A new integrated conceptual framework of health insurance literacy: Results of a critical interpretive synthesis

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2025-07-11 DOI:10.1016/j.healthpol.2025.105394

Reut Ron , Paula Feder-Bubis , Kierstin Trocha , Moriah Ellen

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Abstract

Health insurance literacy (HIL) is the knowledge, ability, and confidence to find and understand health insurance information, and choose, purchase and use an insurance plan. Despite the increasing volume of research on HIL, the approaches to this field remain fragmented.

This review paper aims to develop a conceptual framework delineating the attributes, personal contexts, and environmental influences, which either influence or are influenced by an individual's HIL level.

We have adopted a critical interpretive synthesis approach with purposive sampling and inductive analysis, integrating all existing models from the literature, with additional findings. The CIS methodology emphasizes iterative data synthesis to generate theory from diverse sources, ceasing data extraction upon achieving theoretical saturation. This reflects the stage at which further data collection no longer yields new conceptual insights.

Four databases were systematically screened in September 2020 and July 2023, yielding 6096 articles. Following a review of titles and abstracts, 388 papers were deemed relevant, and 76 were included in the final synthesis. The resulting framework consists of eight categories, 17 subcategories, and 129 codes, with HIL level as its core. Other components include individual predictors, external influences, skills and abilities, perceptions and beliefs, preferences, decision-making processes, and outcomes.

This framework provides a comprehensive tool for guiding interventions and research aimed at improving HIL. It allows researchers and policymakers to address the diverse and interconnected factors influencing HIL and to develop targeted, evidence-based strategies.

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健康保险素养的一个新的综合概念框架：一个关键的解释综合的结果

健康保险素养（Health insurance literacy， HIL）是发现和理解健康保险信息，选择、购买和使用保险计划的知识、能力和信心。尽管对HIL的研究越来越多，但该领域的方法仍然是碎片化的。这篇综述文章旨在建立一个概念框架，描述属性、个人背景和环境影响，这些因素要么影响个人的HIL水平，要么受其影响。我们采用了一种批判性的解释性综合方法，有目的的抽样和归纳分析，整合了文献中所有现有的模型，以及其他发现。CIS方法强调迭代数据合成，从不同来源生成理论，在达到理论饱和时停止数据提取。这反映了进一步的数据收集不再产生新的概念见解的阶段。系统筛选了4个数据库，分别于2020年9月和2023年7月，共收录6096篇文章。在对标题和摘要进行审查后，388篇论文被认为是相关的，76篇论文被纳入最终的综合。该框架由8个类别、17个子类别和129个代码组成，以HIL级别为核心。其他组成部分包括个人预测因素、外部影响、技能和能力、观念和信念、偏好、决策过程和结果。该框架为指导旨在改善HIL的干预措施和研究提供了一个全面的工具。它使研究人员和决策者能够处理影响HIL的各种相互关联的因素，并制定有针对性的、基于证据的战略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.