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Methodology: Listening to Low-Income Patients and Their Physicians

How the Focus Groups Were Conducted

Low-Income Patients: SSRS held eight, two-hour focus groups with 69 low-income adults living in urban areas; 10 individual telephone interviews with rural low-income adults; and two online forums with a total of 26 rural participants and Asian community representatives. To be eligible to participate, participants had to be between 23 and 64 years old, identify as financially poor, have household incomes below $30,000, receive government assistance for health insurance or another need, describe their health as good, have completed at least the eighth grade, and be comfortable sharing opinions. Participants were excluded if they required assistance with activities of daily living, had three or more chronic conditions, or had a severe condition such as cancer. Recruitment, which targeted African American, Hispanic, rural Caucasian, Chinese, Filipino, and Korean individuals, included referral-based sampling, random selection from databases generated by recruitment contractors, and targeted social media advertisements. Focus groups were stratified by race and ethnicity, with separate groups held for each. Two focus groups were conducted in Spanish; all others were in English.

Primary Care Physicians (PCPs) Serving Low-Income Patients: We held six, 75-minute webcam focus groups with 31 board-certified PCPs serving low-income patients in a mix of urban or rural areas across the United States. We also conducted three, 30-minute individual telephone interviews with PCPs unable to join any of the scheduled focus groups. To be eligible to participate, PCPs had to practice for three to 35 years, work full-time, spend at least 60% of their time on direct patient care, be board certified or eligible, have a practice with fewer than 20 physicians and staff, and report a significant portion of their patients were covered through Medicaid or Medicaid Managed Care. PCPs who participated in research in the last six months specific to their community or practice were excluded from the study. Recruitment identified physicians through a verified database of PCPs which was developed using public records and background checks.

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