Community Navigator Research Articles

Service navigation and concrete supports from a family Perspective: A preventative and community-based approach to child welfare

The child welfare system in the United States has historically focused funding on intervening after child maltreatment has occurred, with fewer resources allocated to prevention. However, research has found that families benefit from concrete supports, like financial payments, and when families are provided with these supports, child welfare involvement significantly declines. Less is known about the impact of preventative approaches, such as service navigation, which could act as a bridge between families and essential concrete supports and resources. Additionally, it is vital to incorporate family voice into decisions being made regarding the development and evaluation of prevention programming. This qualitative study explores family experiences and outcomes with community-based service navigation. The sample included 12 family members working with a community navigator at the time of data collection. Data were obtained through focus groups and interviews held in English, Spanish, and Arabic. A thematic analysis guided the researchers in better understanding participants’ perspectives on service navigation. Results indicate that participants found preventative service navigation to be a supportive and collaborative experience through which they were connected with concrete supports and other essential resources. Five themes were identified: (1) normalizing the need for support; (2) time as a limited resource for families; (3) service navigation as empowering and humanizing for families; (4) service navigation poses new challenges for families; and (5) service navigation creates new opportunities for families. Results from this study suggest that service navigation may represent a more socially just intervention to ensure child safety, permanency, and well-being.

Randomised controlled trial of the Community Navigator programme to reduce loneliness and depression for adults with treatment-resistant depression in secondary community mental health services: trial protocol

BackgroundNew treatments are needed for people with treatment-resistant depression (TRD), who do not benefit from anti-depressants and many of whom do not recover fully with psychological treatments. The Community Navigator programme was co-produced with service users and practitioners. It is a novel social intervention which aims to reduce loneliness and thus improve health outcomes for people with TRD. Participants receive up to 10 individual meetings with a Community Navigator, who helps them to map their social world and set and enact goals to enhance their social connections and reduce loneliness. Participants may also access group meet-ups with others in the programme every 2 months, and may be offered modest financial support to enable activities to support social connections.MethodsA researcher-blind, multi-site, 1:1 randomised controlled trial with N = 306 participants will test the effectiveness of the Community Navigator programme for people with TRD in secondary community mental health teams (CMHTs). Our primary hypothesis is that people who are offered the Community Navigator programme as an addition to usual CMHT care will be less depressed, assessed using the PHQ-9 self-report measure, at 8-month, end-of-treatment follow-up, compared to a control group receiving usual CMHT care and a booklet with information about local social groups and activities. We will follow participants up at end-of-treatment and at 14 months, 6 months after end-of-treatment follow-up. Secondary outcomes include the following: loneliness, anxiety, personal recovery, self-efficacy, social network, social identities. We will collect data about health-related quality of life and service use to investigate the cost-effectiveness of the Community Navigator programme.DiscussionThis trial will provide definitive evidence about the effectiveness and cost-effectiveness of the Community Navigator programme and whether it can be recommended for use in practice. The trial is due to finish in August 2025.Trial registrationProspectively registered on 8th July 2022 at: ISRCTN13205972.

Experiences of peer navigators implementing a bilingual multilevel intervention to address sexually transmitted infection and HIV disparities and social determinants of health.

Sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)disproportionately affect young gay, bisexualand other men who have sex with men (GBMSM) and transgender women of colour. We explored the experiences of community-based peer navigators ('Community Navigators') who participated in Impact Triad, a bilingual multilevel intervention developed by our community-based participatory research partnership to reduce STIs and HIV and address social determinants of health (e.g., employment, education, social supportand discrimination) among young GBMSM and transgender women of colour. Individual in-depth interviews were conducted with 15 Community Navigators who participated in Impact Triad. Themes were identified through constant comparison. Community Navigators' mean age was 31.4 years. Sevenwere self-identified as African American/Black, 5 as Latine, 2 as multiracial/multiethnic, 1 as Asian American, 10as cisgender men, 4 as transgender womenand 1 as gender nonbinary. Thirteen themes emerged in three domains: (1) key aspects of the Community Navigator role (e.g., desire to serve as a community resource, the importance of being part of the communities in which one was working, the value of having an official role, being connected to other Community Navigators to problem-solvingand sustaining intervention aspects long-term); (2) experiences implementing Impact Triad (e.g., engaging community members, meeting prioritized needs, building trust, using social media, increasing awareness and knowledgeand challenges related to COVID-19)and (3) lessons learned for future interventions (e.g., facilitating access to broader resources, building additional skills and increasing interactions among Community Navigators). Interviews identified important learnings about serving as Community Navigators and implementing Impact Triad that can guide future efforts to address STI/HIV disparities and social determinants of health through community-based peer navigation. Throughout this intervention trial, our partnership worked collaboratively with a study-specific community advisory board (CAB) comprised primarily of young GBMSM and transgender women of colour. Members of this CAB participated in all aspects of the trial including trial design, intervention development, recruitment and retention strategies, data collection and analysis, interpretation of findingsand dissemination.

Reverse triage in COVID surge planning: a case study of an allied health supported clinical care pathway in an acute hospital setting.

ObjectiveThis case study describes the development and outcomes of a new integrated and multidisciplinary care pathway. Spearheaded by allied health, the 'COVID community navigator team', applied established principles of reverse triage to create additional surge capacity.MethodsA retrospective cohort study examined workflow patterns using electronic medical records of patients who received navigator input at the Royal Melbourne Hospital between 20 September 2021 and 20 December 2021.ResultsThere were 437 eligible patient encounters identified. On average patients stayed 4.15 h in the emergency departments (ED) (s.d. = 4.31) and 9.5 h (s.d. = 10.9) in the short stay unit. Most patients were discharged into a 'low risk pathway' with community general practitioner follow up. Of discharged patients, only 38 re-presented to the ED with symptoms related to their initial COVID-19 diagnosis (34.9% of total re-admissions). Of these re-admissions, more than half did not require admission to a ward.ConclusionThe findings presented here provide support for the clinical utility of a multidisciplinary reverse triage approach in surge planning for anticipated presentation peaks.

Exemplary post-discharge stroke rehabilitation programs: A multiple case study

Objective The objective of this study was to identify essential aspects of exemplary post-discharge stroke rehabilitation as perceived by patients, care partners, rehabilitation providers, and administrators. Design We carried out an exploratory qualitative, multiple case study. Stroke network representatives from four regions of the province of Ontario, Canada each nominated one post-discharge rehabilitation program they felt was exemplary. Setting The programs included: a mixed home- and clinic-based service; a home-based service; a clinic-based service with a stroke community navigator and; an out-patient clinic-based service. Participants Participants included 32 patients, 16 of their care partners, 23 providers, and 5 administrators. Methods We carried out semi-structured qualitative interviews with patients and care partners, focus groups with providers, and semi-structured interviews with administrators. Health records of patient participants were reviewed. Using an interpretivist-informed inductive content analysis, we developed overarching categories and subcategories first for each program and then across programs. Results Across four regions with differing types of programs, exemplary care was characterized by three essential components: stroke and stroke rehabilitation knowledge, relationship built through personalized respectful care, and a commitment to high quality, person-centered care. Conclusion Exemplary post-discharge care included knowledge regarding identification and treatment of stroke-related impairment, that is, information found in best practice guidelines. However, expertise related to building relationship through providing personalized respectful care, within a mutually supportive, improvement-oriented team was also essential. Additionally, administrators played a crucial role in ensuring continued ability to deliver exemplary care.

