Expectations and Needs of Socially Disadvantaged Patients for Navigational Support of Primary Health Care Services

Abstract

Background: Primary healthcare is the main entry to the health care system for most of the population, even for specialized care. In 2014, it was estimated that about 25% of the population in Quebec (Canada) did not have a regular primary healthcare provider. In 2017, after the introduction of a centralized waiting list to enroll unattached patients with a family doctor, nearly 540,000 patients, many of whom were socially disadvantaged, remained on the list. Socially disadvantaged patients often have more health problems, more complex care needs, and more difficult to accommodate life situations (e.g. two or more jobs, no work accommodation, care responsibilities, low income, lack of social network). They can also lack the skills needed to navigate a constantly evolving and complex healthcare system and, consequently, misuse the system. To overcome this problem, a partnership of health system managers, family physician leaders, community agents, and researchers designed, implemented, and evaluated a navigational support initiative. This study aimed to describe and understand the expectations and needs of socially disadvantaged patients towards navigational support interventions to improve their access to healthcare. Methods: A descriptive qualitative study rooted in an international multi-site participatory study (IMPACT) was conducted with socially disadvantaged patients. Semi-structured individual face-to-face and telephone interviews were conducted with patients recruited at universal public primary health care clinics in Montérégie, some of whom received the evaluated navigational service. A thematic analysis was performed using NVivo 11 software. Results: Sixteen patients living in socially deprived contexts were recruited. Three main expectations of patients for navigational support were identified: communication expectations (support to understand providers and to be understood by them, provision of communication tips, and help to improve communication between providers); relational expectations (emotional or psychosocial support); and pragmatic expectations (information on available community resources, information about the clinic, tips and tools for medical appointments, and physical support to navigate the health care system).Conclusions: Our study contributes to the literature by identifying the many expectations socially disadvantaged patients have related to navigational services. This information can be used for navigational intervention design.

Mechanisms for Community Health Worker Action on Patient-, Institutional-, and Community-Level Barriers to Primary Care in a Safety-Net Setting

“…CHWs advocated for culturally sensitive care by leveraging and sharing their intimate understanding of patients' circumstances for shared decision-making. As socially disadvantaged, low-SES patients are at higher risk for low-quality care (Chirikos & Nestel, 1985), describe differential treatment due to their lower SES or insurance status (Arpey et al, 2017;Han et al, 2015;Weech-Maldonado et al, 2012), and describe a need for increased understanding between the provider and patients (Piemeu et al, 2020), CHW PCMH interventions may be important for mitigating unequal treatment. In particular, specific racial/ethnic groups who may have limited access to providers who look like them, hold mistrust in health care (Benkert et al, 2009), or perceive system and provider racial biases (Greer et al, 2014), may benefit from health care integration, further promoting antiracism (Cahn, 2020).…”