A Systematic Review on US-Based Community Health Navigator (CHN) Interventions for Cancer Screening Promotion—Comparing Community- Versus Clinic-Based Navigator Models

Abstract

This study synthesized lessons learned from US-based community and clinic health navigator (CHN) interventions on cancer screening promotion to identify characteristics of models and approaches for addressing cancer disparities. The combination terms "cancer screening" and "community health workers or navigators" or "patient navigators" were used in searching Medline, CINAHL, and PsycInfo. A total of 27 articles published during January 2005∼April 2014 were included. Two CHN models were identified: community-based (15 studies) and clinic/hospital-based (12 studies). While both models used the term "navigators," most community-based programs referred them as community health workers/navigators/advisors, whereas clinic-based programs often called them patient navigators. Most community-based CHN interventions targeted specific racial/ethnic minority or rural groups, while clinic-based programs mostly targeted urban low income or mixed ethnic groups. Most community-based CHN programs outreached members from community networks, while clinic-based programs commonly worked with pre-identified in-service clients. Overall, regardless model type, CHNs had similar roles and responsibilities, and interventions demonstrated effective outcomes. Our review identified characteristics of CHN interventions with attention to different settings. Lessons learned have implication on the dissemination and implementation of CHN interventions for cancer screening promotion across setting and target groups.

Are community‐based health worker interventions an effective approach for early diagnosis of cancer? A systematic review and meta‐analysis

“…LHW roles in a cancer context include providing education to raise cancer awareness and overcoming individual barriers to attending screening. Two LHW models have been proposed in the literature, differentiated by setting: community based and clinic/hospital based .…”

“…Two LHW models have been proposed in the literature, differentiated by setting: community based and clinic/hospital based. 13 Although there is an overlap in tasks completed by both types of LHW, community-based health workers (CBHWs) act as a liaison facilitating initial access between individuals and health care settings. 12,14 By contrast, LHWs based in clinic and hospital settings, commonly referred to as patient navigators, offer guidance to persons with an abnormal cancer screening test or a cancer diagnosis to access the cancer care system.…”

“…Several systematic reviews have examined the effects of CBHW interventions on cancer outcomes, most commonly cancer screening uptake. 13,[17][18][19][20][21] Two previous systematic reviews which applied metaanalytic techniques found that CBHWs can improve breast cancer screening uptake, with small effects of 1.05 11 and 1.06 22 reported.…”

Patient Navigation Models for Lung Cancer

“…We identified four SRs 9-12 that examined patient navigation across the cancer care continuum, including screening, 9, 10 diagnosis, 11,12 and treatment. 11,12 The main cancer types represented included breast, [10][11][12] colorectal, 9-12 prostate, 11 and cervical cancer. 10,11 One SR included patients with a wide range of cancer types (including lung cancer).…”

The Clinical Sustainability Assessment Tool: Measuring Organizational Capacity to Promote Sustainability in Healthcare

“…Furthermore, community outreach, a key driver of sustainability in public health settings, is conducted less in clinical settings as services are mainly delivered to identi ed in-services patients [17]. Finally, although data are somewhat thin, current evidence suggests that sustaining evidence-based practices are challenging in clinical settings (as they are in public health settings).…”