Screening and addressing social needs of children and families enrolled in a pediatric weight management program: a protocol for a pilot randomized controlled trial

BackgroundThere is a paucity of evidence to support interventions that address the social needs of children and families with chronic medical conditions. The primary objective of this pilot randomized controlled trial (RCT) is to assess the feasibility of an intervention that screens for and addresses the social needs of children and families enrolled in a pediatric weight management clinic.MethodWe will conduct a single-center, pilot RCT of 40 families with children enrolled in a pediatric weight management program at a tertiary children’s hospital in Ontario, Canada. Families who are experiencing unmet social needs will be randomized to either a community navigator or self-navigation of community resources. The primary feasibility outcomes and criteria for success include the following: (1) recruitment rates, will be successful if 80% of our target sample is met in the 6 months of recruitment; (2) uptake of intervention, will be considered successful if > 80% of families complete the intervention; and (3) follow-up of participants, will be considered successful if > 90% of participants complete all the study visits. The secondary outcomes include estimating the preliminary effects on body mass index, body composition, and quality of life at 6 months. The analysis of feasibility outcomes will be based on descriptive statistics, and analysis of secondary clinical outcomes will be reported as estimates of effect. We will not perform tests of significance since these analyses are purely exploratory.DiscussionThis study is important because it will aim to improve the treatment of pediatric obesity by testing the feasibility of an intervention that addresses unmet social needs.Trial registrationClinicalTrias.gov: NCT04711707 (Registered January 13, 2021).

Implementing the collective impact model as a gateway to a veterans community navigator program

ABSTRACT Addressing mental health needs and homelessness among the veteran population calls for a coordinated systemic response that is all too often missing from community-based responses. The collective impact (CI) model provides a framework for community collaboration to address entrenched problems by increasing collaboration across sectors. This study used a qualitative descriptive approach to explore the use of CI to develop a veterans’ community navigator program within a community in the Southwestern United States (US). Data was gathered and thematically analyzed from interviews with key stakeholders (N = 7). Findings from this study support the use of the CI model for program development and implementation and suggest that the CI model may be enhanced with strategic approaches that 1) consider the target population as stakeholders, 2) strategize communication to build sustainable partnerships, and 3) use thorough community needs assessments to inform program development.

Influences on participation in a programme addressing loneliness among people with depression and anxiety: findings from the Community Navigator Study

BackgroundLoneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions.MethodsSemi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study’s working group, which included experts by experience, clinicians and researchers.ResultsThe narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant’s relationship with the Community Navigator.ConclusionsWe found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual’s participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.

Abstract A020: Utilizing a community navigator's approach to improve breast and cervical cancer screening in the Deep South

Abstract This presentation illustrates a community-based intervention utilizing community navigators to identify, recruit. and work to eliminate barriers to improve breast and cervical cancer screening in underserved communities in the Deep South. Background: The UAB Comprehensive Cancer Center built an academic-community infrastructure called the Deep South Network for Cancer Control via funding from the National Cancer Institute Center to Reduce Cancer Health disparities from 2000-2016. The Deep South Network (DSN) utilized a Community Health Advisors (CHA) model combined with community engagement and coalition building to conduct community outreach and community-based cancer disparity research in medically underserved communities in Alabama and Mississippi. Through the utilization of the CHA model, cancer mammography screening rates among the Medicare population saw a 17% difference between AA women and Caucasian from 1999 to 2014. Purpose: To utilize the DSN model to train community navigators to identify and recruit rarely or never screened women for breast and cervical cancer screening. Community Navigators with support of the CHAs work to address client barriers to improve screening. Through a collaboration with the Alabama Breast and Cervical Cancer Early Detection Program (ABCCEDP), UAB Community Navigators delivered a community intervention to address barriers to breast and cervical cancer screening. Methodology: The intervention was delivered in eight Alabama counties: seven rural and 1 urban over a 12-month period. Each county had a paid, community-based navigator who received 8-hour training on navigating clients for clinical services. Community Navigators delivered community-based education and identified and addressed barriers to increase cancer screening. Conclusion: At the end of the 12-month intervention, the community navigators held 212 events such as health fairs and community presentations in public housing and faith-based groups that yielded a reach of 16,038 individuals. Of these events, 273 women indicated an interest in or need for these screenings with 83 % of them between ages 40-54. Navigators worked through client barriers to see an overall significant increase of 5% in women enrolled in the ABBCECP compared to previous years in the nine counties Citation Format: Clauda M. Hardy, Kumari Seetela, Tara Bowman, Katherine Norris, Nancy Wright. Utilizing a community navigator's approach to improve breast and cervical cancer screening in the Deep South [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 A020.

