Evaluation of Selected Aspects of the National Medicare Education Program: Final Design Report. 4.3.3 Theoretical Foundation


Because understanding beneficiaries’ decision-making processes is a primary objective for this study, we propose using a theoretical foundation that helps explain IDM the Elaboration Likelihood Model (ELM) (Petty and Cacioppo, 1986Petty and Cacioppo, 1986). The ELM suggests that individuals can use two different cognitive processes to make decisions: a central processing route and a peripheral processing route. Individuals who use central processing try to evaluate information critically and exhaustively, consider the truthfulness and reliability of different arguments, and make a rational decision based on these considerations. This aligns closely with IDM, which entails a clear understanding of the issue and options available and a decision in line with one’s preferences and values (Briss et al., 2004Briss et al., 2004). Conversely, individuals who use peripheral processing make a decision that is not based on critical evaluation. Instead, individuals who use a peripheral decision-making process rely on peripheral cuessuch as likeability of an information source or perceived valueto guide their decision.

ELM also suggests that two constructs encourage central processing motivation and capacity. Motivation refers to an individual’s incentive to be engaged and involved in an issue (i.e., the perceived importance of selecting a Medicare health plan). Capacity refers to an individual’s ability to understand and assess information related to the issue (i.e., the ability to interpret a Medicare plan comparison chart). When individuals are both engaged in an issue and capable of assessing relevant information, they are more likely to use a central processing route and make an informed decision.

The ELM theory has important implications for understanding how Medicare beneficiaries make decisions about enrollment and health care plans. First, ELM can help identify beneficiaries who participate in IDM. Because individuals who use central processing are most likely to evaluate information critically, these same individuals are likely to make informed decisions that are consistent with their values. Second, ELM can help us identify NMEP components that are associated with and promote IDM. For example, the study may find that individuals who review www.Medicare.gov’s plan comparison information are more likely to be motivated to make, and capable of making, enrollment decisions.

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