Feasibility and Acceptability of a Telephone-Based Intervention for Hispanic Children to Promote Treatment Adherence After Traumatic Brain Injury: A Pilot Study

Abstract

Objective: To assess the feasibility and acceptability of a telephone-based education and navigation program for Hispanic parents of children hospitalized with traumatic brain injury (TBI). Setting: Level I trauma hospital and pediatric inpatient rehabilitation unit in the Northwestern United States. Participants: Fourteen Hispanic parentchild dyads. Parents were 85% female, with a mean age of 35 years. Children were 58% male, with a mean age of 9.7 years, and had been hospitalized for complicated mild/moderate (n = 5) or severe (n = 9) TBI. Design: Pilot prospective cohort design. Main Measures: Feasibility measures include recruitment, retention, and intervention adherence rates. Acceptability of intervention was measured by parents' use of educational materials and satisfaction with navigation program. We also evaluated study processes, including completion of baseline, 3, 6, and 12 months functional assessments of the child; assessment of parental health literacy and self-efficacy; and adherence to followup rehabilitation appointments. Results: Eighty-two percent of approached potential participants were recruited into the study. One hundred percent of participants completed the intervention, and 85% had 1-year follow-up. Intervention acceptability was high: 90% reported satisfaction with navigator, and 92% used the educational manual. Assessments demonstrated significant improvement in parents' TBI caregiving and community self-efficacy; 92% attendance to follow-up rehabilitation appointments; and improvement in the child's functional measures, except communication skills. Conclusions: Findings support feasibility and acceptability of a culturally relevant program to facilitate transitions of care for Hispanic children with TBI. A future randomized trial is warranted to determine the efficacy of the intervention on long-term treatment adherence and the child's post-TBI function.

Hospital-based patient navigation programs for patients who experience injury-related trauma and their caregivers: a scoping review

“… 32 38 Two programmes reported providing emotional or psychosocial support to patients and families. 29 38 One programme administered needs assessments, 33 while others (n=2) provided problem-solving. 31 38…”

“… 29–31 36–38 Two programmes employed lay navigators with additional training. 34 35 One programme had a certified medical interpreter fulfilling the navigator role, 33 and another programme had a social worker. 32 …”

“…Two programmes reported having difficulty recruiting or enrolling patients who had shorter hospital stays, which led to a difficulty delivering the programme. 33 35 One attributed this difficulty to a combination of barriers, including difficulty verifying patients’ identities and patients’ distrust of the state and state institutions. 35 This particular programme also reported a lack of understanding from and collaboration with hospital administrators impeding their access to eligible patients.…”

“…30 Another programme had an increase in participation in rehabilitation after discharge, as well as a significant improvement in parents' caregiving self-efficacy. 33 Two sources reporting on the same programme found that most patients attended their follow-up appointments and that the overwhelming majority of patients (96%) completed the programme. 31 Open access Barriers There were a range of barriers to programme implementation and delivery.…”

“…29 As well, for another programme, low language literacy was reported as a barrier to understanding programme materials. 33 Facilitators Two sources reporting on two programmes found that the backgrounds of the navigators facilitated programme delivery, but for different reasons. 35 37 One source listed the lived experience of the lay navigators as community members as facilitators to building trust and rapport with clients.…”