An observational study in Access to Health Care, sponsored by Pacific Institute for Research and Evaluation. Completed at 1 site in United States. Open to participants aged 18 Years and older, including healthy volunteers. Per ClinicalTrials.gov, last updated 2024-07-10.
Sponsored by Pacific Institute for Research and Evaluation · Observational
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.
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:
Pacific Institute for Research and Evaluation is the lead sponsor of 15 studies on the registry; 1 is open to participants now.
Counted across the registry records on this site, refreshed daily.
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.
Navigators
Inclusion Criteria:
Exclusion Criteria:
American Indian Elders (AIEs) Inclusion
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
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
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
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
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.
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
Time frame: Once at the end of P2 (Month 8 of 8)
Navigator Pre- and Post-Evaluation Interview
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
Time frame: Month 1 and 4 (of 8) for P1 Navigators; Month 5 and 8 (of 8) for P2 Navigators
User Evaluation Demographic Survey
A demographic survey with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app
Time frame: Once at the end of P2 (Month 8 of 8)
Feasibility Questionnaire
A written questionnaire to assess navigator's experiences with, and effects of, Seasons of Care Guide
Time frame: Assessed monthly for 4 months; participants' ratings for each category were averaged. Average ratings per participant for each category is reported here.
We used reputational case selection to identify potential participants who were individuals who provided healthcare navigation services to Elders as part of their everyday work. We approached individuals or administrators at community organizations, healthcare facilities, and tribal agencies with an email or in-person description of the study and an invitation to participate. We followed up at each site with up to three emails, visits, or phone calls.
| Milestone | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff |
|---|---|---|---|
| Started | 8 | 0 | 0 |
| Completed | 8 | 0 | 0 |
| Not completed | 0 | 0 | 0 |
| Milestone | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff |
|---|---|---|---|
| Started | 8 | 0 | 0 |
| Completed | 4 | 0 | 0 |
| Not completed | 4 | 0 | 0 |
| Withdrew: Unable to complete due to other duties during covid-19 pandemic | 3 | 0 | 0 |
| Withdrew: Vacated position | 1 | 0 | 0 |
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
No measurements were reported for this outcome.
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
| Participants | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff |
|---|---|---|---|
| Effects of Seasons of Care Guide on Communication with Providers — Improved | 3 | — | — |
| Effects of Seasons of Care Guide on Communication with Providers — Improved but with some remaining barriers | 2 | — | — |
| Effects of Seasons of Care Guide on Communication with Providers — No change | 1 | — | — |
| Effects of Seasons of Care Guide on Communication with Providers — No response | 6 | — | — |
| Effects of Seasons of Care Guide on Communication with Elders — Improved | 5 | — | — |
| Effects of Seasons of Care Guide on Communication with Elders — Improved but with some remaining barriers | 0 | — | — |
| Effects of Seasons of Care Guide on Communication with Elders — No change | 3 | — | — |
| Effects of Seasons of Care Guide on Communication with Elders — No response | 4 | — | — |
A demographic survey with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app
No measurements were reported for this outcome.
