Community Navigation Research Articles

Addressing unmet social needs of children with obesity: a pilot randomized controlled trial

BackgroundChildhood obesity is an ongoing public health crisis, and recent clinical practice guidelines identify addressing the role of social inequities in the disparity of health among children with obesity as an area to address. This study aimed to assess the feasibility of a community navigation intervention in a pediatric weight management clinic.MethodsA single-center pilot randomized controlled trial (RCT) recruiting families from a tertiary hospital pediatric weight management program to evaluate the feasibility of a community navigation intervention. The primary feasibility outcomes were recruitment rates (goal to recruit 80% of the sample in 6 months), uptake of the intervention (goal > 80% of participants in the intervention group to have a visit with the navigator), and acceptability (goal > 90% of families in the intervention group complete all follow-up).ResultsEighty participants completed the social needs screening, and 42 (52.5%) participants screened positive for an unmet social need. In the first 6 months of recruitment, 18 participants were recruited out of a goal of 40 participants (the recruitment rate was 45% vs. the goal of 80% in 6 months), and complete recruitment was achieved in 12 months. Of the 21 participants randomized to the intervention arm, 20 completed the intervention (uptake of intervention was 95% vs. goal 80%). Ten participants in the intervention arm completed all four planned follow-up study visits (the acceptability of follow-up was 48% vs. the goal of 90%).ConclusionWe completed a pilot RCT of implementing a community navigator program in a pediatric weight management program. We found feasibility in the intervention’s uptake but limited feasibility in recruiting participants and the acceptability of the follow-up.Trial registrationClinicaltrials.gov, NCT04711707, https://clinicaltrials.gov/ct2/show/NCT04711707

Sharing Social Needs Data Across Sectors: Lessons From the Centers for Medicare and Medicaid Services Innovation Center's Accountable Health Communities Model.

Health-related social needs (HRSNs), like unstable housing, inability to afford utilities, food insecurity, unreliable transportation, and lack of personal safety, profoundly affect people's health and well-being. Between 2017 and 2022, awardees of the Accountable Health Communities Model (AHC) addressed the health-related social needs of Medicare and Medicaid beneficiaries through screening, referral, and community navigation services. Using and sharing HRSN data between clinical and community partners was a critical component of these efforts. This article shares findings from focus groups and interviews with 19 AHC awardees and seven of their partners. It explores the following:1. Whether sharing HRSN data with clinical partners informed clinical care2. Successes and challenges related to sharing data with community-based organizations (CBOs) and clinical partners3. How awardees collected and used HRSN data to advance health equityHalf of awardees interviewed documented HRSNs in electronic health records and shared aggregated HRSN data with CBOs. HRSN data enabled some clinicians to adjust patient care, although most were uncertain about how to do so. Participants described how sharing HRSN data with communities informs program and funding priorities to improve equity. However, CBOs noted that they had limited incentive to participate in data-sharing platforms. Our work highlights opportunities to provide guidance to clinicians on how to use HRSN screening results in care, standardize HRSN screening results in electronic health records, and co-create data-sharing initiatives with CBOs and patients to ensure meaningful participation.

Understanding experiences and perspectives in addressing unmet social needs of children and families in a paediatric weight management program: a qualitative descriptive study

ObjectiveThe objective is to describe the experiences and perceptions of caregivers who participated in a community systems navigator intervention that addressed unmet social needs.Design, setting and patientsA qualitative descriptive study...

Access to primary health care: perspectives of primary care physicians and community stakeholders

