Abstract PO-030: Qualitative analysis of case notes and narratives reported by community health navigators in the Yale Cancer Disparities Firewall project
Authors: Suttiratana Sakinah C , Stefanou Monique , Ibrahim Eiman , Colon Jonathan , Reyes Eduardo , Herbst Roy , Jones Beth A. 
Published: January 2022

Abstract
Background: The Yale Cancer Disparities Firewall Project launched a pilot “health” navigation program that combines multicultural and bilingual health navigators, geo-coded resource referrals, screening for social determinants of health (SDOH), and telephonic support to set and achieve cancer screening and prevention (lifestyle change) goals among vulnerable populations. This study examines benefits of and barriers to program participation based on navigators' interaction notes and case narratives. Methodology: Qualitative analysis of interaction notes recorded in electronic databases as well as case narratives documented over the course of the pilot program. Thematic analysis highlighted benefits of and barriers to program participation. Triangulation of qualitative findings with quantitative measures of SDOH and demographic factors helped characterize goal progress related to cancer screening, preventive medicine appointments, and healthy lifestyles (e.g. healthy eating, quit smoking). Results: Between May 2019 and December 2020, 196 community members expressed interest in receiving navigation support focused on cancer screening and healthy lifestyle support; 73 completed an intake process and 69 had at least one post-intake interaction with a navigator. Demographic characteristics of those who completed the intake were: 75.4% female, 60.9% Black, 27.5% Latinx, and 23.2% immigrant. Based on a validated screening tool, 66.7% of participants had one or more SDOH need. Representing more than 2,500 interactions between navigators and participants, 658 case notes revealed the complexity of making and attending medical appointments and maintaining healthy lifestyles amidst dynamic life circumstances and limited resources. Data describe institutional, interpersonal/social, and individual level benefits of and barriers to program participation. Navigator-facilitated benefits included Spanish language access to information, improved navigation of local health systems, tangible support to address SDOH and make appointments, health information dissemination, and enhanced trust in health care workers. Barriers to participation included: a mismatch between community resources and resource needs, consistent and reliable access to technology, time constraints and household or individual health/medical conditions. Conclusion: The Yale Cancer Disparities Firewall was designed to identify and address SDOH for vulnerable residents, while facilitating healthy lifestyles and cancer screening. Based on two years of implementation data, we have identified areas for program refinement that might enhance navigation services for community members and advance cancer prevention and screening strategies to help address cancer disparities. Furthermore, systematic analyses of administrative case notes, a commonly available source of data for many health and social service programs, has been a valuable tool to help reveal barriers and facilitators to program engagement that may complement conventional evaluation strategies.
Citation Format: Sakinah C Suttiratana, Monique Stefanou, Eiman Ibrahim, Jonathan Colon, Eduardo Reyes, Roy Herbst, Beth A. Jones. Qualitative analysis of case notes and narratives reported by community health navigators in the Yale Cancer Disparities Firewall project [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-030.