Consumer Education Initiatives in Financial and Health Literacy. Lessons Learned Applicable to Both Financial and Health Literacy


Materials and resources targeting low-literacy and low-income audiences have widespread applicability. Products that do not require high levels of literacy and products created for low-income consumers can have a broader benefit, as audiences of varying literacy and economic levels can understand them. Overall, participants acknowledged that consumer education materials can have a positive impact on building health care decision-making skills among consumers. A participant from AHRQ stated that materials that are created for low-literacy audiences are inherently accessible to all audiences:

Consumer materials have had a very big impact. The products that require very low literacy appeal to a much wider audience than some of the major research [publications], which have a much smaller audience. People want and need these tools.
AHRQ interview participant

A participant working with ODPHPs HealthFinder web-site reinforced this idea:

When you design things to be easier for people with low health literacy, it is easier for everyone.
ASH interview participant

In a similar manner, participants noted that some resources created to increase skills and knowledge of positive financial practices can have far-reaching appeal. Although many resources are created to benefit low-income audiences specifically, the general public is often in need of information on healthy financial behaviors. A participant from ACFs AFI program described the need for a broader approach:

Its not just low-income families that need [financial education]. Other families and people, even those that have money, are not necessarily good managers.
ACF interview participant

In order to develop materials that are comprehensible to all audiences, many initiatives include consumer feedback and testing. AHRQ and CMS participants stated that they conducted substantial and regular usability and cognitive testing for web-based and print information. CMS specifically targets individuals with low education levels, who are representative of their intended audience, as part of the annual consumer testing of the Medicare & You handbook.

Consumer feedback is key, especially when solicited early and on an ongoing basis. Multiple initiatives had processes to solicit consumer feedback regularly, and participants reiterated the need for consumer input early in the development of education materials, trainings, and web-sites. A participant working with the HealthFinder web-site stated that designing a web-site with input from the target audience would increase the likelihood that the web-site would be easy to use and would engage that audience. A participant from the Federal Reserve noted that she solicited feedback from prospective consumers, for materials available on the agencys consumer information web page. Another participant described how CMSs Medicare & You handbook underwent multiple rounds of testing annually and how that input was incorporated into the final product:

The Medicare & You handbook is tested with consumers each year ... about 75 interviews with beneficiaries and caregivers, [through] multiple rounds ... [with] beneficiaries and caregivers primarily, in multiple cities around the country. Each year, we test the sections of the book where there are significant changes.
CMS interview participant

This participant also commented on the fact that consumer input was incorporated into the final product:

Each year we learn something in testing or get feedback in a certain direction. This information is used to make changes to or clarify handbook content to enhance consumer understanding. If suggested edits are significant, the revised content is tested again with consumers.
CMS interview participant

An AHRQ participant described a broader approach to engaging consumers in product development:

It is really valuable to have consumers represented on expert panels or as part of advisory groups. [Consumers] should be involved from the beginning, when thinking about what products are going to be developed.
AHRQ interview participant

Participants from private organizations echoed the importance of understanding consumer perspectives. An AARP official noted that consumer feedback was essential throughout the process of materials and message development. For example, the organization used focus groups to gather consumer input during formative stages, as well as for testing final products. The official described how consumer feedback alerted the organization that some of its existing materials were not fully addressing the needs of the target audience.

[A lesson learned is to] understand your audience segment very deeply before designing the curricula or tactical approaches, understand where people are and [make sure] that you segment carefully based on gender, race, level of financial literacy, etc. [AARP] found out [that] for new Spanish-speaking immigrants, [the materials] were coming in at too high a comprehension level. [AARP is] creating two sets of Spanish materials; one for a more general Spanish-speaking population, and one aimed specifically at the new immigrant population that is at a more basic reading level.
AARP interview participant

In-person or phone-based assistance is valuable, especially when delivering complex information or providing assistance to older adults. Many initiatives that assisted consumers with making complex financial decisions (e.g., buying a home or allotting cash assistance), enrolling in or coordinating public financial and health benefits (e.g., long-term care), and navigating multifaceted public assistance programs (e.g., Medicaid) utilized direct interaction with these consumers. Initiatives may have served more than one of these purposes. Eight health-related federal initiatives, 13 financially-related federal initiatives, and seven private initiatives contained a component that included in-person assistance or training. Some examples of initiatives that assisted consumers with complex financial decision making are ACFs AFI program, programs run by ACFs ORR, AoAs Pension Counseling and Information program, and Treasurys Community Financial Access Pilot. Some of these programs include cash assistance. It is therefore especially important for these initiatives to incorporate accompanying counseling or training on proper use and management of the cash benefit. Initiatives that use direct consumer interaction to coordinate benefits include AoAs Part D Outreach, Aging Disability and Resource Centers, and Benefits Enrollment Centers. ASPEs Cash and Counseling program is an initiative that assists consumers with navigating public assistance programs. Many of these initiatives specifically target older adults, who are often recipients of public assistance such as Medicare and who may be less likely than younger people to use the web as a major source of information and assistance.