BackgroundAction on the social determinants of health is important to strengthen primary health care and promote access among underserved populations. We report on findings from stakeholder consultations undertaken at one of the Canadian sites of the Innovative Models Promoting Access-to-Care Transformation (IMPACT) program, as part of the development of a best practice intervention to improve access to primary health care. The overarching objective of this qualitative study was to understand the processes, barriers, and facilitators to connect patients to health enabling community resources (HERs) to inform a patient navigation model situated in primary care.MethodsFocus groups and interviews were conducted with primary care physicians, and community health and social service providers to understand their experiences in supporting patients in reaching HERs. Current gaps in access to primary health care and the potential of patient navigation were also explored. We applied Levesque et al., (2013) access framework to code the data and four themes emerged: (1) Approachability and Ability to Perceive, (2) Acceptability and Ability to Seek, (3) Availability and Accommodation, and Ability to Reach, and (4) Appropriateness.ResultsDeterminants of access included patient and provider awareness of HERs, the nature of the patient-provider relationship, funding of HERs, integration of primary and community care services, and continuity of information. Participants’ perspectives about the potential scope and role of a patient navigator provided valuable insight for the development of the Access to Resources in the Community (ARC) navigation model and how it could be embedded in a primary care setting.ConclusionAdditional consultation with key stakeholders in the health region is needed to gain a broader understanding of the challenges in caring for primary care patients with social barriers and how to support them in accessing community-based primary health care to inform the design of the ARC intervention.

Immigrant Perspectives of Social Connection in a Nontraditional Migration Area.

Social connection is a core dimension of health and wellness among all populations, yet the experience of moving to and living in a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Using hybrid (inductive/deductive) qualitative analysis, we identified seven domains of social connection from the perspective of the interviewed participants: (1) lens of the individual; (2) immigrant experience; (3) interpersonal support; (4) community belonging; (5) community capital; (6) community navigation; and (7) social acceptance. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of social connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. Additionally, these results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess the social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants.

Ensuring Equitable Application of Interventions to Vulnerable Subpopulations in the Kentucky Consortium for Accountable Health Communities (KC-AHC).

The Centers for Medicare and Medicaid Services (CMS) has funded the Accountable Health Communities (AHC) model to test whether systematically identifying and addressing the health-related social needs (HRSNs) of individuals would impact healthcare utilization and total cost of care for Medicare and Medicaid beneficiaries. Toward this effort, AHCs implement screening, referral, and community navigation services in their local areas. There are 28 CMS-funded AHCs nationwide, including the Kentucky Consortium for Accountable Health Communities (KC-AHC). This study aims to assess the equity of KC-AHC model activities in three vulnerable subpopulations: dual enrollees, disabled individuals, and women. Twenty-eight primary care clinical sites across 19 healthcare organizations administered (inperson or telephonic) the AHC screening instrument from August 2018 to April 2021. Every six months, social needs positivity rates, navigation eligibility, service opted-in rates and delivery data were monitored among dual enrollees, disabled persons, and women. Subpopulations were compared to their comparisons (for example, non-dual enrollees) and to available benchmarked data. All proportions of subpopulation in screened beneficiaries approximated or exceeded regional benchmarks. While needs among groups fluctuated over time, most reflected positivity rates in excess of comparisons: (1) rates among females ranged from 29.6% to 36.1%, but tended to narrow (relative to males) over time; (2) disabled individuals' positivity rate ranged from 27.8% to 36.1% but also lessened over time compared with non-disabled counterparts; and (3) positive rates among the dually-enrolled ranged from 34.7% to 42.4%, with the disparity to non-dual enrollees remaining relatively stable. Rates of opt-in and receipt of navigation in dual enrollees and women did not show disparities. There was a persistent gap in opt-in rates between disabled and non-disabled beneficiaries, though one was not identified in receipt. Results suggest that the KC-AHC adequately screened dual enrollees, disabled individuals, and women during model implementation. The AHC Model may have helped to narrow gaps in social needs between sub-populations and comparison groups, with beneficiaries becoming better connected to community services.

Abstract C132: Multilevel facilitators and barriers to cancer screening programs in federally qualified health centers serving Asian American communities