A written questionnaire to assess navigator's experiences with, and effects of, Seasons of Care Guide
| Participants | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff |
|---|---|---|---|
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 4 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 4 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 3 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 1 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 0 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 1 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 0 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 3 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 2 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 6 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 1 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 0 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 1 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 0 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 3 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 3 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 5 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 1 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 0 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 1 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 0 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 5 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 1 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 6 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 0 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 0 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 1 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 0 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Can find relevant info using "Search" (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 1 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 5 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 3 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 2 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 2 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 0 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 0 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 1 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 2 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 3 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 1 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 1 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 1 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 1 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 2 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 1 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| Useful for working with AIEs — 10 | 3 | — | — |
| Useful for working with AIEs — 9 | 3 | — | — |
| Useful for working with AIEs — 8 | 2 | — | — |
| Useful for working with AIEs — 7 | 2 | — | — |
| Useful for working with AIEs — 6 | 1 | — | — |
| Useful for working with AIEs — 5 | 1 | — | — |
| Useful for working with AIEs — 4 | 1 | — | — |
| Useful for working with AIEs — 3 | 0 | — | — |
| Useful for working with AIEs — 2 | 0 | — | — |
| Useful for working with AIEs — 1 | 0 | — | — |
| Useful for working with AIEs — Not rated | 0 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 2 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 0 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 5 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 2 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 2 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 2 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 0 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 2 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 1 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 6 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 2 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 0 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 2 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 0 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 0 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 10 | 2 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 9 | 2 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 8 | 4 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 7 | 0 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 6 | 0 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 5 | 1 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 4 | 3 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 3 | 0 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 2 | 0 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — 1 | 0 | — | — |
| Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) — Not rated | 1 | — | — |
Collected over Adverse event data were collected from Navigators monthly during Phase 1 and Phase 2. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Navigators | 0/16 (0%) | 0/16 (0%) | 0/16 (0%) |
| American Indian Elders (AIEs) | — | — | — |
| Healthcare Providers/Staff | — | — | — |
Due to complete closure of tribal communities during the COVID-19 pandemic, we were unable to complete baseline measures with any American Indian Elders or healthcare providers/staff
| Age, Continuous(years) | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff | Total |
|---|---|---|---|---|
| Mean | 36 (21 to 70) | — | — | 36 (21 to 70) |
| Sex: Female, Male(Participants) | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff | Total |
|---|---|---|---|---|
| Female | 12 | — | — | 12 |
| Male | 4 | — | — | 4 |
| Ethnicity (NIH/OMB)(Participants) | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff | Total |
|---|---|---|---|---|
| Hispanic or Latino | 4 | — | — | 4 |
| Not Hispanic or Latino | 12 | — | — | 12 |
| Unknown or Not Reported | 0 | — | — | 0 |
| Race (NIH/OMB)(Participants) | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff | Total |
|---|---|---|---|---|
| American Indian or Alaska Native | 12 | — | — | 12 |
| Asian | 0 | — | — | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | — | — | 0 |
| Black or African American | 0 | — | — | 0 |
| White | 3 | — | — | 3 |
| More than one race | 1 | — | — | 1 |
| Unknown or Not Reported | 0 | — | — | 0 |
| Confidence communicating with Elders(Participants) | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff | Total |
|---|---|---|---|---|
| Comfortable communicating with AIEs about health and healthcare issues | 16 | — | — | 16 |
| Comfortable communicating with AIEs about health insurance | 11 | — | — | 11 |
| Uncomfortable communicating AIEs about insurance due to lack of knowledge | 3 | — | — | 3 |
| Experienced language barriers communicating with AIEs | 5 | — | — | 5 |
| Experienced challenges communicating with AIEs about difficult or taboo topics | 4 | — | — | 4 |
| Confidence communicating with healthcare providers(Participants) | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff | Total |
|---|---|---|---|---|
| Comfortable communicating with healthcare providers due to regular experience doing so | 12 | — | — | 12 |
| Comfortable communicating with healthcare providers when receiving referrals to help AIEs | 7 | — | — | 7 |
| Comfort using Seasons of Care Guide(Participants) | Navigators | American Indian Elders (AIEs) | Healthcare Providers/Staff | Total |
|---|---|---|---|---|
| Comfortable using the Seasons of Care Guide in their work | 10 | — | — | 10 |
| Confident that they would become comfortable with the Seasons of Care Guide over time | 5 | — | — | 5 |
| Felt that the Seasons of Care Guide was no different than other resources they already used | 1 | — | — | 1 |
PDFs hosted by the registry, ClinicalTrials.gov.
Plan to share: No
This study is completed, as verified in Jul 2024. You cannot join it, but the record below documents what was studied.
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