audit environments. The results of the study suggest that the extent to which an auditor narrows the lengthy list of explanations is important to the implementation of decision aids in analytical review.

scholarly journals Systematic Development of Patient Decision Aids: An Update from the IPDAS Collaboration

2021 ◽  
pp. 0272989X2110141
Author(s):  
Holly O. Witteman ◽  
Kristin G. Maki ◽  
Gratianne Vaisson ◽  
Jeanette Finderup ◽  
Krystina B. Lewis ◽  
...  
Keyword(s):  
Decision Aid ◽  
Decision Aids ◽  
Rapid Development ◽  
User Involvement ◽  
User Centered Design ◽  
Patient Decision Aid ◽  
Patient Decision Aids ◽  
Patient Decision ◽  
Development Processes ◽  
Systematic Development

Background The 2013 update of the evidence informing the quality dimensions behind the International Patient Decision Aid Standards (IPDAS) offered a model process for developers of patient decision aids. Objective To summarize and update the evidence used to inform the systematic development of patient decision aids from the IPDAS Collaboration. Methods To provide further details about design and development methods, we summarized findings from a subgroup ( n = 283 patient decision aid projects) in a recent systematic review of user involvement by Vaisson et al. Using a new measure of user-centeredness (UCD-11), we then rated the degree of user-centeredness reported in 66 articles describing patient decision aid development and citing the 2013 IPDAS update on systematic development. We contacted the 66 articles’ authors to request their self-reports of UCD-11 items. Results The 283 development processes varied substantially from minimal iteration cycles to more complex processes, with multiple iterations, needs assessments, and extensive involvement of end users. We summarized minimal, medium, and maximal processes from the data. Authors of 54 of 66 articles (82%) provided self-reported UCD-11 ratings. Self-reported scores were significantly higher than reviewer ratings (reviewers: mean [SD] = 6.45 [3.10]; authors: mean [SD] = 9.62 [1.16], P < 0.001). Conclusions Decision aid developers have embraced principles of user-centered design in the development of patient decision aids while also underreporting aspects of user involvement in publications about their tools. Templates may reduce the need for extensive development, and new approaches for rapid development of aids have been proposed when a more detailed approach is not feasible. We provide empirically derived benchmark processes and a reporting checklist to support developers in more fully describing their development processes. [Box: see text]

scholarly journals Basing Information on Comprehensive, Critically Appraised, and Up-to-Date Syntheses of the Scientific Evidence: An Update from the International Patient Decision Aid Standards

2021 ◽  
pp. 0272989X2199662
Author(s):  
Tammy C. Hoffmann ◽  
Mina Bakhit ◽  
Marie-Anne Durand ◽  
Lilisbeth Perestelo-Pérez ◽  
Catherine Saunders ◽  
...  
Keyword(s):  
Decision Aid ◽  
Scientific Evidence ◽  
Decision Aids ◽  
Future Research ◽  
Patient Decision Aid ◽  
Patient Decision Aids ◽  
Research Areas ◽  
Patient Decision ◽  
Evidence Quality ◽  
Emerging Issues

Background Patients and clinicians expect the information in patient decision aids to be based on the best available research evidence. The objectives of this International Patient Decision Aid Standards (IPDAS) review were to 1) check the currency of, and where needed, update evidence for the domain of “basing the information in decision aids on comprehensive, critically appraised, and up-to-date syntheses of the evidence”; 2) analyze the evidence characteristics of decision aids; and 3) propose updates to relevant IPDAS criteria. Methods We searched MEDLINE and PubMed to inform updates of this domain’s definitions, justifications, and components. We also searched 5 sources to identify all publicly available decision aids ( N = 471). Two assessors independently extracted each aid’s evidence characteristics. Results Minor updates to the definitions and theoretical justifications of this IPDAS domain are provided and changes to relevant IPDAS criteria proposed. Nearly all aids (97%) provided a year of creation/update, but most (81%) did not report an explicit update or expiration policy. No scientific references were cited in 33% of aids. Of the 314 that cited at least 1 reference, 39% cited at least 1 guideline, 44% cited at least 1 systematic review, and 23% cited at least 1 randomized trial. In 35%, it was unclear what statement in the aid the citations referred to. Only 14% reported any of the processes used to find and decide on evidence inclusion. Only 14% reported the evidence quality. Many emerging issues and future research areas were identified. Conclusions Although many emerging issues need to be addressed, this IPDAS domain is validated and criteria refined. High-quality patient decision aids should be based on comprehensive and up-to-date syntheses of critically appraised evidence.

The Impact of Transparency and Decision Risk on Human–Automation Teaming Outcomes

2021 ◽  
pp. 001872082110334
Author(s):  
Shayne Loft ◽  
Adella Bhaskara ◽  
Brittany A. Lock ◽  
Michael Skinner ◽  
James Brooks ◽  
...  
Keyword(s):  
Decision Aid ◽  
Financial Incentive ◽  
Decision Aids ◽  
Rejection Rate ◽  
Decision Time ◽  
Correct Rejection ◽  
Incentive Scheme ◽  
Operator Behavior ◽  
The Impact ◽  
Financial Penalty

Objective Examine the effects of decision risk and automation transparency on the accuracy and timeliness of operator decisions, automation verification rates, and subjective workload. Background Decision aids typically benefit performance, but can provide incorrect advice due to contextual factors, creating the potential for automation disuse or misuse. Decision aids can reduce an operator’s manual problem evaluation, and it can also be strategic for operators to minimize verifying automated advice in order to manage workload. Method Participants assigned the optimal unmanned vehicle to complete missions. A decision aid provided advice but was not always reliable. Two levels of decision aid transparency were manipulated between participants. The risk associated with each decision was manipulated using a financial incentive scheme. Participants could use a calculator to verify automated advice; however, this resulted in a financial penalty. Results For high- compared with low-risk decisions, participants were more likely to reject incorrect automated advice and were more likely to verify automation and reported higher workload. Increased transparency did not lead to more accurate decisions and did not impact workload but decreased automation verification and eliminated the increased decision time associated with high decision risk. Conclusion Increased automation transparency was beneficial in that it decreased automation verification and decreased decision time. The increased workload and automation verification for high-risk missions is not necessarily problematic given the improved automation correct rejection rate. Application The findings have potential application to the design of interfaces to improve human–automation teaming, and for anticipating the impact of decision risk on operator behavior.

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