Abstract Purpose: Cancer screening disparities among medically underserved Asian Americans are well documented. Assessing multilevel barriers and facilitators to cancer screening programs within safety-net settings is critical to the implementation of evidence-based strategies to improve cancer screening. This study aims to examine how community and clinic driven priorities and activities can inform multilevel processes for planning of cancer screening programs for Asian American patients within FQHCs. Methods: Academic, clinic and community partners established the Advancing Care Together (ACCT) formal network to increase knowledge, attitudes and screening behaviors among low-income Chinese, Korean and Vietnamese individuals in Orange County, California. ACCT focused on breast, cervical, and colorectal. Over three years, a series of meetings, surveys and interviews were conducted with community and clinic partners before implementing evidence-based strategies (community navigation, educational workshops) to increase cancer screening to address cultural and language barriers. We used the Implementation Research Logic Model to guide our analysis of these data and identify multilevel determinants of cancer screening with input provided by the ACCT network. Using a shared drive to gather formative data, we assembled a codebook in Excel to organize AACT activities and identify barriers and facilitators according to the Consolidated Framework for Implementation Research (CFIR). Results: Our study found barriers and facilitators that represent CFIR domains: i) Community-clinic resources can provide increased awareness of screening services (intervention characteristics); ii) patients had difficulty obtaining a provider with their preferred language (inner setting); iii) transportation issues and cultural stigma around receiving specific cancer education (outer setting); iv) clinic and patient outcomes improved as a result of ACCT activities, payers were unable to establish referrals from federally qualified health centers to comprehensive cancer centers (characteristics of individuals involved in the implementation); and v) staff turnover presented challenges to obtaining electronic medical records to evaluate screening and follow-up services (implementation process). Implications: Community-clinic-academic partnerships can facilitate increasing cancer screening and awareness, including cultural screening barriers and identification of adaptation needs for educational materials, specific to Asian American communities. Barriers identified in the cancer screening process included a lack of motivation to resolve payer-related provider networks to address patient accessibility to specialty care, high turnover among clinic quality improvement teams, and challenges of prioritizing cancer screening throughout the COVID19 pandemic. Successful implementation of evidence-based strategies to increase guideline-adherent care for Asian Americans must overcome longstanding clinic- and community-level barriers, and we believe community-clinic-academic partners hold the key. Citation Format: Samantha Garcia, Sora Tanjasiri, Cevadne Lee, Jaqueline Train, Jennifer Tsui. Multilevel facilitators and barriers to cancer screening programs in federally qualified health centers serving Asian American communities [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C132.

Retracted: The Optimization Design of the Accurate Community Navigation Map for the Terminal Distribution to Promote the Development of E-Commerce New Retail

Retracted: The Optimization Design of the Accurate Community Navigation Map for the Terminal Distribution to Promote the Development of E-Commerce New Retail

Abstract B020: “Access to these screenings have been a gift”: A mixed methods assessment of a community navigation program for breast and cervical in the era of COVID-19

Abstract Background: The COVID-19 pandemic exacerbated health inequities among systematically marginalized populations. At the onset of the pandemic, routine cancer screenings were effectively halted; from March to May 2021, there was a deficit of 9.3 million screens. Early evidence suggests that non-White patients, compared to White, have experienced even greater declines in breast and cervical cancer screenings. Consequences of missed or late screenings include later stage diagnosis and poor outcomes. Community navigation programs have been used to promote engagement in cancer screenings in under-resourced communities, but these too were interrupted as restrictions were put in place to mitigate the spread of COVID-19.Objective: To use a mixed methods approach to describe the challenges, strengths, and lessons learned of implementing a community navigation program for breast and cervical cancer screening during the COVID-19 pandemic. Methods: In 2019, The University of Illinois Cancer Screening, Access, Awareness, and Navigation (UI CAAN) intervention was established to address breast and cervical cancer disparities on Chicago’s West side, an area with large Black and Latinx populations. The intervention included community navigators who worked in partnership with community-based safety net hospitals and organizations. Participants were recruited at community events and through clinical referrals and were eligible if they were overdue for a guideline concordant breast or cervical cancer screening. Quantitative navigation and screening data were collected by the navigators in a REDCap database. Qualitative data, four focus groups with participants and partners, were also collected to broaden our understanding of impact of COVID-19 on the community navigation intervention. For these analyses, we describe participants’ navigation and screening outcomes and use content analysis methods for the focus groups. We then triangulate the findings to understand the challenges, strengths, and lessons learned of the UI CAAN. Results: From 2019-2022, a total of 366 individuals were navigated for breast and cervical cancer screenings. Of these, 68% (n = 248) received a breast and/or cervical cancer screening. Among those who were screened, 75% were Latinx and 23% were Black, 92% were uninsured, and 86% did not have a primary care provider. Concerning services received, 30% had a mammogram and a pap smear, 37% a pap smear only, and 33% a mammogram only. At the height of the pandemic, navigators coordinated with community and clinical partners to deliver 500 meals, held 9 PPE distribution events, distributed 3000 masks, and conducted 2 webinars about COVID-19. Conclusion: Despite the challenges of the COVID-19 pandemic, the UI CAAN community navigation program was able to shift its efforts at the height of the pandemic to assist its community and clinical partners. The continued collaboration allowed for a successful resumption of navigation and screening efforts once healthcare systems were able to re-engage patients in cancer screenings. Citation Format: Leslie R. Carnahan, Chibuzor Abalsalim, Jeanette Santana González, Mari Goudy, Hunter Holt, Jessica Madrigal, Thrishka McKinnor, Tigist Mersha, Theresa Mobley, Maria Olivero, Mary Rinder, Barbara Williams, Vida Henderson. “Access to these screenings have been a gift”: A mixed methods assessment of a community navigation program for breast and cervical in the era of COVID-19 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B020.

