The Evolution of an Innovative Community-Engaged Health Navigator Program to Address Social Determinants of Health

Page-Reeves, Janet; Moffett, Maurice L.; Steimel, Leah; Smith, Daryl T

doi:10.1353/cpr.2016.0069

Cited by 10 publications

(8 citation statements)

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“…Our interpretation is that this sharing and empathy likely contribute to the lower and more sustained levels of depression symptoms. Participants at both sites indicated the importance of these factors in qualitative data, and our broader research with Latina and Mexican immigrant women and CHWs in Albuquerque strongly supports this finding of the deep importance of social support in the lives of Latinxs[90][91][92][93][94][95]. In fact, this is why our patient advisors were adamant that we find a way to include social support and social context in the design of our study, and why we enrolled participants as patient participant-social support participant dyads rather than merely recruiting patient participants to participate as individuals.Furthermore, although patient participants at both sites rated their program high in cultural competence and expressed that they really like the program and the staff, when posed with a question about what was missing from the program design, DSMS patient participants tended to indicate that the DSMS model of six discrete group sessions was not really sufficient and was less attractive than a program like the CCM that provides ongoing classes and support.DSMS patient participants and their social support participants reported that patient participants often feel socially isolated and alone in relation to the issue of diabetes-and CCM patient participants discussed the importance of having the social support of the program in an ongoing way.…”

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confidence: 62%

A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management

Page-Reeves

Murray‐Krezan

Burge

et al. 2023

Preprint

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This project compared the effectiveness of two evidence-based models of culturally competent diabetes health promotion: The Diabetes Self-Management Support Empowerment Model (DSMS), and The Chronic Care Model (CCM). Our primary outcome was improvement in patient capacity for diabetes self-management as measured by the Diabetes Knowledge Questionnaire (DKQ) and the Patient Activation Measure (PAM). Our secondary outcome was patient success at diabetes self-management as measured by improvement in A1c, depression sores using the PHQ-9, and Body Mass Index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC). We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latino diabetes patients from low-income households. Participants were enrolled as dyads—a patient participant (n=226) and a social support participant (n=226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self-management and education program design may deliver benefit for patients, especially for patients with higher A1c levels.

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confidence: 62%

A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management

Page-Reeves

Murray‐Krezan

Burge

et al. 2023

Preprint

Self Cite

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“…In 2014, the Institute of Medicine recommended that health care settings begin to screen for and report on HRSN (Institute of Medicine, 2014). To act upon this recommendation, many primary care practices have implemented screening processes (Andermann, 2018; Fraze et al., 2019; Page‐Reeves et al., 2016; Smith et al., 2017).…”

Section: Introductionmentioning

confidence: 99%

Implementing health‐related social needs screening in western Colorado primary care practices: Qualitative research to inform improved communication with patients

Broaddus-Shea

Duarte

Jantz³

et al. 2022

Health Social Care Comm

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Social determinants profoundly impact health. Many primary care practices now seek to screen their patients for health-related social needs (HRSN) and refer them to resources in the community. However, there is little empirical evidence to guide communication with patients in order to ensure their comfort with the process and increase the likelihood that it results in positive outcomes. This paper describes the first phase of the Improving Messaging Around Gaps in Needs and rEfferals (IMAGINE) study-a multi-phase study aiming to develop and test patient-centred messages about screening and referral for HRSN. In this initial qualitative phase, our objective was to identify communication strategies that might make western Colorado primary care patients more comfortable with the HRSN screening and referral process. From May to July 2020 we interviewed 10 staff members responsible for HRSN screening from primary care practices participating in the western Colorado Accountable Health Communities (AHC) initiative and 20 patients from 2 of these practices. We used a rapid qualitative analysis process that involved summarising interview transcripts across key domains of interest and then identifying emergent themes within each domain using a data matrix. Through this process, we examined current communication about HRSN screening, as well as suggestions for messages and other strategies that could improve communication. In most practices, the AHC Screening Tool was handed to patients by front desk staff at check-in with little explanation as to its purpose. Patients and staff alike recommended that patients be provided with information that: normalises the screening and referral process; assures privacy; clarifies that the purpose is to help and support rather than judge or report; emphasises community benefits; and respects patient autonomy. Interviewees also suggested broader strategies to support more effective communication, such as practice staff and clinicians building trusting relationships with patients and understanding and acknowledging the complex structural barriers that often prevent patients from accessing meaningful assistance. These findings provide actionable suggestions for improving communication about HRSN screening and referral in primary care settings. The next steps include developing specific messages based on these findings and testing their impact on screening tool completion rate, referral uptake, and patient-reported comfort with the process.

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“…In 2014, the Institute of Medicine recommended that health care settings begin to screen for and report on social determinants of health (SDOH)related needs, 1 leading to development of screening tools and increasing implementation of screening processes. [2][3][4][5] However, even earlier, the American Academy of Pediatrics and others recommended screening for food insecurity (FI) in health care settings. 6,7 FI is defined by the U.S. Department of Agriculture as "a household level economic and social condition of limited or uncertain access to adequate food."…”

Section: Introductionmentioning

confidence: 99%

Multistakeholder Perspectives on Data Sharing to Address Patient Food Insecurity

et al. 2022

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Background: Social determinants of health (SDOH) influence health outcomes. Food insecurity (FI) is the most common need related to SDOH. Many primary care practices and health systems have begun to screen for FI and refer patients to resources. How this process is viewed by multiple stakeholders, including patients, health care workers, and staff at food assistance organizations (FAOs), will influence its impact.Methods: In this mixed-methods study, we completed 42 interviews with individuals from the 3 stakeholder groups. We then conducted a survey with 126 respondents using questions developed from the qualitative results.Results: All stakeholders recognized the impact FI has on health outcomes, but perspectives varied on the value of sharing information through referrals to FAOs and concerning receipt of services, including privacy concerns and that the process would require significant work and not necessarily improve FI.Discussion: Stakeholders agree that FI impacts health but have differences in perceptions around screening and referral done in health care settings. Perspectives of multiple stakeholders need to be considered when designing these systems.Conclusion: Successfully designing systems to address FI through referral to FAOs requires input of multiple stakeholders because perspectives on the value and work required for this process vary.

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The Evolution of an Innovative Community-Engaged Health Navigator Program to Address Social Determinants of Health

Abstract: One of the important innovations of the pathways approach is a shift in focus from merely providing discrete services to confirming healthy outcomes for the individual patient.

Cited by 10 publications

References 10 publications

A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management

A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management

Implementing health‐related social needs screening in western Colorado primary care practices: Qualitative research to inform improved communication with patients

Multistakeholder Perspectives on Data Sharing to Address Patient Food Insecurity

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