Translating access into utilization: Lessons from the design and evaluation of an online resource to expand health insurance coverage and promote reproductive health care for young women in Massachusetts

Lack of insurance coverage and/or high costs are associated with contraceptive discontinuation and low utilization of sexual and reproductive health (SRH) services among women in the US. In the wake of national-level healthcare reform hope remains high that greater access to insurance will lead to greater care utilization. However, any improvement in care utilization relies on women being able to understand information about the coverage of SRH services within available health plans and to obtain health insurance that meets their SRH needs. Prior studies have demonstrated that health insurance plan information is often written at a reading grade level far exceeding the literacy skills of the average US adult. Following the implementation of state-level healthcare reform in Massachusetts, a statewide stakeholder coalition found that young women in need of SRH services had difficulty understanding the different types of health plans available and what contraceptive and other SRH services their plans covered. In response, this coalition created an insurance information website specifically targeting young adults seeking SRH services. We performed a rigorous, mixed-methods evaluation of this site using validated assessment methods from the field of health communications, including a literacy demands assessment and qualitative usability interviews with women in the targeted end user population, the latter conducted in a laboratory setting. Our study provides an example of how to develop and evaluate internet-based health insurance resources as well as important lessons for other states ramping up for health reform implementation.