Date of Award

Spring 5-31-2026

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Martha Grant Fuller, PhD, APRN, PPCNP-BC

Abstract

Background: With advances in surgery and medical management, 95% of children with congenital heart disease (CHD) survive into adulthood. Transition to adult care is an intricate process. Up to 60% of adolescents fail to follow through with cardiology care, facing three times the risk of needing emergency services. Only 25% of young adults with CHD knew of the need to change their care to an adult provider and to acquire health insurance as an adult. One barrier to successful transition is a lack of insurance coverage and limited insurance health literacy. Higher insurance literacy is associated with increased utilization of appropriate health care.

Methods: English speaking adolescents enrolled in a cardiac transition program at an urban children's hospital received an educational session on health insurance during the telehealth visit. Pre-and post- assessments were the Health Insurance Literacy Measure (HILM) and the Health Insurance Knowledge (HIK).

Results: Out of 25 participants. 14 completed pre-assessments, 10 patients received the intervention, and 6 completed post-assessments. The average HIK score increased from 2.36 out of 10 to 7.5. The self-reported ability to use insurance increased by 7% and confidence in choosing and using insurance increased by 29% and 24% on the HILM.

Conclusion: CHD patients’ insurance knowledge, literacy, and self-reported confidence in choosing and using insurance improved with education. Incorporating the importance of continued health insurance coverage into adulthood and education regarding insurance terminology are important components to include in adolescent transitional programs.

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