Table 3.

Barriers to Engaging With Offered Social Care Assistance

Survey findings	Interview themes and illustrative quotes	Integrated analyses
Reasons for not following up with in-person assistance (n=146) 38%–did not need help 16%–other responsibilities took priority 14%–did not think that the resource would be helpful 13%–does not recall being provided information for assistance 13%–not enough time 12%–forgot 10%–did not apply to needs 10%–other 8%–support from resource outside of the program 6%–information too general 5%–not interested in information 3%–too complicated to navigate 3%–felt embarrassed or uncomfortable 1%–used before, met needs 1%–used before, did not meet needs 1%–did not trust the assistance 1%–past negative experience 1%–fearful care could be compromised Reasons for not following up with guided self-navigation (n=30) 27%–not interested 27%–could not figure out how to log into the website 23%–not enough time 20%–no access to the Internet 17%–forgot to log in 17%–unable to connect to the website 13%–not good with technology 10%–other 3%–no access to computer 3%–did not know the password Reasons for not following up with resources offered by in-person assistance (n=16) 63%–did not receive a referral to resources 4%–contacted and did not hear back Reasons for not following up with resources offered by guided self-navigation (n=16) 38%–did not need help 31%–did not apply to needs 31%–support from resources outside of the program 31%–information was too general 25%–not enough time 19%–other 19%–information not helpful 13%–did not think the resources would be helpful 6%–too complicated to navigate 6%–used before, did not meet needs 6%–used before, met needs 6%–other responsibilities took priority 6%–felt embarrassed or uncomfortable	Not interested in assistance Offered resources not relevant “It just didn’t strike me that I needed any of the services that were listed on there.” (in-person assistance) “I think if my resources were to diminish, I would probably seek out some of their assistance, but I’m just in a good place right now… I have a job. I have a house. I am doing okay through COVID and… it’s like, I just don’t have a need right now. (in-person assistance) “A lot of it… has to do with finances and trying to get help for your medications and things like that. That does not apply to me. I have really good insurance, and I have enough money that I can get what I need… So… it doesn’t apply to me.” (guided self-navigation) Able to navigate resources on own “I feel independent. I feel like most of the time, I can figure it out” (in-person assistance) “I have to tell you, quite honestly, I didn’t look at it very carefully. But I’m sort of the kind of person who does things myself, and I kind of see myself as, like, ‘Oh, no, I don’t need help.’ (in-person assistance) “I’ve been to all of the websites individually in the past, like the ADA’s. I know how to access that without having to go through a separate step.” (guided self-navigation) Uncomfortable asking for assistance, stigma “I’m not interested in government programs. Somebody says, ‘We can save 80% by signing up for this [state] resource. ‘No. I’d rather go another route… I just don’t want to participate in government programs… whatever else direction my findings take me, I’m more inclined to do it that way than any free help…” (in-person assistance) “I think it’s just me and my background. It’s, you know, we were taught by example from my grandparents, both sides actually, at a very young age that you don’t ask for assistance. (in-person assistance) “I don’t know why I haven’t called… I feel like it’s just more me not wanting to, like, accept help from other people… I just feel kind of bad or ashamed that I even need help in the first place.” (in-person assistance) “It’s frustrating, you know. It’s like you feel like you’re asking for… stuff for free, but it’s not like you’re doing it because you want it for free. It’s just you want to be able to take care of yourself so you’re not as much of a burden on everybody with your disease.” (guided self-navigation) Not in enough need “I don’t want to take away resources from somebody that might need them more than me and that might have less resources than me.” (in-person assistance) “I would rather struggle than… take away somebody’s place that I feel needs it more than I do.” (in-person assistance) Competing priorities, lack of time “It’s just an added task. And if I’m already in a kind of crazy or chaotic state in terms of feeling overwhelmed, not only with my own personal health but just with the day-to-day challenges of life, then this is one more thing to research out.” (in-person assistance) “I just didn’t really look into it. I guess I didn’t have any time at that time, so I just really didn’t utilize it at all.” (guided self-navigation) Did not think offered assistance would be helpful Did not think would qualify for assistance “My experience is kind of like, “No. I’m right above the poverty level. I don’t get anything.” (in-person assistance) “A couple of times I’ve used the [social care assistance program]… I had no insurance. I was going to a free clinic, and they gave me insulin, and then they hooked me up with [social care assistance program]. And [program] is, like, why don’t you apply for Medicaid. And every time I did… they’d find some reason not to cover