Health Navigators Research Articles

Cancer prevention for homeless people: Qualitative evaluation of the Health Navigator Model

Abstract Background People experiencing homelessness (PEH) face significant barriers when accessing cancer preventive services. The Health Navigator Model (HNM) seeks to address these challenges by improving access and engagement with cancer preventive care through tailored navigation services. This study aimed to explore PEH’s and health navigators’ experiences with the HNM. Methods This qualitative evaluation involved semi-structured interviews with a total of 61 PEH receiving the HNM intervention and 11 health navigators across four pilot sites in Austria, Greece, Spain, and the UK. Data were analyzed thematically using a cross-national coding framework. Results Following overarching themes were identified: (1) State of health and perception of health of PEH; (2) Experiences and understanding of cancer prevention; (3) Perceived effects of the Health Navigation intervention; (4) Navigators’ experiences with the implementation of the Health Navigation intervention; and (5) Effects of the Health Navigation intervention from the navigator perspective and sustainability of the intervention. Participants reported a general lack of access to healthcare services and low cancer prevention literacy. The HNM intervention led to increased engagement in cancer prevention activities, such as screenings, facilitated by the personalized support from health navigators. Navigators played a crucial role in bridging the gap between PEH and healthcare systems, though challenges such as mistrust and logistical barriers persisted. Conclusions The HNM has shown potential in enhancing cancer preventive care access for PEH by providing personalized guidance and support. The navigators’ role was pivotal in overcoming systemic and individual barriers, suggesting the need for integrated services that cater specifically to PEH. Future implementations should consider continuous training for navigators and further integration into local health systems to expand the benefits of the intervention. Key messages • The Health Navigator Model effectively enhanced cancer prevention engagement among people experiencing homelessness and empowered them through tailored and person-centered support. • Health navigators bridged healthcare gaps for people experiencing homelessness, improving their access to cancer preventive care services in their local settings.

Cancer prevention in people experiencing homelessness: feasibility of the Health Navigator Model

Abstract Background The Health Navigator Model (HNM) is a newly developed skill-mixed model that may improve access to cancer prevention services for over 895,000 People who are currently Experiencing Homelessness (PEH) in Europe. The aim of this study was to assess the feasibility and implementation of the model in European settings. Methods A co-designed pilot implementation study was undertaken in Austria, Spain, Greece and the United Kingdom. A total of 20 trained health navigators were appointed at support centres for PEH and facilitated PEH’s access to cancer prevention activities based on a comprehensive and tailored needs assessment. The study duration was 19 months, with two follow-ups. Feasibility data (recruitment/retention/participation rates, barriers, facilitators) were monitored throughout the study. Results More than 1,981 PEH were informed about the study and 652 of them participated. Most participants were male (64%), with low or no income (42%) and had previously experienced homelessness (51.7%). The mean age of participants was 47.4 years old. Overall, 69% of participants completed the first, and 42.5% completed the second follow-up. Main dropout reasons were loss of contact, loss of interest or having other priorities. Participants undertook a range of cancer prevention activities, including education (n = 494), workshops (n = 280), health consultations (n = 251), referrals for specialist care (n = 212) and cancer screening tests (n = 169). Difficulties in accessing the healthcare system, de-prioritising cancer and PEH’s complex needs were identified as the main barriers. Building trusting relationships with PEH, increasing cancer awareness and coordinating social and health services were identified as the main facilitators. Conclusions Implementing the Health Navigator Model was a feasible and dynamic process leading to improved equity and inclusion of people experiencing homelessness in cancer preventive services. Key messages • The Health Navigator Model is a feasible model to enhance cancer prevention among people experiencing homelessness following a person-centred, destigmatising approach. • Effective liaison between health and social services under the Health Navigator Model plays a critical role in facilitating access to cancer preventive care among people experiencing homelessness.

