Improving Native American Elder Access to and Use of Healthcare

NCT03550404 | Completed Results

• 1 other identifier: 0784.01.01
• Study Type: observational
• Target: 16
• Locations: 1 country
• Sites: 1

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.

Conditions

Access to Health Care

Outcome Measures

Primary Outcomes (1)

• User Evaluation Survey

  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

  Once at the end of P2 (Month 8 of 8)

Secondary Outcomes (1)

• Navigator Pre- and Post-Evaluation Interview

  Month 1 and 4 (of 8) for P1 Navigators; Month 5 and 8 (of 8) for P2 Navigators

Other Outcomes (2)

• User Evaluation Demographic Survey

  Once at the end of P2 (Month 8 of 8)

• Feasibility Questionnaire

  Assessed monthly for 4 months; participants' ratings for each category were averaged. Average ratings per participant for each category is reported here.

Study Arms (3)

Navigators

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.

Behavioral: Seasons of Care App

American Indian Elders (AIEs)

Elders will be exposed to the Seasons of Care app when they reach out to navigators for assistance navigating the healthcare system.

Behavioral: Seasons of Care App

Healthcare providers/staff

This cohort will be exposed to the Seasons of Care app via navigators and their patients.

Behavioral: Seasons of Care App

Interventions

Seasons of Care App BEHAVIORAL

A web-based mobile application (app) called the Seasons of Care Elder Navigation Guide will assist elders, their families/caregivers, healthcare providers, outreach workers, and other community members in navigating healthcare and insurance systems. The app has the added advantage of being easy to update to respond to future changes in health care and insurance, and sustainable because it is not dependent on intensive training, developing, and retaining of individuals in professional navigation positions.

American Indian Elders (AIEs); Healthcare providers/staff; Navigators

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)
• 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.

You may qualify if:

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

You may not qualify if:

• Not Routinely interacting with AIEs as part of their jobs
• Not willing to be trained in or use the Seasons of Care app
• Age 55+
• Identifying as AI
• Able to read in English
• Able to consent and complete study procedures
• Interacted with Navigator
• 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
• ● 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

Sponsors & Collaborators

• Pacific Institute for Research and Evaluation: lead
• University of California, San Diego: collaborator
• University of New Mexico: collaborator

Study Sites (1)

Pacific Institute for Research and Evaluation

Albuquerque, New Mexico, 87106, United States

Location

Related Publications (1)

• 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.

  PMID: 29914446 DERIVED

Limitations and Caveats

Data collection with American Indian Elders and healthcare providers/staff to evaluate their experiences with the Seasons of Care Guide was not possible due to the closure of tribal communities during the COVID-19 pandemic and the infeasibility of collecting data with these participants remotely. These evaluation data are qualitative; future research on the dissemination of the Seasons of Care Guide should prioritize quantitative methods.

Results Point of Contact

• Title: Cathleen Willging
• Organization: Pacific Institute for Research and Evaluation

cwillging@pire.org

505-765-2328

Study Officials

• Cathleen Willging

  Pacific Institute for Research and Evaluation

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: No
• Restrictive Agreement: No

Study Design

• Study Type: observational
• Observational Model: CASE ONLY
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Senior Research Scientist/Center Director

Study Record Dates

• First Submitted: May 15, 2018
• First Posted: June 8, 2018
• Study Start: August 1, 2018
• Primary Completion: November 30, 2021
• Study Completion: June 30, 2022
• Last Updated: July 10, 2024
• Results First Posted: July 10, 2024

Record last verified: 2024-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)