me… And it’s, like, you know, I’m tired of asking. (in-person assistance) “[Social care assistance that participant previously received] only helped me with what I qualify for, and, well, right now it’s like jumping through hoops to qualify for anything because everything’s stretched so thin.” (guided self-navigation) Felt already aware of offered resources “I just didn’t feel like they could help me with anything that I’m not already aware of.” (in-person assistance) “There was nothing [on the online assistance platform] that I don’t already know. That’s how I felt. And I don’t have a lot of time, so for me to just sit there and go through everything page by page and slowly it wasn’t working for me.” (guided self-navigation) Previous negative experiences with requested assistance “When I went around to various agencies in 2010, they all gave me the same list. And finally, at one place, I said, ‘I have the list. I don’t need the list. I need the service.’ And I didn’t qualify. I didn’t qualify for anything because they were using last year’s taxes… People say, ‘Well, why don’t poor people ask for help?’ Because they don’t think of themselves as poor people. And to have to go ask for help and then have [someone tell you]… one social worker… did tell me… ‘You’re too proud. You have to be humble.’ And I said, ‘No. I can be as proud as I want.’ So, I’m not going to deal with people who see me as some poor creature. I’m very competent… We have to change the attitude of the so-called helpers. So, if they change their attitude, maybe I’ll go. But I’m not going to put myself through that again. (in-person assistance) “With assistance, there’s certain guidelines and regulations, and you may think you’re following the guidelines and regulations, but then in the end you get hit with, bam, you didn’t follow the guidelines… I was substitute teaching, and you don’t get paid very much at all. It’s probably even less than $10,000 a year. So, I signed up for the assistance, and I got the assistance. But after–at the end of it, then I had to pay it back. Like, how am I going to pay it back? So, it’s stressful the whole time.” (in-person assistance) “If we’re talking kind of public health systems and public health support, I think those generally… made you feel more like a number, that you were just being processed through. You… didn’t feel like somebody was connecting to you on just where your individual situation was… So, that humanity aspect was kind of failing.” (in-person assistance) Did not remember getting information about assistance “I must say I don’t remember what it said when I read it. I read it so long ago I don’t remember it specifically.” (in-person assistance) “Yeah, I got a flier, but I kind of tucked it away and then never read it… I don’t remember what was in it.” (in-person assistance) Forgot to follow-up with offered resources “I don’t know… I was referred by something else, and I just was going down the row doing stuff. So, there wasn’t a reason. I just didn’t have it written down.” (in-person assistance) “I just kind of put it off in the back of my mind and then didn’t really remember to be, like, hey, I should check that out.” (guided self-navigation) Attempted to engage with offered resources and told ineligible “I was in need of some help… paying my utility bills, and nothing was there for that type of assistance. My insurance covered 80% [of medical costs], but the other 20% was uncovered. I had to pay one or the other, medication or utilities, medication or utilities… Government agencies and other agencies… that was suggested, I didn’t qualify for. They said I made too much money. I don’t understand what that means, but okay, one dollar more than what the guidelines are–that’s not too much money, I think.” (in-person assistance) “I tried getting to… [resource] to help us get extra food in the house, because… we’ve got a rent payment, car payment, insurance, renter’s insurance, other bills that were outstanding before my husband lost his job that we’re still paying… we don’t have a lot of money coming in by the time we get done paying the bills. So, I was trying to get help for the food by going through [the Department of Human Services]… They said we had too much income. They did not take into consideration what income we have and what income goes out. And I don’t think that’s kind of fair.” (guided self-navigation)	The most prevalent reasons for not engaging with offered assistance were similar for both in-person assistance and online self-navigation, including participants not being interested in or needing assistance, feeling offered assistance was not relevant to needs or that they would not qualify, competing priorities/lack of time, forgetting and difficulty qualifying for assistance. Additional findings in the survey data for in-person support included already receiving support from other resources and the information about the resource was too general. Barriers more prominently expressed in the in-person assistance group were feeling uncomfortable asking for assistance, thinking based on prior negative experiences with social care assistance that the offered assistance would not be helpful, and not remembering getting information about the program. Barriers unique to the online self-navigation included lack of internet/computer access and challenges using the website.