Empowering People Experiencing Homelessness for cancer prevention using the Health Navigator Model

Abstract Cancer poses a significant public health concern. Reports highlight that cancer-related mortality rates are double among people experiencing homelessness (PEH). CANCERLESS project delivered an innovative solution based on the Health Navigator Model (HNM). The HNM is an evidence-based patient-centred intervention that develops patient empowerment through health education and social support, promoting timely access to cancer prevention services. A pre-post design study conducted across four pilot sites in Europe (Austria, Greece, Spain, UK) involved 652 PEHs. Pilot interventions based on the HNM were implemented, with effectiveness evaluated at baseline and post-intervention. The study assessed the impact of the HNM on various factors including risk behaviors, lifestyles, quality of life, empowerment, health literacy, psychological distress and utilization of health and care services. Preliminary findings from CANCERLESS HNM intervention showed significant improvements (p= .000) in participants’ quality of life (55.82 (27.65) vs. 66.18 (22.27)) and sense of empowerment (25.58 (19.95) vs. 59.94 (43.10)). However, there were no observable impacts in health literacy (p= .509) or psychological distress (p= .140), which remained within acceptable ranges both pre- and post-intervention. Similarly, there were no significant changes observed in lifestyle or risk behaviours among PEHs. Nonetheless, the evaluation of effectiveness suggested that the HNM increase in the uptake of cancer prevention care, such as cancer screening (p= .000). The CANCERLESS HNM intervention significantly improved the quality of life and empowerment of PEHs. Additionally, it successfully promoted their involvement in cancer prevention efforts, addressing disparities in access to preventive healthcare services. Increased engagement in such initiatives can lead to early detection and treatment, ultimately reducing cancer morbidity and mortality rates, thereby positively impacting public health. Key messages • By promoting health equity and social justice, interventions like CANCERLESS HNM contribute to building healthier and more resilient public health systems. • CANCERLESS boosts cancer prevention awareness, tackles healthcare disparities, enhances cancer early detection, benefiting public health.

HIV Outcomes and Intervention Experiences of Enlaces Por La Salud: A Personal Health Navigation Intervention Informed by the Transnational Framework.

Latinos in the United States are disproportionately affected by HIV and experience sub-optimal levels of viral suppression. Enlaces Por La Salud is an individual-level intervention implemented by personal health navigators and guided by the transnational framework to improve HIV care outcomes among newly diagnosed and out-of-care Mexican and Mexican American men and transgender women in North Carolina. The purpose of this study was to assess: (1) changes in HIV care and treatment outcomes among Enlaces participants and (2) intervention engagement and experiences. Ninety-one participants were recruited between October 2014 and August 2017 for a single-arm, mixed-methods design including surveys at baseline, 6 and 12 months and qualitative in-depth interviews immediately following the intervention with an embedded cohort (n = 19). Mean participant age was 36.8 years and most identified as cisgender male (90%). Participants were significantly more likely to have an undetectable viral load at baseline (18%) compared to 6-months (78%) (p < .001). Outcomes were sustained but not significantly increased from 6 to 12 months. Intervention engagement was high with 81% completing all six intervention sessions. In qualitative interviews, participants emphasized the importance of their relationship with the personal health navigators, who provided information, instrumental, and emotional support. A person-centered intervention guided by the lived experience of migration could be an effective way to support Latinos with HIV from diverse countries of origin to achieve viral suppression and improve overall wellbeing.

Integrating health and child protection systems: towards collaboratively improving health outcomes for children in kinship care in rural Australia

PurposeThere is a growing recognition that the integration of health systems will benefit children in out-of-home care (OOHC), especially those who have experienced trauma. This paper examines the adaptation of existing health systems and the persistent barriers between rural health and child protection programs. It focuses on health systems integration for children aged 0–6 years in kinship care and their siblings.Design/methodology/approachThe study applied a multi-methods qualitative approach involving individual interviews and focus groups with project members from operational or strategic reference groups, child protection personnel and the kinship carer program. We also reviewed documentary evidence.FindingsWe found evidence that health clinicians and child protection practitioners adapted and adjusted services as they collaboratively worked together to improve care delivery to children in kinship care. Yet, despite successful adaptations to systems and the appointment of a health navigator, systemic barriers remain. These include service and staff shortages in rural Australia, complications around information sharing, authority and power dynamics and siloed operations. Such barriers prevent better-integrated health systems and ultimately impair health outcomes for children in kinship care.Originality/valueThis paper contributes to knowledge and practice to improve the integration of child protection and healthcare services in Australian OOHC. It provides valuable insights into the challenges and successes of health systems integration, highlighting the need for continued collaborative effort to create effective, place-based models of care that benefit these children and their carers.