A program official from NCOA discussed multiple initiatives that provided personalized assistance to older adults who needed assistance with complex health and financial matters. The My Medicare Matters campaign utilized counselors to provide Medicare beneficiaries with education and enrollment assistance related to Medicare Part D. The Reverse Mortgage Counseling Services network offers in-person and telephone assistance to middle- and low-income seniors who need education and assistance related to reverse mortgages. The organization recently launched a demonstration program to establish eight Economic Security Service Centers throughout the country. The Centers provide low-income older adults with comprehensive counseling and casework assistance to navigate federal and state benefits and services.

As is common in such programs, participants in EARNs IDA program receive matched savings accounts to help them build their savings. Since program participants often do not have the requisite financial knowledge and familiarity with financial products to independently reach their savings goals, they receive mandatory in-person training. Participants receive coaching throughout their tenure in the program.

Effective dissemination of information is more challenging than content development. Multiple participants noted that developing content for initiatives that aimed to raise awareness or elicit behavior change was an easier issue to address than ensuring effective delivery and dissemination of that content. A participant from Treasury described this challenge:

A major lesson learned is that developing the "products" is the easy part of implementation. Delivery is more challenging. Financial institutions often have low-cost products that are not reaching the people who need the services. A lot of communities have financial education providers, but their reach and access [are] somewhat limited because of knowledge of availability, meaning that people don't know about them, or they are not reaching the people who could use their services.
Treasury interview participant

A participant from AoAs Pension Counseling and Outreach program noted that grantees received technical assistance related to increasing outreach practices, not developing program content. Grantees are encouraged to invest extra resources in expanding their outreach component rather than expanding to new content areas, in order to prevent grantees from diluting their focus. Treasurys Community Financial Access Pilot aims to learn from grantees varying models of community approaches to providing financial services to populations outside the financial mainstream. One finding from the pilot was that identifying or developing a financial educational product was not difficult, while implementation and service delivery were the challenge. An obstacle that community providers in Community Financial Access Pilot faced was their inability to disseminate their information and products on a larger scale. Participants felt that a poor understanding of how to disseminate information to a target audience could greatly hinder an initiatives effectiveness, regardless of the usefulness of the initiatives educational materials,

Audiences more effectively use content that is contextually relevant and acknowledges consumers varying decision-making styles. Consumers are more likely to use information that is relevant to their daily lives. When developing program content, initiatives must consider how and why consumers make specific decisions, and what factors affect different types of decision making. An AARP official explained the importance of fully understanding the target audience prior to building program strategy.

[The] most important lesson is understanding the audience segment very deeply before you design any of the curricula or your tactical approaches. Making sure you fully understand where people are and that you segment carefully, especially because people are in such different places with financial literacy. [A] one size fits all [approach] is not good. What you want to do is really design things for your segment [in a manner] that really resonates and is actionable. If the research supports it, segment based on gender or race, along with current level of financial literacy.
AARP interview participant

A participant from the Health Education Council discussed how the organizations different tobacco cessation initiatives collaborate with their varying target audiences, which include African American churchgoers and pastors, and individuals in correctional facilities. This allows the organization to understand each audiences priorities and decision-making capabilities, and to develop materials that are relevant and usable, and that engage the target audiences.

There were no [tobacco cessation] manuals for the prison setting so together with the National Commission on Correctional Healthcare, we collaborated to assess needs and create a cessation manual [for use] in prisons and jails. A lot of traditional approaches were to suggest things like  if you need to smoke, take a hot bath or go for a walk,  things that werent feasible in [a prison] environment. We feel like [we] served a need that wasnt being addressed by other cessation approaches.
Health Education Council participant

Similarly, we developed a toolkit with a booklet addressing African American churches role in tobacco control one for women; one for men; one for pastors [The booklet] has resonated well with the community its intended to reach. People pick it up, they like it [and] they want it. They love the imagery and messaging. The use of scripture related to health is very targeted... Also, the person carrying the message has a lot of respect and hierarchy in [the Black Church]. I think thats really important. We learned that any approach [must be] specific to who we are trying to reach.
Health Education Council participant

A participant from the Federal Reserve also noted that it is important to consider how to frame choices when presenting them to consumers; to put information into a context that allows consumers to understand its importance; and to present timely, relevant, and evidence-based information that will help people make the connection between that information and the decision they need to make. A representative from ASPEs Own Your Future campaign noted that consumers decision making is not strictly dependent on their understanding of a particular financial concept. He also explained how a social marketing approach can aid understanding of the complexity inherent in individuals financial decision making:

The social marketing approach tries to understand how [consumers] make decisions. Theres a whole variety of factors. Long-term care is laden with emotional, family, and psychological issues. You have to take this into consideration... Its necessary to understand the target market and what their motivators are in order to bring around change.
ASPE interview participant

A participant affiliated with ACFs Office of Head Start described the importance of understanding how to present information in way that encourages its uptake by consumers:

Give important information in a way that is understandable and applicable to [consumers] lives. Its one thing to learn what to do, but if it doesnt fit into [a consumers] lifestyle, its not realistic.
ACF interview participant

In discussing how the Financial Literacy Center designed a video game to make financial education interesting to low-income women, the interview participant described how the Center considered the womens learning style, interests, and motivators, in order to design its product.

