# Modifiable Factors Associated with Financial Burden: Improving Health Insurance Literacy

> **NIH NIH R37** · NORTHWESTERN UNIVERSITY · 2021 · $100,000

## Abstract

This application is being submitted in response to the Notice of Special Interest (NOSI)
identified as NOT-CA-21-055. The goal of the parent grant,
Facilitated
Oncology,
R37CA255875 Technology 
Behavioral Intervention for Depression among Diverse Patients in Ambulatory 
i s to evaluate the effectiveness and the implementation of an evidence-based health
:
information technology (HIT) behavioral treatment for cancer patients with elevated depressive
symptoms. This HIT treatment combines systematic, electronic health record-integrated
screening for depressive symptoms with an individually-tailored HIT intervention to address
gaps in the treatment of depression among cancer patients. Under this infrastructure, we
propose to explore predictors of health insurance literacy and financial burden (FB) including the
impact of out-of-pocket costs. We will develop and test the feasibility and acceptability of
delivering health insurance education via the HIT platform to improve HIL in patients
experiencing FB and/or low health literacy in addition to at least mild depression.
Our specific aims include: (1) Identify predictors of patient-reported HIL and FB with covariates
including actual and self-reported OOP costs for the previous three months and patient-reported
symptoms. We hypothesize that those with higher OOP costs (either actual or self-reported),
lower education level, higher levels of anxiety and/or depression, lower self-efficacy, non-
English speaking, and those being treated with palliative intent will have higher perceived FB.
Those with low education level, low self-efficacy, and those being treated with curative intent
may have lower HIL. (2) Develop (via literature review, expert and patient input) an animated
infographic, educational video (HEalth insurance Literacy Primer “HELP”) that reviews basic
elements of health insurance plans. (3) Pilot the acceptability and feasibility of incorporating the
“HELP” video within the parent grant's, My Cancer Support, for patients that report FB and/or
low health literacy on baseline screening question and evaluate the effectiveness of the
intervention on HIL at one month. We hypothesize that incorporation of the “HELP” video will be
feasible and acceptable and HIL will improve immediately following an educational intervention,
which will be sustained at one month. Predictors of those who improve HIL will be those that
have low baseline HIL, a combination of low baseline HIL and high FB, higher education level,
and higher self-efficacy.

## Key facts

- **NIH application ID:** 10436080
- **Project number:** 3R37CA255875-01S1
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** BETINA YANEZ
- **Activity code:** R37 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $100,000
- **Award type:** 3
- **Project period:** 2021-03-01 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10436080

## Citation

> US National Institutes of Health, RePORTER application 10436080, Modifiable Factors Associated with Financial Burden: Improving Health Insurance Literacy (3R37CA255875-01S1). Retrieved via AI Analytics 2026-06-01 from https://api.ai-analytics.org/grant/nih/10436080. Licensed CC0.

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