Digital Health Readiness: Making Digital Health Care More Inclusive.

This paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person's stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person's goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care.

Abstract B077: La lengua materna: Understanding language challenges experienced by Latino patients and caregivers in rectal cancer care

Abstract Background/Purpose: Language concordance is critical for effective communication between patient and provider. Compared to the percentage of primary Spanish speakers in California, there is a lack of Spanish-speaking providers in healthcare, especially in oncology. In-house hospital interpreters help overcome basic language barriers; however, even with the adoption of these services, there remain gaps in comprehension. Such gaps in communication can compromise the informed decision-making process, necessitating novel approaches to multilingual health communication. This study aimed to (a) explore language barriers Hispanic/Latino patients and their caregivers face when navigating rectal cancer care services and (b) propose a culturally-tailored solution that could address these barriers. Methods/Study Population: We designed a community-based participatory study using qualitative methods. Specifically, we formed a Community Advisory Board and partnered with local promotoras – health navigators with strong ties to the Hispanic/Latino community. Together, we developed a semi-structured interview guide to shape our conversations with individuals residing in the Bay Area or the San Joaquin Valley who identify as Hispanic/Latino, and who reported having either a past or current rectal cancer diagnosis. We also invited their caregiver(s) to attend the interview. Interviews lasted 45-60 minutes in English or Spanish. Over a 6-month period, twenty interviews were conducted with patients alone (n= 14), a caregiver alone (n=2), and patient-caregiver pairs (n=4). Data analysis utilized grounded theory and reflexive thematic analysis to identify core themes. Results: Themes that arose include (1) ineffective and non-satisfactory communication through electronic interpreter services, (2) bilingual caregiver burden in reinforcing interpreter translations due to dialect differences, (3) patients not actively seeking out translation services for concern of causing inconvenience to the healthcare team, (4) patients’ preferred language not accurately captured in the electronic medical record. Conclusion: Interpreter services have helped bridge the language gap in healthcare, but inevitable gaps remain as language involves more than just the spoken word; it includes the culturally influenced non-verbal cues and the management of emotional responses to the information provided, components of communication which interpreters may miss. A solution to address the cultural complexities of language among this population in this setting, could be the adoption of promotoras; these health navigators share multiple aspects of their cultural identities with the patient population, making them uniquely positioned to bridge the gap between the medical system and the Hispanic/Latino community. Citation Format: Eleanor Brown, Julian P Howland, Min Y. Kim, Lucas K. Carpenter, Patricia Castañeda, Maria Gonzalez, Miriam T. Hernandez, Zaria N. Cosby, Kristen M. Davis-Lopez, Ysabel Duron, Gladys M. Rodriguez, Sandra S. Zaky, Arden M. Morris, Aaron J. Dawes. La lengua materna: Understanding language challenges experienced by Latino patients and caregivers in rectal cancer care [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B077.

Abstract A107: Be Part of the Cure Clinical Trials Campaign: Koreans, Hispanic/Latino/a/e/x, and Black/African Americans living in Los Angeles County

