Socioeconomically disadvantaged populations stand to benefit greatly from the 2010 Patient Protection and Affordable Care Act (ACA), which will provide Medicaid or subsidized insurance coverage for the lowest-income Americans. Yet to see judge the potential value from of the ACA to themselves and their families, these individuals will need to be aware of how the law may benefit them, know their eligibility for benefits, and enroll in an appropriate plan. Existing mechanisms to reach the most socioeconomically disadvantaged populations with information about the ACA may not be ideal. This study explores characteristics of those with low knowledge versus high knowledge of health reform legislation in a low-income population with disproportionately high rates of uninsurance and cancer prevention and control needs, and investigates the sources of health reform and related communication by mapping social networks. Recruiting participants from United Way 2-1-1 Missouri - an information and referral hotline that reaches low-income and minority Missourians and connects them to local resources that can help meet their basic needs -- this study: 1) Assesses knowledge of the Affordable Care Act and describes social and word-of-mouth communication networks in a sample of callers to 2-1-1, 2) Tests whether individual characteristics and social support and communication network characteristics of participants differ between lower and higher scorers on ACA knowledge, 3) Compares the relative importance of network characteristics versus individual characteristics in predicting ACA knowledge by creating a model predicting high knowledge of ACA in a low-income population, and 4) Evaluates the relative contribution of community on ACA knowledge by including census level variables in a multi-level predictive model of ACA knowledge. Results include a structural and communication model of ACA- and health-related knowledge in a socioeconomically disadvantaged population. Through a better understanding of communication networks in and knowledge of the ACA among socioeconomically disadvantaged populations, we can inform communication strategies and shape policy to disseminate knowledge of ACA benefits and health services to millions of Americans greatly impacted by the ACA. This may help increase access to and use of health care services, resulting in reduced health disparities
