Clinical trial NCT03550404: Improving Native American Elder Access to and Use of Healthcare
Official title: Improving Native American Elder Access to and Use of Healthcare Through Effective Health System Navigation
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Access to Health Care
Lead sponsor: Pacific Institute for Research and Evaluation
Sponsor class: OTHER
Collaborators: name: University of California, San Diego
name: University of New Mexico
First posted: 2018-06-08
Enrollment: 16
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: CASE_ONLY
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Outreach workers from indigenous communities in the southwest United States, and then the American Indian elders, healthcare staff and providers that interact with those outreach workers.

Brief summary: This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.

Detailed description: This five-year project was developed by investigators from the Behavioral Health Research Center of the Southwest (BHRCS), a center of the Pacific Institute of Research and Evaluation (PIRE), the Health Committee of the New Mexico Indian Council on Aging (NMICoA), and the University of New Mexico (UNM). The project combines qualitative and quantitative interviews with concept-mapping (CM) techniques and focus groups to study insurance coverage, help-seeking behavior, and the healthcare experiences of American Indian Elders (AIEs) in New Mexico (NM). Practical knowledge grounded in the actual perspectives of AIEs and other key stakeholders may improve healthcare practices and policies for a population largely excluded from national and state discussions of health reform. The study data will also inform the adaptation and development of culturally tailored programming to enrich understanding and facilitate negotiation of a changing landscape of healthcare by AIEs. Our four specific aims are to:

1. Assess how AIEs understand, access, maintain, and use insurance coverage.
2. Characterize AIE help-seeking and healthcare experiences in dominant service delivery settings, i.e., Indian Health Service (IHS), tribally-run 638 facilities, and managed care programs.
3. Identify and compare factors that affect AIE access to health care as perceived by multiple stakeholders, i.e., AIEs, outreach workers (OWs), healthcare staff and providers, public sector administrators, and tribal leaders.
4. Develop and assess implementation feasibility of a structured intervention for OWs that promotes enhanced patient navigation, in addition to healthcare literacy, access, and usage among AIEs.

Eligibility criteria: Navigators

Inclusion Criteria:

* Working in a health and health insurance outreach
* Routinely interacting with AIEs as part of their jobs
* Primary service region includes target AIEs.

Exclusion Criteria:

* Not Routinely interacting with AIEs as part of their jobs
* Not willing to be trained in or use the Seasons of Care app

American Indian Elders (AIEs) Inclusion

* Age 55+
* Identifying as AI
* Able to read in English
* Able to consent and complete study procedures
* Interacted with Navigator

Exclusion ● Individuals who cannot read in English or who have not interacted with a pilot test Navigator will not be eligible to participate

Healthcare Staff/providers Inclusion

* Individuals who have been in contact with a pilot test Navigator
* Work in a healthcare facility that serves AIEs in one of our 4 regions

Exclusion

● Individuals who have not interacted with a pilot test Navigator or do not work in a healthcare facility serving our primary population, will not be eligible to participate

Primary outcomes:
measure: User Evaluation Survey
timeFrame: Once at the end of P2 (Month 8 of 8)
Secondary outcomes:
measure: Navigator Pre- and Post-Evaluation Interview
timeFrame: Month 1 and 4 (of 8) for P1 Navigators; Month 5 and 8 (of 8) for P2 Navigators
Other outcomes:
measure: User Evaluation Demographic Survey
timeFrame: Once at the end of P2 (Month 8 of 8)
measure: Feasibility Questionnaire
timeFrame: Assessed monthly for 4 months; participants' ratings for each category were averaged. Average ratings per participant for each category is reported here.
Locations:
city: Albuquerque
country: United States
facility: Pacific Institute for Research and Evaluation
state: New Mexico
Study officials:
affiliation: Pacific Institute for Research and Evaluation
name: Cathleen Willging
role: PRINCIPAL_INVESTIGATOR
References:
citation: Willging CE, Sommerfeld DH, Jaramillo ET, Lujan E, Bly RS, Debenport EK, Verney SP, Lujan R. "Improving Native American elder access to and use of health care through effective health system navigation". BMC Health Serv Res. 2018 Jun 18;18(1):464. doi: 10.1186/s12913-018-3182-y.