Abstract Background. There is negative perception and lack of participation in clinical trials among Koreans, Hispanic/Latino/a/e/x, and Black/African Americans living in Los Angeles County, which may be attributed to cultural beliefs, language barriers, historical mistrust of medical research, and lack of awareness about the benefits of participation. Without representation from diverse groups, there may be missed opportunities to develop personalized treatment approaches tailored to specific genetic, cultural, and lifestyle factors. Methods. Cedars Sinai Cancer Community Outreach and Engagment (COE) developed a multi-level approach to increase representation of minority populations in clinical trials. With active Community Advisory Board involvement in the development and implementation, a culturally sensitive clinical trials awareness campaign, “Be Part of the Cure”, was developed to offer in-language cancer information, education on clinical trials, and navigation through the cancer care continuum. To support patients and facilitate access to trials, COE has developed bi-directional engagement between CCSC physicians, nurses and Clinical Trials Office representatives, FQHCs, and community and faith-based organizations to ensure a seamless navigation process to care. Additionally, our multicultural and multilingual COE staff have trained Community Health Workers and navigators to expand our outreach efforts and effectively engage our target communities. Results. In total, COE has facilitated 7 health education workshops and attended 3 community outreach events with 501 people educated (37% or 184 Black/African American; 25% or 123 Asians; 17% or 87 Hispanic/Latinx; and 21% or 107 White). Pre/post-tests administered to 73 Koreans during health education workshops showed significant increase in positive perception on clinical trials from 57% to 95%. Korean (n=9) cancer patients have expressed interest in clinical trials, and 1 have been enrolled in Neoadjuvant HER2-Targeted Therapy and Immunotherapy with Pembrolizumab clinical trial. Among Hispanic/Latinx/a/o community, 1 clinical trials health awareness workshop was convened with clinicians who presented to promotores, patients, caregivers, survivors and community members. There were 25 people who completed the pre/post test. There was an increase in positive perception on clinical trials from 52% to 100%, willingness to participate from 60% to 96%, and likelihood of encouraging others to participate from 60% to 96%. In the Black/African American community, 1 clinical trials health awareness workshop was also convened. Among attendees, 21 people completed Pre/Post Test and positive perception on clincal trials increased from 47% to 85%, willingness to participate from 43% to 81%, and likehood on encouraging others to participate from 52% to 81%. Conclusion. Efforts to increase diversity and inclusion in clinical trials should focus on culturally sensitive recruitment strategies, language accessibility, community engagement, and building trust between researchers and communities. Citation Format: Ghecemy Lopez, Dong Hee Kim, Zul Surani, Lourdes Barajas. Be Part of the Cure Clinical Trials Campaign: Koreans, Hispanic/Latino/a/e/x, and Black/African Americans living in Los Angeles County [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A107.

Codesigning a Community Health Navigator program to assist patients to transition from hospital to community

Background This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption. Methods Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model. Results CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision. Conclusions This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs’ effectiveness and the acceptance of their role within the healthcare team.

Destitute and dying: interventions and models of palliative and end of life care for homeless adults – a systematic review

BackgroundHomeless adults experience a significant symptom burden when living with a life-limiting illness and nearing the end of life. This increases the inequalities that homeless adults face while coping with...

Health literacy and non-communicable disease knowledge of pregnant women and mothers in Tasmania: Qualitative exploration.

The World Health Organisation is prioritising health literacy development to address the growing burden of non-communicable diseases (NCDs). Empowering pregnant women and mothers through health literacy development may help to reduce the intergenerational impact of NCDs. However, significant gaps exist in understanding the health literacy needs of this priority population globally. This study aimed to qualitatively explore the health literacy strengths and challenges as well as NCDs knowledge and beliefs of pregnant women and mothers with young children (0-8 years) in Tasmania. Data were collected online using in-depth semi-structured interviews and analysed inductively using reflexive thematic analysis. Twenty women (mean age 35.5 years, standard deviation 5.13) participated. Four parent themes were generated from the data: perceived knowledge and awareness of NCDs and their causative factors; social determinants of health and the surrounding environment; social networks and peer support as health navigator; and trust in health services and social connections. These themes highlighted diverse factors that influenced the participant's access and use of health information and services and their engagement in healthy lifestyle practices and active health management. Participants demonstrated good knowledge and awareness about NCDs and associated risk factors but experienced numerous health literacy strengths and challenges which influenced their access to health care and engagement in healthy lifestyle practices. This study highlights the need to address the diverse health literacy needs of pregnant women and mothers through codesigning locally informed health literacy development strategies combined with the creation of enabling service environments to reduce the growing burden of NCDs.

A key informant study of rural behavioral health agency providers assessing barriers to care and knowledge of peer health navigator interventions.

A key informant study of rural behavioral health agency providers assessing barriers to care and knowledge of peer health navigator interventions.

