Matthias Kirch

Objectives: COVID-19 has strained the household finances of many Americans already experiencing increasing healthcare expenses. Concerns about the cost of care may deter patients from seeking even urgent care from the emergency department (ED). This study examines predictors of older Americans’ concerns of ED visit costs, and how cost concerns may have influenced their ED use in the early stages of the pandemic.Study Design: This was a cross-sectional survey study using a nationally representative sample of US adults aged 50-80 years (N=2,074) in June 2020.Methods: Multivariate logistic regressions assessed the relationship between sociodemographic, insurance, and health factors with cost concerns for emergency department care. Results: Of the respondents, 80% were concerned (45% very, 35% somewhat) about costs of an ED visit and 18% were not confident in their ability to afford an ED visit. Of the entire sample, 7% had avoided ED care due to cost concerns in the past two years. Of those who may have needed ED care, 22% had avoided care. Predictors of cost-related ED avoidance included: aged 50 to 54 years (4.57 aOR [95%CI 1.44-14.54]), uninsured (2.93 aOR [95%CI 1.35-6.52]), poor-fair mental health (2.82 aOR [95%CI 1.62-4.89]), and income <$30K (2.30 aOR [95%CI 1.19-4.46]). Conclusions: During the early COVID-19 pandemic, most older US adults expressed concerns about the financial impact of ED use. Further research should examine how insurance design could alleviate the perceived financial burden of ED use and prevent cost-related care avoidance, especially for those at higher risk in future pandemic surges.

In October 2017, the National Poll on Healthy Aging surveyed a nationally representative sample of 2,007 adults aged 50–80 years to assess attitudes toward influenza (flu) vaccination policies in long-term care facilities. Support for requiring vaccinations was lowest for visitors. Policy makers can use these findings to develop sustainable vaccination strategies.

Objective Autonomous motivation is a key driver of health-related behaviors. However, individual preferences exist for health messaging. This paper outlines the development and validation of the Health Communication Orientations Scale (HCOS), a new measure to assess health communication style preferences. Methods Nationally representative online panels from the US (n = 603) and the Netherlands (n = 737) completed a survey containing the HCOS, established motivational measures, and demographic questions. Results Exploratory and confirmatory factor analysis identified five subscales valid for both populations. Factors include HCOS (1) Expert, (2) Others, (3) Self, (4) Oppositional, and (5) Internet. Scores for HCOS Expert and HCOS Internet were higher in the US than in the Dutch sample, and Others, Self, and Oppositional were higher in the Dutch sample. Internal reliability for the five factors was high across both samples (range 0.84-0.91). Many significant correlations with established measures were observed in both samples indicating the construct validity of the scale. Conclusion The HCOS subscales have strong psychometric properties.Practice implications The HCOS represents a novel approach to assessing communication style preferences for general and patient populations. Further investigation in how the HCOS may be used to tailor health messaging is warranted.

Patient-Centered Innovations, Education and Technology for Cancer Care and Cancer Research