The Community Navigator Study: Results from a feasibility randomised controlled trial of a programme to reduce loneliness for people with complex anxiety or depression.

BackgroundLoneliness is common among people with mental health problems and predicts poorer recovery from depression and anxiety. Needs for support with loneliness and social relationships are often under-addressed in mental health services.The Community Navigator programme was designed to reduce loneliness for adults (aged 18 and above) with complex depression or anxiety who were using secondary mental health services. Acceptability and feasibility of the programme and a trial evaluation were tested in a feasibility randomised controlled trial with qualitative evaluation.MethodsForty participants with depression or anxiety using secondary mental health services were recruited from mental health services in two London sites and randomised to receive: the Community Navigator programme over six months in addition to routine care (n = 30); or routine care (n = 10). Measures of loneliness, depression, other clinical and social outcomes and service use were collected at baseline and six-months follow-up. Levels of engagement in the programme and rates of trial recruitment and retention were assessed. Programme delivery was assessed through session logs completed by Community Navigators. The acceptability of the programme was explored through qualitative interviews (n = 32) with intervention group participants, their family and friends, programme providers and other involved staff.ResultsForty participants were recruited in four months from 65 eligible potential participants asked. No one withdrew from the trial. Follow-up interviews were completed with 35 participants (88%). Process records indicated the programme was delivered as intended: there was a median of seven meetings with their Community Navigator (of a maximum ten) per treatment group participant. Qualitative interviews indicated good acceptability of the programme to stakeholders, and potential utility in reducing loneliness and depression and anxiety.ConclusionsA definitive, multi-site randomised controlled trial is recommended to evaluate the effectiveness and cost-effectiveness of the Community Navigator programme for people with complex anxiety and depression in secondary mental health services.

Hands and feet: A reflection on Polynesian navigation—a Niue Fakafifine community practitioner perspective in Aotearoa-New Zealand

As a community navigator, my practice draws from skills, knowledge and principles of Polynesian navigation such as wayfinding . In this essay, I will provide personal experiences that have influenced and nurtured me in my development as a community navigator. I will discuss four influences of Polynesian practices: dance, weaving, storytelling and navigation. These are concepts that I draw from to support people who experience hardship in life and are intrinsically connected and complementary of one another when applied in my practice.

The picture talk project: Aboriginal community input on consent for research

BackgroundThe consent and community engagement process for research with Indigenous communities is rarely evaluated. Research protocols are not always collaborative, inclusive or culturally respectful. If participants do not trust or understand the research, selection bias may occur in recruitment, affecting study results potentially denying participants the opportunity to provide more knowledge and greater understanding about their community. Poorly informed consent can also harm the individual participant and the community as a whole.MethodsInvited by local Aboriginal community leaders of the Fitzroy Valley, the Kimberley, Western Australia, The Picture Talk project explores the consent process for research. Focus groups of Aboriginal community members were conducted to establish preferences for methods of seeking individual consent. Transcripts were analysed through NVivo10 Qualitative software using grounded theory with inductive and deductive coding. Themes were synthesised with quotes highlighted.ResultsFocus groups with Aboriginal community members (n = 6 focus groups of 3–7 participants) were facilitated by a Community Navigator as a cultural guide and interpreter and a researcher. Participants were recruited from all main language groups of the Fitzroy Valley – Gooniyandi, Walmajarri, Wangkatjungka, Bunuba and Nikinya. Participants were aged ≥18 years, with 5 female groups and one male group. Themes identified include: Reputation and trust is essential; The Community Navigator is key; Pictures give the words meaning – milli milli versus Pictures; Achieving consensus in circles; Signing for consent; and Research is needed in the Valley.ConclusionAboriginal communities of the Fitzroy Valley recommend that researchers collaborate with local leaders, develop trust and foster a good reputation in the community prior to research. Local Aboriginal researchers should be employed to provide cultural guidance throughout the research process and interpret local languages especially for elders. Pictures are preferred to written text to explain research information and most prefer to sign for consent. The Fitzroy Valley welcomes research when collaborative and for the benefit of the community. Future research could include exploring how to support young people, promote health screening and improve understanding of medical knowledge.