The Dallas Accountable Health Community: Its Impact on Health-Related Social Needs, Care, and Costs

Summary In May 2017, the U.S. Centers for Medicare & Medicaid Services (CMS) launched the Accountable Health Communities (AHC) Model, a 5-year initiative to address a critical gap between clinical care and community services in the current delivery system. The initiative tested whether systematically identifying and addressing the health-related social needs (HRSNs) of Medicare and Medicaid beneficiaries through screening, referral, and community navigation would reduce utilization and health care expenditures. As one of 32 original awardees, the Parkland Center for Clinical Innovation (PCCI) served as an Alignment Track bridge organization. PCCI partnered with 17 clinical sites, representing five Dallas health care systems and more than 100 local community-based organizations (CBOs), to establish the Dallas Accountable Health Community (DAHC). Using a CMS-developed HRSN screening tool, PCCI and its partners screened 12,548 unique Dallas County beneficiaries meeting the criteria for Model eligibility. PCCI and partner community health workers provided 9,161 unique individuals with active navigation services consisting of referrals to aligned CBOs, accompanied by monthly follow-up calls for up to 12 months or until the documented HRSNs were addressed successfully. Over the initiative’s 5-year course, PCCI identified more than 19,000 distinct needs, with 61% of individuals having two or more concurrent needs. Through the referral process, CBOs provided a multitude of support services, including more than 200,000 pounds of food and $540,000 in utility and rent assistance. Results show that actively navigated individuals experienced a greater decrease in per-person ED visits than those in a comparable control cohort, with the navigation cohort having a statistically significant reduction in average ED utilization, both while actively navigated and in the 12 months after navigation. The navigated cohort also demonstrated a greater likelihood to seek — and keep — outpatient visits compared with the control cohort. Although inpatient admissions were reduced within both cohorts, the between-cohort differences were not statistically significant. Not including the CBO-provided intervention costs and using Model year 4 data (May 2020 to April 2021), the DAHC demonstrated a positive ROI of 1.3 to 1 with a gross savings exceeding $1.25 million. The impact analysis accounted for the dynamic, multidimensional Covid-19 impact via an innovative control group matching algorithm. This study demonstrated the nature and scope of HRSNs among a high-risk vulnerable Dallas County population, a positive impact on health care outcomes, and a more muted impact on expenditures using regularly occurring active navigation of engaged beneficiaries. Importantly, the DAHC showed that combining clinical care with appropriate social services to address HRSNs — at the right time and by the right personnel — resulted in lower utilization and a decrease in health care expenditures. These two factors alone argue for the expansion of the initiative to other at-risk populations while establishing the initiative’s long-term sustainability.

Student coaching in a rural community fall prevention program: An exploratory study

ABSTRACT Falls are a significant cause of disability internationally. The purpose of this exploratory study was to examine the effectiveness of a community fall prevention program, Stepping On (SO), using nine student physical therapists and program faculty in a rural setting. A mixed-methods design was utilized. Students partnered with older adults to master exercises, demonstrate floor recovery techniques, and manage community navigation in line with program fidelity. A descriptive survey assessed program outcomes. Students participated in a follow-up focus group to discuss perspectives on their role in the program. One hundred and seventeen community-dwelling older adults (mean age: 75.2 ± 8.5) completed the program. Participants who lived alone were likely to limit their activities because of fear of falling (p = .045). Following SO most subjects (87.7%) described having a better understanding of falls and their causes, with a plan to arise from the floor (82.6%). Focus group themes underscored students’ opportunity to facilitate, reinforce safety during mobility activities, and motivate participants. Furthermore, an increased awareness of other professions’ contribution to fall prevention was noted. Following a community fall prevention program, older adults have a better understanding of fall prevention and plan for floor recovery. In turn, student coaching skills are reinforced.

