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Background: In response to the federal passage of the Patient Protection and Affordable Care Act (PPACA) in 2010, ongoing efforts have been underway nationally to expand health insurance coverage to the uninsured population primarily through subsidized health insurance programs. Reasons why individuals choose not to participate in subsidized and other health insurance programs are not clearly understood. Method: Guided by the key assumptions of the Health Belief Model (HBM), this qualitative case study inquiry examined the participation rates of nine direct care workers who shared their perceptions of barriers and experiences with the Part-time Worker Coverage Voucher Program (PTWCVP). Analysis of the transcribed data suggested that both financial and non-financial barriers influenced participation rates. Results: While financial reasons were the primary impediment to participation in the PTWCVP, a number of other important findings emerged that influenced non-participation in the program including inaccurate perceptions of general health; incomplete perceptions regarding the role, purpose, and function of health insurance programs; strongly negative perceptions of program design and delivery; and inadequate knowledge and lack of effort to obtain health insurance coverage. Conclusion: Based on the HBM, the findings from this research can have significant implications nursing practice by guiding educational efforts to address perceived barriers while enhancing the likelihood of taking action by increasing participation in health insurance programs, health promotion and prevention efforts.

international journal of nursing and clinical practice

Health Beliefs, Health Insurance Status, and the Uninsured: Revisiting the Findings From the Part-Time Worker Study and Barriers to Participation in Subsidized Health Insurance Programs, Exploring the Implications for Nursing Practice