Developing a holistic, multidisciplinary community service for frail older people.

This article explores the development of an ambulatory community service that demonstrates multidisciplinary working to meet the diverse needs of frail older people and their carers. The service comprises advanced nurse practitioners, a pharmacist, a community navigator, consultants, occupational therapists, physiotherapists, a nurse, rehabilitation assistants, a healthcare assistant and an administrator. This multidisciplinary team (MDT) serves adults with complex medical and rehabilitation needs who are being discharged from hospital, staying in bedded rehabilitation units or living at home by offering assessments, investigations and rehabilitation, where appropriate closer to home. The aims of the service are to: keep people well, prevent unplanned hospital admissions, promote health and well-being, reduce the risk of falls, enable independent living and provide rehabilitation. Personalised care plans are developed with patients and their carers. Advanced nursing practice is demonstrated in assessment, investigation, diagnosis, management, referral and non-medical prescribing. Development of this MDT is required to support and promote integrated, evidence-based work. Such development leads to integrated care across communities, and bridges gaps between patients and carers, GPs, home, residential and hospital-based services, and the voluntary, statutory and non-statutory sectors.

Building Community-Based Awareness and Navigating Breast Cancer and Palliative Care Programme in Kumasi, Ghana

Introduction: Breast cancer is the leading cancer in Ghana and most patients report with advanced disease. Patients face many challenges in trying to access health care and support; these are particularly relevant in the case of metastatic diseases. A structured program would provide a means of rapid referral for definitive diagnosis, treatment and palliative care, where necessary. Aim: To establish community-based structured patient network, navigation and breast health awareness programs that will reduce delays in accessing care, improve the quality of end-of-life care among patients with metastatic breast cancer. Strategy: We established a community-based patient network program comprising 15 community-based patient navigators in the Kumasi metropolis and a social media networking and navigation platform made up of a team of experts and community navigators, breast cancer survivors and patients with advanced breast cancer to share experiences and express/address concerns. We assessed the breast cancer database of Komfo Anokye Teaching Hospital to establish the number, location and density of patients. Community navigator's established direct in-person contacts with the patients to offer support explain and enroll them into the social media network and navigation platform. The project team carried out various awareness campaigns including talks to organized groups, house-to-house and media campaigns. Program/Policy process: We engaged with the Ghana Health Service, local government authorities as well as traditional and community leadership in the design and implementation of the program, to encourage community ownership from the onset. These key stakeholders were also pivotal in organizing durbars, talks to organized groups and community meetings to reach out to the people. Recruitment of volunteers within the communities will ensure that patient navigation has the best chance to continue within these communities beyond the grant period. The project coordinator and her team were available for consultation and also paid periodic visits to the communities. Outcomes: A structured program to enhance referral and access to care; a community-based patient navigation system to recruit and provide support to patients with advanced breast cancer; a social media platform to provide guide and immediate support to patients with metastatic breast cancer; and improved awareness of breast cancer and its prevention in the communities. Conclusions: The program improved the health care system in the communities and also expands outreach to persons living with metastatic breast cancer to provide support and improve treatment outcomes and quality of life. It also encourages patients to visit hospitals for treatment through ease of access to medical care and informed treatment choices and palliative care.

