- breast cancer
- colorectal cancer
- disease management
- gastrointestinal illness
- health insurance
- hearing loss
- hearing protection
- heart disease
- HIV / AIDS
- lung cancer
- medical history
- medication adherence
- mental health
- oral health
- organ donation
- organ transplant
- ovarian cancer
- physical activity
- prostate cancer
- quality of life
- sedentary behavior
- skin cancer
- sleep safety
- weight loss
- African Americans
- college students
- fraternities and sororities
- health care providers
- high risk
- HMO members
- older adults
- people living with HIV/AIDS
- research volunteers
- school age children
- transplant recipients
- transplant waiting list
- young adults
Project Overview +
eCHAT is a CD-ROM-based version of CHAT, a game designed to help ordinary people better understand health insurance and help health insurance policy-makers better understand the health care wishes of ordinary people.
Aim 1. Design, develop, and deliver a prototype of an electronic version of the CHAT exercise.
Aim 2. Perform functionality and usability testing.
The CHAT exercise has been used with several populations. For a review of research involving CHAT, visit: http://www.bioethics.nih.gov/research/chat.shtml
This project entails converting the game board version of CHAT into an electronic version (available on CD-ROM), as described below:
CHAT is game-like exercise designed to help people pick health insurance benefits. CHAT presents the challenge of a full array of possible health care options, but limited resources. The goal of the exercise is to help people better understand health insurance and become more involved in designing group health insurance plans. Throughout the exercise, tradeoffs have to be made between competing needs for limited resources.
For the electronic version of CHAT, participants go step-wise through "rounds" online. The exercise is done both as an individual effort as well as by team effort (similar to the original board game) as the exercise progresses.
Round 1a (Individual): Participants are presented with a circular health care board divided into as many as 17 benefit areas, with up to 3 levels of coverage (basic, medium, high) for each benefit. They are given a specific number of "markers" to spend on their benefits, which allows them to choose a subset of the benefit options they most prefer. It is impossible to select all benefits at their highest level of coverage with the markers they are given. Participants have access to information about what each benefit and level coverage provides while making their decisions. This information helps them weigh various tradeoffs, such as more or less convenience, flexibility of services, and cost sharing, as they consider which benefit options and level of coverage to select.
Round 1b (Individual): Once all the markers are spent, and participants' benefit choices are saved, they view randomly presented "health events" depicting potential illnesses and accidents that could befall them. These events explain the consequences of participants' coverage decisions. The format gets across the message that resources for healthcare are limited, and that difficult tradeoffs have consequences for patients.
Round 2 (Team): Once individual health care decisions are made, participants move to a group event. Participants view a health care board that shows where there was consensus of coverage amongst all members of the team as well as where there were individual decisions that do not correspond with others' choices. To get to a health care board with full consensus, individuals can nominate changes for the group plan, giving reasons and comments. They are encouraged through the user interface to visit a "discussion board" space to share their thoughts and respond to others' thoughts.
Round 3 (Team): Participants view a final consensus board based on Round 2 discussions and changes, and finalize a group plan.
Round 4 (Individual): Participants return to their original individual health care board and create an individual health plan again, making potential changes from their first board based on influences of the team process.
Ultimately, CHAT aims to help design and select health care plans that reflect everyone's values and priorities.
- People have significantly greater appreciation for the interdependence of resources and clinical decisions after playing the game, and the CHAT exercise has been evaluated favorably, by participants, as a way to influence tough health policy decisions.
- Testing of the electronic version of the exercise with ten groups showed that participants with no computer experience and individuals who use the computer as infrequently as once a month, found the exercise understandable and enjoyable.
Due to the large number of studies conducted with CHAT (board game and electronic version) with very diverse populations, we refer you to publications for information about specific study results.
02/01/2001 - 06/30/2002
- Deliberation to enhance awareness of and prioritize socioeconomic interventions for health (2011)
- Priorities of low-income urban residents for interventions to address the socio-economic determinants of health (2010)
- Experience in the United States with public deliberation about health insurance benefits using the small group decision exercise, CHAT (2010)
- The views of low-income employees regarding mandated comprehensive employee benefits for the sake of health (2010)
- Eliciting Health Insurance Benefit Choices of Low Income Groups (2007)
- Enhancing employee capacity to prioritize health insurance benefits (2007)
- Low-income employees' choices regarding employment benefits aimed at improving the socioeconomic determinants of health (2007)
- Health insurance benefit packages prioritized by low-income clients in India: three criteria to estimate effectiveness of choice (2006)
- (De)constructing 'basic' benefits: citizens define the limits of coverage (2006)
- The coverage priorities of disabled adult Medi-Cal beneficiaries (2006)
- Web tool for health insurance design by small groups: Usability study (2006)
- Choosing Healthplans All Together: a deliberative exercise for allocating limited health care resources (2005)
- Development and evaluation of a computer decision exercise for consumer participation in insurance benefit planning (2005)
- Designing health plan benefits: a simulation exercise (2004)
- Will insured citizens give up benefit coverage to include the uninsured? (2004)
- Enrollees choose priorities for Medicare (2004)