[We considered] how to reach low-income women. [The women] are high school dropouts and dont want to be in school, so lectures arent the way to do it. Dartmouth is partnering with a nonprofit foundation to design a good way to reach this group. [They looked] at what these women do they play video games. They supported the design of a video game for low-income women that teaches them the work of credit cards and interest rates You have to motivate people and make it enjoyable. This is an important way to reach specific groups. [Its important to consider] the needs and obstacles of that particular group It is important that the intervention meets the needs of the specific group because there are big differences [between target groups]. If you want to be effective, you need to ask what people do and enjoy doing.
Financial Literacy Center participant

Moreover, initiatives must recognize that consumers process information differently. For example, active consumers may independently seek out information to assist with decision making. They may not require assistance from others in processing the information and using it to make decisions. Passive consumers may need more assistance and may be less likely to seek out information themselves. A CMS participant described the importance of classifying audiences by their style of decision making:

[We] try to look at consumers in general, in terms of whether theyre active or passive users of information, and whether theyre motivated to take action. When we do outreach to people, we need to make sure they can read and understand the materials they get  language, reading level, decision making. For example, for active decision makers  we can just put things on [the] internet. [But] if theyre not motivated, well need to contact them directly and help them understand why taking action is important. If they dont have the skills necessary to understand materials and take action  we need to get them in touch with people to help them through the process, such as SHIPs [State Health Insurance Assistance Programs].
CMS interview participant

Community-based partnerships and collaborations are a central component of effective outreach. Partnerships and community collaborations can deepen an initiatives penetration into a target community and increase the breadth of its outreach to target populations. When discussing AoAs Part D Outreach initiative, a participant stated, partnership and community collaboration is essential. A CMS participant noted that beneficiaries tend to trust local community resources more than government ones. A participant with ASPEs Own Your Future campaign described how consumers are more apt to trust local information sources and how this realization informed the campaigns approach:

We realized quickly that if you stay at a national level, youre not going to get consumers information they can actually use. Consumers are looking for something on the ground... We had to let go of branding the campaign... From a consumers perspective, they dont care where the message comes from. But they do know who a Governor is. So a lot of the press on the campaign doesnt often refer to the federal government. None of the press names ASPE.
ASPE interview participant

Participants suggested that grantees worked best with organizations that were physically located within a specific target community, had a history of being active within the particular community, and had direct connections with the target populations, such as minority aging populations. Participants also noted the importance of collaborations with other organizations serving a specific target audience. A CMS participant described how the organization uses partnerships to better serve particular audiences:

There are Hispanic organizations, African American organizations, and disease-specific organizations  all of whom have their own special agendas. Part of what we do is engage those people and bring them in when were testing. [We] get their input [and] ask them how they can use it to relay to their audience segments... We work with national organizations, their local chapters, grassroots organizations, and the SHIP. All of that is designed to help provide resources for the beneficiary in the community [where] they live.
CMS interview participant

In a similar manner, EARN obtains a portion of its IDA participants through partnerships with local nonprofit groups. Generally, most individuals who open IDAs directly with EARN learn about the service through word of mouth, which limits the spread of information about EARNs services. However, the nonprofit partners inform their clients about EARNs IDA program and are able to open IDAs for them if they decide to participate. Through these collaborations, EARN works with local groups that target vulnerable populations, such as women, refugees, and ethnic minorities, and specific geographic areas with high concentrations of these target populations. Therefore, EARN is able to utilize local partners to expand its penetration into target communities and increase the number and demographic diversity of program recipients.

In addition to strengthening an initiatives outreach, community collaborations can also serve as sources of information about new techniques for service delivery. Treasurys Community Financial Access Pilot was created specifically to promote and learn from varying community-based approaches to providing financial access and financial services to low- and moderate-income individuals. A program official from the Health Education Council described how the council sought out community partnerships and used these local networks to build relationships with the target audience, identify an unmet need, and customize the approach to promoting tobacco cessation.

We really worked to develop relationships with national organizations who were stakeholders. They put us in touch with local people working at the ground level. Weve maintained those [local] relationships over the years We worked with the Black Church in doing direct health education among congregation members and developed relationships with pastors. [We realized] it would be great if we had [tobacco cessation] materials culturally relevant to the Black Church. [Our] strong relationship with the African American community was the main reason for developing the initiative.
Health Education Council participant

One participant cited the importance of community collaborations in ensuring an initiatives sustainability in the field. A participant from Head Starts Innovation and Improvement Grant program described how one grantee that trains local and regional Head Start programs asks trainees to create plans for involving community partners:

They [have to] develop a health improvement plan that has marketing efforts and a communication plan to ensure success at the local level. Some resources would be hospitals, clinics, physicians, schools, county offices, local business, church organizations... The idea is that this is something that could be sustained after the grant is over.
ACF interview participant

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