The Feasibility and Performance of the Patient Navigation Programme in Improving Breast Cancer Care in Malaysia

Background: Breast cancer is the most common cancer in Malaysia and it is anticipated that incidence will increase by 49% from 2012 to 2025. Unfortunately, survival remains poor because of late presentation and poor adherence to evidence-based medicine. Barriers to early presentation include inadequate knowledge about the disease, financial issues, negative influence of relatives and perceived poor quality of care and services in state-run hospitals. Poor adherence to treatment is also a common struggle, and is further exacerbated by the use of traditional, alternative healing methods. While patient navigation (PN) programs have been shown to improve breast cancer outcomes in the US, its implementation and performance in low and middle income countries is not well studied. Aim: We sought to determine the impact of a PN program in reducing treatment delays and improving adherence to treatment and patient satisfaction, as well as to evaluate the barriers faced by women seeking breast cancer care in Malaysia. Methods: We established a nurse-led patient navigation center at a secondary government hospital in Klang. This clinical team involved the surgery, pathology, radiology and nursing departments and provided patient-centered care, including patient tracking and call reminder systems, family counseling, health education and decision aids. The community team involved a Patient Navigator Program Coordinator and a Community Navigator. We compared treatment delays and adherence to treatment between navigated patients and patients registered in the year prior to the PN program. We used Student t-tests and Pearson χ2 or Fisher's Exact tests to compare timeliness between navigated patients and patients registered in the year prior. Results: Of the 136 Malaysian women enrolled in the PNP in 2015, 48.9% were diagnosed with advanced disease (stage 3 or 4). Women with advance disease had a lower median monthly household income compared with women with early disease (USD $350 vs $540, P = 0.023). Women with advance disease were also less likely to have personal transportation to the hospital (36.4% vs 56.5%, P = 0.048). Compared with the year before PN, more navigated patients underwent mammography within 7 days of their first visit (96.4% vs 74.4%, P < 0.001) and received their diagnosis within 14 days of their first visit (80.0% vs 58.5%, P < 0.001). The proportion of women who met timeliness to treatment initiation was similar for navigated patients and patients in the year prior. The proportion of defaulters were marginally lesser among navigated patients compared with the year prior (4.4% vs 11.5%, P = 0.048). Conclusion: We found that integrating PN within a breast clinic of a middle income country is feasible, and in the long run, could improve outcomes for breast cancer patients. Long-term follow-up is needed to assess the impact of the PN program on improving treatment completion and survival.

The Community Navigator Study: a feasibility randomised controlled trial of an intervention to increase community connections and reduce loneliness for people with complex anxiety or depression

BackgroundLoneliness is associated with poor health outcomes at all ages, including shorter life expectancy and greater risk of developing depression. People with mental health problems are particularly vulnerable to loneliness and, for those with anxiety or depression, loneliness is associated with poorer outcomes. Interventions which support people to utilise existing networks and access new social contact are advocated in policy but there is little evidence regarding their effectiveness. People with mental health problems have potential to benefit from interventions to reduce loneliness, but evidence is needed regarding their feasibility, acceptability and outcomes. An intervention to reduce loneliness for people with anxiety or depression treated in secondary mental health services was developed for this study, which will test the feasibility and acceptability of delivering and evaluating it through a randomised controlled trial.MethodsIn this feasibility trial, 40 participants with anxiety or depression will be recruited through two secondary mental health services in London and randomised to an intervention (n = 30) or control group (n = 10). The control group will receive standard care and written information about local community resources. The coproduced intervention, developed in this study, includes up to ten sessions with a ‘Community Navigator’ over a 6-month period. Community Navigators will work with people individually to increase involvement in social activities, with the aim of reducing feelings of loneliness. Data will be collected at baseline and at 6-month follow-up – the end of the intervention period. The acceptability of the intervention and feasibility of participant recruitment and retention will be assessed. Potential primary and secondary outcomes for a future definitive trial will be completed to assess response and completeness, including measures of loneliness, depression and anxiety. Qualitative interviews with participants, staff and other stakeholders will explore experiences of Community Navigator support, the mechanisms by which it may have its effects and suggestions for improving the programme.DiscussionOur trial will provide preliminary evidence of the feasibility and acceptability of Community Navigator support and of trial procedures for testing this. The results will inform a future definitive randomised controlled trial of this intervention.Trial registrationISRCTN10771821. Registered on 3 April 2017.

