Improving Native American Elder Access to and Use of Healthcare

Completed

Conditions: Access to Health Care

Interventions: Behavioral: Seasons of Care App

Registration Number: NCT03550404

Lead Sponsor: Pacific Institute for Research and Evaluation

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.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 16

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

Study & Design

Study Type: OBSERVATIONAL

Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
American Indian Elders (AIEs)	Seasons of Care App	Elders will be exposed to the Seasons of Care app when they reach out to navigators for assistance navigating the healthcare system.
Healthcare providers/staff	Seasons of Care App	This cohort will be exposed to the Seasons of Care app via navigators and their patients.
Navigators	Seasons of Care App	AIE Navigators will use the Seasons of Care app in the context of their everyday outreach work with AIEs over two four-month intervention periods (P1 and P2). Their goal will be to facilitate health literacy to shift attitudes, beliefs, and behaviors to create a "Culture of Coverage" for AIEs at individual, organizational/community, and policy levels. Separated by distance, the AIE Navigators will receive coaching as necessary, using virtual meeting space, to help refine their implementation skills from a member of the research team with experience in AIE health outreach.

Primary Outcome Measures

Name	Time	Method
User Evaluation Survey	Once at the end of P2 (Month 8 of 8)	A semi-structured, in-person interview (or focus group, depending on availability) with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app to assess experiences with, and effects of, the Seasons of Care app; suggestions to improve the Seasons of Care app

Secondary Outcome Measures

Name	Time	Method
Navigator Pre- and Post-Evaluation Interview	Month 1 and 4 (of 8) for P1 Navigators; Month 5 and 8 (of 8) for P2 Navigators	A semi-structured, in-person interview comprised of open-ended questions to assess navigator's confidence and experiences with communicating health information to AIEs and healthcare providers; perceptions of the Seasons of Care app