1 RTI International, Washington, DC, USA.
2 RTI International, Research Triangle Park, NC, USA.
Health Educ Behav. 2019 Aug;46(4):689-699. doi: 10.1177/1090198118822710. Epub 2019 Feb 15.
Despite the promise of incentive-based chronic disease prevention programs, comprehensive evidence on their accessibility among low-income populations remains limited. We adapted Aday and Andersen's framework to examine accessibility and consumer satisfaction within the Medicaid Incentives for the Prevention of Chronic Disease (MIPCD) cross-site demonstration. MIPCD provided 10 states with 5-year grants to implement incentivized chronic disease prevention and management programs for low-income and/or disabled-Medicaid enrolled-Americans. We conducted 36 focus group discussions between July 2014 and December 2015 with Medicaid enrollees participating in the MIPCD programs. We assessed participants' satisfaction by program type (i.e., diabetes prevention, diabetes management, hypertension reduction, smoking cessation, and weight management) related to three components: program enrollment and participation, staff courtesy, and program convenience. Based on Aday and Andersen's framework, we conducted thematic analysis to determine similarities and differences across MIPCD programs by type. Participant feedback confirmed the importance of several features of the Aday and Andersen framework, particularly programs with easy enrollment and participation procedures, courteous and helpful staff, and those that are convenient and flexible for participants. Participants valued programming around the clock via telephone and flexible, in-person hours of operation as well as proximity of the program to reliable transportation. We observed that most participants, despite enrollment and participation barriers, perceived programs as accessible and were willing to engage and continue to participate. This finding may reflect behavior change theory's perspective on personal readiness to change. Individuals in the preparation stage of change can effectively change health habits despite barriers they may encounter. In some cases, personal readiness to change was more impactful than consumer satisfaction at encouraging ongoing participation and perceived access to the programs. Thus, program developers may want to consider individual participant readiness to change and its impact on consumer satisfaction when designing, implementing, and evaluating behavior change initiatives.
尽管基于激励的慢性病预防计划前景广阔，但关于其在低收入人群中可及性的综合证据仍然有限。我们采用 Aday 和 Andersen 的框架，来考察 Medicaid 慢性病预防激励计划（MIPCD）跨站点示范项目中的可及性和消费者满意度。MIPCD 为 10 个州提供了为期 5 年的赠款，以实施针对低收入和/或残疾 Medicaid 参保人群的激励性慢性病预防和管理计划。我们于 2014 年 7 月至 2015 年 12 月期间开展了 36 次焦点小组讨论，对象是参与 MIPCD 项目的 Medicaid 参保者。我们根据方案类型评估了参与者的满意度（即糖尿病预防、糖尿病管理、高血压降低、戒烟和体重管理），涉及三个方面：方案注册和参与、员工礼貌以及方案便利性。根据 Aday 和 Andersen 的框架，我们对 MIPCD 项目进行了主题分析，以确定各方案类型之间的相似点和不同点。参与者的反馈证实了 Aday 和 Andersen 框架的几个特征的重要性，特别是那些注册和参与程序简单、员工礼貌和乐于助人、对参与者方便灵活的方案。参与者重视 24 小时电话咨询和灵活的当面服务时间，并希望方案能靠近可靠的交通。我们观察到，尽管存在注册和参与障碍，大多数参与者还是认为方案是可及的，愿意参与并继续参与。这一发现可能反映了行为改变理论中个人改变意愿的观点。处于改变准备阶段的个体尽管可能遇到障碍，但仍能有效地改变健康习惯。在某些情况下，个人改变意愿比消费者满意度更能鼓励持续参与和感知对方案的可及性。因此，方案开发者在设计、实施和评估行为改变计划时，可能需要考虑个人参与者的改变意愿及其对消费者满意度的影响。