The Picture Talk Project: Starting a Conversation with Community Leaders on Research with Remote Aboriginal Communities of Australia

BackgroundResearchers are required to seek consent from Indigenous communities prior to conducting research but there is inadequate information about how Indigenous people understand and become fully engaged with this consent process. Few studies evaluate the preference or understanding of the consent process for research with Indigenous populations. Lack of informed consent can impact on research findings.MethodsThe Picture Talk Project was initiated with senior Aboriginal leaders of the Fitzroy Valley community situated in the far north of Western Australia. Aboriginal people were interviewed about their understanding and experiences of research and consent processes. Transcripts were analysed using NVivo10 software with an integrated method of inductive and deductive coding and based in grounded theory. Local Aboriginal interpreters validated coding. Major themes were defined and supporting quotes sourced.ResultsInterviews with Aboriginal leaders (n = 20) were facilitated by a local Aboriginal Community Navigator who could interpret if necessary and provide cultural guidance. Participants were from all four major local language groups of the Fitzroy Valley; aged 31 years and above; and half were male. Themes emerging from these discussions included Research—finding knowledge; Being respectful of Aboriginal people, Working on country, and Being flexible with time; Working together with good communication; Reciprocity—two-way learning; and Reaching consent.ConclusionThe project revealed how much more there is to be learned about how research with remote Aboriginal communities should be conducted such that it is both culturally respectful and, importantly, meaningful for participants. We identify important elements in community consultation about research and seeking consent.

What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review.

IntroductionImmigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare.MethodsWe systematically searched electronic databases for primary articles and grey literature. Study selection was performed following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Articles were selected based on four criteria: (1) the study population was comprised of immigrants or ethnic minorities living in Canada or the United States ; (2) study outcomes were related to chronic disease management or primary care access; (3) the study reported effects of community navigator intervention; (4) the study was published in English. Relevant information from the articles was extracted and reported in the review.ResultOnly one study was found in the literature that focused on navigators for immigrants in Canada. In contrast, 29 articles were found that reported navigator intervention programs for immigrant minorities in the United States. In these studies navigators trained and guided members of several ethnic communities for chronic disease prevention and management, to undertake cancer screening as well as accessing primary healthcare. The studies reported substantial improvement in the immigrant and ethnic minority health outcomes in the United States. The single Canadian study also reported positive outcome of navigators among immigrant women.ConclusionNavigator interventions have not been fully explored in Canada, where as, there have been many studies in the United States and these demonstrated significant improvements in immigrant health outcomes. With many immigrants arriving in Canada each year, community navigators may provide a solution to reduce the existing healthcare barriers and support better health outcomes for new comers.

'Community navigators': making a difference by promoting health in culturally and linguistically diverse (CALD) communities in Logan, Queensland

A key component of the 2011 Australian National Health Reform, via the Access and Equity Policy, is to improve access to quality health services for all Australians including CALD communities. Awareness has been raised that certain CALD communities in Australia experience limited access to health care and services, resulting in poor health outcomes. To address this issue, the Community Navigator Model was developed and implemented in four CALD communities in Logan, Queensland, through a partnership between government and non-government organisations. The model draws on local natural leaders selected by community members who then act as a conduit between the community and health service providers. Nine 'navigators' were selected from communities with low service access including the Sudanese, Burmese, Afghan and Pacific Islander communities. The navigators were trained and employed at one of two local non-government organisations. The navigators' role included assessing client needs, facilitating health promotion, supporting community members to access health services, supporting general practitioners (GPs) to use interpreters and making referrals to health services. This paper explores the 'lived experience' of the navigators using a phenomenological approach. The findings revealed three common themes, namely: (1) commitment to an altruistic attitude of servility allowing limitless community access to their services; (2) becoming knowledge brokers, with a focus on the social determinants of health; and (3) 'walking the walk' to build capacity and achieving health outcomes for the community. These themes revealed the extent to which the role of CALD community navigators has the potential to make a difference to health equity in these communities, thus contributing to the Australian National Health Reform.