A Community Navigation Scale for Persons With Serious Mental Illnesses.

The recovery paradigm in the context of serious mental illnesses pertains to several characteristics of community functioning, adjustment, and integration, among other constructs. Additional rating scales would be beneficial for measuring various facets of community functioning for research that is recovery oriented as opposed to symptom focused. The Community Navigation Scale was developed as part of the Opening Doors to Recovery project to address several aspects of navigating community resources. After item development, the 21-item Community Navigation Scale was used across two studies with 340 participants who had serious mental illnesses. Factor analysis revealed three potential factors, and subscales were computed. The social and physical well-being subscale (seven items, Cronbach's α=0.82) addressed community involvement, volunteering, finding enjoyable activities, and engaging in positive health behaviors. The accessing external resources subscale (nine items, Cronbach's α=0.80) tapped one's ability to obtain needed resources, ranging from medications to housing and from small appliances to classes in the community. The home and self-maintenance subscale (five items, Cronbach's α=0.73) measured abilities around shopping, cooking, cell phone use, house cleaning, and personal grooming and hygiene. Initial validity of the subscales was suggested through correlations with the Multnomah Community Ability Scale (r=0.65, 0.55, and 0.41 for social and physical well-being, accessing external resources, and home and self-maintenance, respectively). The Community Navigation Scale assesses dimensions of community functioning among persons with serious mental illnesses and may add to the array of research and clinical measures pertinent to recovery outcomes. Additional research on its psychometric properties is warranted.

The Optimization Design of the Accurate Community Navigation Map for the Terminal Distribution to Promote the Development of E-Commerce New Retail

In recent years, the development of e-commerce new retail formats is in full swing, and the terminal distribution has become a hot research topic under the background of new retail. The accuracy of the community navigation map is related to the low cost and high efficiency of terminal distribution and then affects the development of new e-commerce retail. However, in large communities, the existing navigation map software can only locate the main entrance of the community, and there is a lack of effective positioning for the location of buildings. Therefore, based on the existing navigation map, this paper expects to correct its application defects and carry out optimization design from the design principle, design idea, product function, product customization, and product application effect, so as to make the community navigation more accurate, faster, and more efficient, to help the low cost and efficient development of door-to-door distribution under the new retail of e-commerce.

Fluid Cognition Relates to Locomotor Switching in Neurotypical Adults, Not Individuals After Stroke.

The ability to switch between walking patterns (ie, locomotor switching) is vital for successful community navigation and may be impacted by poststroke impairments. Thus, the purpose of this work was to examine locomotor switching and the relationship between locomotor switching and fluid cognition in individuals after stroke compared with neurotypical adults. Twenty-nine individuals more than 6 months after stroke and 18 neurotypical adults participated in a 2-day study. On day 1, participants were taught a new walking pattern on the treadmill and then locomotor switching was assessed by instructing participants to switch between the new walking pattern and their usual walking pattern. The change between these 2 patterns was calculated as the switching index. On day 2, the NIH Toolbox Cognition Battery was administered to obtain the Fluid Cognition Composite Score (FCCS), which reflected fluid cognition. The switching index was compared between groups using an analysis of covariance, and the relationship between locomotor switching and fluid cognition was assessed with regression. Individuals after stroke had significantly lower switching indexes compared with neurotypical adults (P = 0.03). The regression showed a significant interaction between group and FCCS (P = 0.002), with the FCCS predicting the switching index in neurotypical adults but not in individuals after stroke. Individuals after stroke appear to have deficits in locomotor switching compared with neurotypical adults. The relationship between fluid cognition and locomotor switching was significant in neurotypical adults but not in individuals after stroke. Future work to understand the relationship between specific cognitive domains and locomotor switching is needed (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A361).

Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals.

Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.

Once is rarely enough: can social prescribing facilitate adherence to non-clinical community and voluntary sector health services? Empirical evidence from Germany

BackgroundNon-clinical health interventions provided by the voluntary and community sector can improve patients’ health and well-being and reduce pressure on primary and secondary care, but only if patients adhere to them. This study provides novel insights into the impact of doctor referrals to such services, known as social prescribing, on patients’ adherence to them.MethodsUsing a negative binomial model, we analysed electronic visitor records from a community health advice and navigation service in Germany between January 2018 and December 2019 to determine whether social prescribing was associated with greater adherence to the service (measured in terms of return visits) compared to patients who self-referred. We also explored whether this effect differed according to patient characteristics.ResultsBased on 1734 observations, we found that social prescribing was significantly associated with a greater number of return visits compared to patient self-referrals (p < 0.05). For patients who visited the service because of psychological concerns, the effect of social prescribing was lower. For all other patient characteristics, the effect remained unchanged, suggesting relevance to all other patient groups.ConclusionsThe results of our study indicate that social prescribing may be an effective way to facilitate adherence to non-clinical community and voluntary sector health services. This knowledge is important for policy makers who are deciding whether to implement or expand upon social prescribing schemes.

Abstract A025: Community breast health outreach and navigation in medically underserved communities: Insurance status of participants

Abstract Introduction: Breast cancer is the most commonly diagnosed cancer among nearly every racial and ethnic group. With almost 40,000 fatalities every year, breast cancer is the second leading cause of death among women. Better care in the past 25 years has reduced breast cancer deaths by up to 34% in certain communities, but not all communities are benefiting equally from these improvements. To address these disparities, we launched a navigation-based program as a model to improve outcomes for medically underserved women with breast cancer by reducing barriers to quality care and advancing pioneering treatments for breast cancer. We look at the insurance status of the women educated and navigated over the past two years. Methods: The program has three objectives: (1) advance an effective and scalable community-based navigation model for reducing disparities in screening and diagnostic follow-up care in medically underserved women; (2) improve access to and use of high-quality breast cancer care and supportive services at Bellevue, Tisch, and NYU Brooklyn hospitals among underserved woman utilizing patient navigation; and (3) increase access to, and participation in, clinical trials for the most promising and innovative therapies for breast cancers among underserved women. Preliminary data were collected between August 2016 and April 2018 from women on their first encounter with the navigator. Results: Our community navigators have provided outreach to 144 unique sites in New York City, primarily in Brooklyn and lower Manhattan. Community navigators provided health outreach to 8,304 women, of whom 2071 were eligible but not up to date on screening. 887 of these women enrolled in patient navigation and 711 women provided insurance information. 69% of our clients are AA, 25% Hispanic. 24% of our clients were uninsured, 19% had Medicaid, 10% had Medicare, and the remaining women had private insurance. The most salient reported barriers to screening addressed by our navigators included lack of adequate insurance, immigration status, housing and food insecurity, and lack of transportation and child care. Discussion: Through a combination of outreach, education, and navigation, we have developed a novel interdisciplinary model to reduce barriers for screening and treatment for breast cancer. While many of our clients and patients had insurance, many still had formidable financial challenges. In our experience, comprehensive assessment of financial, social, and logistical barriers is an integral component of the navigation process, and is necessary to overcome the significant roadblocks to high-quality breast cancer screening, diagnosis, and treatment that underserved women face. Citation Format: Margaret Cheng, Anita McFarlane, Joseph Ravenell, Kathie-Ann Joseph. Community breast health outreach and navigation in medically underserved communities: Insurance status of participants [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A025.

