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Improving Native American Elder Access to and Use of Healthcare

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ClinicalTrials.gov Identifier: NCT03550404
Recruitment Status : Recruiting
First Posted : June 8, 2018
Last Update Posted : September 11, 2018
Sponsor:
Collaborators:
University of California, San Diego
University of New Mexico
Information provided by (Responsible Party):
Cathleen Willging, 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.

Condition or disease Intervention/treatment
Access to Health Care Behavioral: Seasons of Care App

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.

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Study Type : Observational
Estimated Enrollment : 112 participants
Observational Model: Case-Only
Time Perspective: Prospective
Official Title: Improving Native American Elder Access to and Use of Healthcare Through Effective Health System Navigation
Actual Study Start Date : August 1, 2018
Estimated Primary Completion Date : June 30, 2019
Estimated Study Completion Date : December 31, 2019

Group/Cohort Intervention/treatment
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
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)
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
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.

Healthcare providers/staff
This cohort will be exposed to the Seasons of Care app via navigators and their patients.
Behavioral: Seasons of Care App
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.




Primary Outcome Measures :
  1. User Evaluation Survey [ Time Frame: 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 :
  1. Navigator Pre- and Post-Evaluation Interview [ Time Frame: 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


Other Outcome Measures:
  1. User Evaluation Demographic Survey [ Time Frame: Once at the end of P2 (Month 8 of 8) ]
    A demographic survey with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app

  2. Feasibility Questionnaire [ Time Frame: Monthly for 8 months ]
    A written questionnaire to assess navigator's experiences with, and effects of, Seasons of Care app



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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
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.
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


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03550404


Contacts
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Contact: Elise Jaramillo, Ph.D. 505-765-2327 etrott@pire.org
Contact: Patricia Hokanson, MPH 505-765-2325 phokanson@pire.org

Locations
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United States, New Mexico
Pacific Institute for Research and Evaluation Recruiting
Albuquerque, New Mexico, United States, 87106
Contact: Patricia Hokanson, MPH    505-765-2325    phokanson@pire.org   
Principal Investigator: Cathleen Willging, Ph.D>         
Sponsors and Collaborators
Pacific Institute for Research and Evaluation
University of California, San Diego
University of New Mexico
Investigators
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Principal Investigator: Cathleen Willging Pacific Institute for Research and Evaluation

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Cathleen Willging, Senior Research Scientist/Center Director, Pacific Institute for Research and Evaluation
ClinicalTrials.gov Identifier: NCT03550404     History of Changes
Other Study ID Numbers: 0784.01.01
First Posted: June 8, 2018    Key Record Dates
Last Update Posted: September 11, 2018
Last Verified: September 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No