Connecting underserved populations to health care reform benefits through 2-1-1: A communication network perspective

Socioeconomically disadvantaged populations stand to benefit greatly from the 2010 Patient Protection and Affordable Care Act (ACA). This study explored knowledge and attitudes of the ACA in a low-income population and investigated sources of this knowledge and related communication by mapping social and communication networks. Participants were recruited from an information and referral hotline (2-1-1) that reaches predominantly low-income and racial/ethnic minority callers with unmet basic needs. A telephone survey assessed social and communication networks, sources of information, knowledge, attitudes, and personal relevance of the ACA. Regression models were built to determine the importance of network and non-network characteristics in predicting ACA knowledge. Results (n=398) show participants had lower knowledge of ACA benefits than the U.S. population. African-Americans (aOR=2.95, p<.01), those who got ACA information from the Internet (aOR=3.35, p<.01), trust people in their neighborhood “a lot” (aOR=2.45, p<.01) and have a higher proportion of their social network they can talk to about health information (aOR=2.38, p=0.03) had higher scores on ACA knowledge. ACA knowledge is low in this disadvantaged population, with knowledge significantly lower in the poorest members of the sample. Low ACA knowledge in this population indicates a need for action to educate the population most likely to benefit from the ACA, particularly through the extensive reach of the 2-1-1 system. Understanding how networks in disadvantaged populations influence access to information and resources and, therefore, health outcomes is important for shaping intervention and policy approaches to improve access to and use of health care services for disadvantaged Americans.