Abstract C105: Exploring cancer health disparities among formerly incarcerated African Americans

Abstract African Americans are disproportionately impacted by cancer rates, prevalence, incidents, morbidity and mortality. The National Cancer Institute, Division of Cancer Control and Population Sciences (2016), identified incarcerated persons as an understudied population for cancer risks and incidents. Further the availability of high quality data about cancer prevalence, incidence and mortality among people who experience incarceration is lacking. African American persons with a history of incarceration are at particular risk for chronic health diseases, cancer risks and health disparities due to their experience of incarceration; discrimination and stigma post-incarceration; personal lifestyle factors; socioeconomic status and, environmental barriers to cancer prevention and control resources. Despite these risk factors scant research has been conducted on risks for cancer health disparities among formerly incarcerated African Americans. This qualitative pilot study explored cancer health disparities among African American men and women (n=25) who were formerly incarcerated in an Illinois prison or the Cook County Jail. Four qualitative focus groups were conducted in Chicago to collect preliminary data on barriers to cancer health care access, screening, and treatment, post-release. The Integrative Model of Behavioral Prediction guided the study. An iterative process of content analysis was used to identify facilitators and barriers to cancer early detection, screening and treatment among the target population. Preliminary analysis revealed five central themes: (1) Increased access to health care through the Affordable Care Act, Medicaid, and County Care motivated active participation in health maintenance routines and cancer early detection, prevention and treatment services; (2) Long wait times for appointments with primary care physicians increased reliance on emergency room visits; (3) Significant insurance and community resource, gaps occur at release and community reentry; (4) Costs for care (co-pays and deductibles, pre and post release) are barriers to routine care and delay urgent care-seeking; and, (5) Cancer health literacy and cancer awareness messages specifically designed for persons who experience incarceration is lacking. Study findings will inform the development of a pilot community health worker training and navigation intervention aimed at increasing access to cancer health care and decreasing cancer health disparities among formerly incarcerated African Americans in Chicago. Citation Format: Vickii Coffey, Carolyn Rodgers, Shirley Spencer, Joseph Strickland, Mary Muse, Phoenix Alicia Matthews, Catherine Balthazar. Exploring cancer health disparities among formerly incarcerated African Americans [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C105.

The saliency of geographical landmarks for community navigation: A photovoice study with persons living with dementia

This study uses the photovoice method to explore how persons living with mild-to-moderate dementia perceive neighborhood landmarks and identify characteristics that render these landmarks salient for outdoor navigation. Previous research has highlighted the role of well-designed, stable geographical landmarks in improving the navigability of neighborhoods for persons living with dementia. However, the specific attributes that render landmarks salient have not yet been sufficiently explored, resulting in inadequate evidence-based environmental design guidelines for dementia-friendly communities. To address this gap, a photovoice study was conducted with five community-dwelling persons living with dementia and their care partners, as part of a dementia-friendly neighborhood walking program in the city of Seattle, USA. Photovoice facilitated the exploration of saliency of neighborhood landmarks from an emic perspective by (i) empowering persons living with dementia to identify and take photos of salient landmarks during the group walk and (ii) interpret and reflect on attributes that contributed to saliency using the photos as visual aids in a focus group discussion and survey questionnaire. Participants associated the saliency of landmarks with two groups of attributes: (i) visual distinctiveness, which encompassed physical aspects, such as size, shape, color, texture; and (ii) meaningfulness, which included subjective factors of personal and emotional significance that linked the landmarks to participants' pasts, passions, hobbies, and emotions related to having dementia. Findings suggest that outdoor landmarks should be designed for maximum legibility and noticeability, as well as familiarity, recognizability, and memorability. The evidence from this research also points to the likely positive effect of salient neighborhood landmarks on the community navigation of persons living with dementia.

"We need more things for us": Being low income and underoccupied in older age.

Low-income older adult populations have increased vulnerability to occupational engagement barriers and poor health outcomes while aging in community settings. The purpose of this study was to examine the relationship between community navigation and well-being for low-income older adults. Community-dwelling older adults (N = 10) were recruited for this multimethod observational cohort study, which employed GPS data, measures of well-being, and semistructured interviews across 12 months. Grounded theory processes were followed to analyze and integrate the qualitative, quantitative, and spatial data. Findings were three patterns of community navigation. In particular, patterns of being chronically underoccupied were noted for this low-income population. Specific place-based challenges are explained along with strategies used to mitigate these challenges. Supporting community navigation, especially social interaction opportunities, can maximize well-being; and older residents' occupational participation may be unnecessarily curtailed by geographic, economic, and social factors beyond their control. Community navigation strategies should be considered holistically by occupational therapists as part of interventions supporting aging in place.