Qualitative Evaluation of a Community Health Representative Program on Patient Experiences in Navajo Nation

Abstract

Background:Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturally-appropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs)of clients who consent to receiving the COPE intervention (COPE clients)using a qualitative methods evaluation.Methods:Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes.Results:Through qualitativesemi-structuredinterviews, clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educatedtheir family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. Conclusion:The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes.

Participant Perspectives on Community Health Workers' Critical Role in Their Experience of the Pathways Program to Address Complex Needs

“…Pathways participants discussed how working with a CHW increased their awareness of and access to a variety of health and social services resources. Similar findings have emerged in evaluations of other CHW-led care coordination programs among diverse populations (Hudson et al, 2019;Lalla et al, 2020). Our findings support a growing body of evidence outlining the effectiveness of CHWs as a key component of care coordination service delivery within Pathways among a general adult population.…”

Community Outreach for Navajo People Living with Diabetes: Who Benefits Most?

“…The finding that patients aged 64 or younger had a greater response to the intervention than patients aged 65 or older is particularly salient, in light of the fact that type 2 diabetes is affecting Navajo and other Native populations at increasingly younger ages (26). A systematic review of tailored integrated diabetes primary care interventions found the opposite, namely that younger people, compared with older people, had higher HbA 1c values in followup (25).…”

Women with breast cancer’s perceptions of nurse-led telephone-based motivational interviewing consultations to enhance adherence to adjuvant endocrine therapy: a qualitative study

“…A tailored physical activity program supported by providers trained in MI techniques also fuelled sense of optimism for the future in people with mental health conditions [29]. Among patients with diabetes, combining information provision, MI techniques, and meaningful relationships led to improved sense of control [30], while others reported that it drove optimism [31]. Provision of information combined with MI techniques was also identified as two intervention components perceived as most beneficial in people receiving antiretroviral therapy [32].…”