Communicating Effectively about the Affordable Care Act: A Qualitative Study of Communication Sources and Needs Among African Americans, Whites, and Latinos

Theoretical Background and research questions/hypothesis:  The Affordable Care Act (ACA), signed into law in March 2010, established a new Health Insurance Marketplace that has enabled 11.7 million individuals to obtain health coverage. Despite the success of enrollment through the Marketplace, there is a continuous need for education, communication, and outreach efforts to ensure that the public, particularly minority populations, are aware of, and understand, their health care options. Further, research continues to suggest that many Americans are confused about the ACA and lack the information they need to make informed health care decisions. This study qualitatively assessed the communication sources and needs of residents in one southeastern county to provide recommendations to develop a community-based, media campaign to raise awareness of ACA educational resources available to community residents. The following research questions were examined:

1. Where do residents receive ACA information?
2. How do residents seek additional information about the ACA?
3. What type of ACA information would residents like to receive?
4. What are the most effective ways to communicate with residents about the ACA?

Methods:  Prior to the first ACA Marketplace Insurance open enrollment, twelve one-hour focus groups (FGs) were conducted with 123 individuals in one southeastern county in November-December 2013. FGs were divided by age (younger/older), race/ethnicity (White/African American (AA)/Latino), and language (English/Spanish). For this analysis, transcripts were analyzed for themes by race using NVivo® 10, a qualitative data analysis software.

Results:  Whites and AAs said they received ACA information from their health provider more often than Latinos. Whites most often received ACA information from television and the Internet, AAs from printed materials or from ACA experts, and Latinos from family/friends and community forums. AAs and Latinos believed the most effective means of disseminating ACA information was through churches and community forums. Whites said public libraries were most effective. Regardless of race, participants were interested in receiving more ACA information about cost, eligibility, how it would affect them, and enrollment.

Conclusions:  Results suggest that there is a significant need for ACA education and that lack of understanding and awareness about ACA provisions is prevalent, regardless of race. Communication strategies to reach community members varied by race. Specifically, Whites most often used mass media channels for information and said that ACA outreach should occur through public libraries. AAs and Latinos most often used interpersonal sources that they know and trust for ACA information and thought community-based discussion sessions were the most effective communication channels.

Implications for research and/or practice:  Findings are helpful for health practitioners who want to promote awareness of and provide educational outreach about the ACA and other complex health or medical-related issues. Implications for practice include a heightened need for targeted strategic communications by race to increase ACA awareness and the information addressing the concerns and benefits surrounding the ACA. Study findings informed the development of ACA messages, materials, and programs that have effectively informed residents in one county, as well as other areas of this southeastern state.