Crisis and curfew: Lived experiences of community members seeking emergency maternal and neonatal care before and during the COVID-19 pandemic on Mfangano Island, Lake Victoria, Kenya

Prior to the COVID-19 pandemic, families in rural sub-Saharan Africa faced numerous well-documented barriers in accessing timely care during maternal and neonatal health emergencies. We are now beginning to further appreciate the complex impacts that global disruptions, like the COVID-19 pandemic, can have on access to maternal care across vulnerable health systems, particularly for mothers seeking care in remote settings. In 2021, we initiated a qualitative follow-up study to the MOMENTUM (Monitoring Maternal Emergency Navigation and Triage on Mfangano) cohort study conducted within the remote communities of Mfangano Island on Lake Victoria, in Western Kenya, in 2019 and early 2020. Given the timing of this follow-up study, we sought to further qualify the barriers previously identified during the initial MOMENTUM quantitative survey, as well as explore specific ways that the COVID-19 pandemic impacted these barriers. In September 2021, 4 Focus Group Discussions (FGDs), with a total of 44 participants, were conducted among patients and families who had recently experienced maternal and neonatal emergencies. Additionally, 15 Key Informant Interviews (KIIs) were conducted with community leaders and health-care providers to allow reflection more broadly on their local emergency health-care system. A grounded theory methodology was utilized to analyze respondent themes. The lived experiences reported here by FGD and KII participants substantiate and validate numerous challenges previously identified in our prior study. Importantly, participants also highlighted specific ways that the pandemic intensified each of these factors, through the spread of misinformation, restricted mobility due to government curfews and lockdowns, increased frequency of health worker strikes, and worsening financial and resource constraints across the health system. Participants also described creative ways in which contextually experienced providers (i.e., Mfangano Health Navigators) facilitated critical coordination to help patients access care during the chaotic circumstances generated by the pandemic. These findings suggest that trained community health workers can play an influential role in improving emergency care coordination, particularly during future pandemics and similar public health disruptions within extremely resource-limited environments.

"Nobody does checkups back there": A qualitative study of refugees' healthcare needs in the United States from stakeholders' perspectives.

The number of refugees globally grew to 35.3 million in 2022, and many refugees are exposed to various health risks along their migration journey. As a result, they may arrive in host communities with numerous health issues, including communicable diseases and chronic and mental health conditions. Navigating the healthcare system in a host country proves to be a significant challenge for them, leading to delayed care. This qualitative study explored the convolute healthcare needs of refugees in the United States by soliciting insights from stakeholders involved in refugee resettlement and healthcare. In-depth interviews were conducted with fifteen stakeholders who work closely with refugees, including healthcare providers, cultural/clinical health navigators supporting refugees, staff from refugee resettlement agencies and governmental entities, and researchers studying refugee health. Following informed consent, interviews were audio-recorded, transcribed verbatim, and imported into MAXQDA 2022 (VERBI Software) for thematic analysis. The results revealed key themes, including the heterogeneity of refugee populations, limited awareness of preventive healthcare, high prevalence and suboptimal management of chronic conditions, complexity of the healthcare system, lack of follow-up, and language barriers. Further research is warranted concerning the long-term health of refugee populations in the United States. Additionally, more tailored programs involving peer educators are recommended to support refugee communities in navigating the complex healthcare system in the host country.

Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project.

The incidence of cancer in Europe has been increasing in recent years. Despite this, cancer prevention has remained a low priority in health policies. Cancer is one of the main causes of mortality among people experiencing homelessness, who continue to have difficulties accessing prevention programs. A strategy that has been tested to favor cancer prevention is the health navigator figure. The objective of CANCERLESS project is to implement this model among populations experiencing homelessness in four European countries to foster the prevention and early detection of cancer. In this perspective, a presentation of CANCERLESS project is made, and its ethical aspects are discussed according to the ethics of public health, the ethics of care, solidarity, relational autonomy, and the social recognition of the virtue of just generosity. The ethical foundations of CANCERLESS project are rooted in social justice and in equity in access to health systems in general and cancer screening programs in particular. The ethics of public health guided by utilitarianism are insufficient in serving the interests of the most disadvantaged groups of the population. Hence, it is necessary to resort to relational bioethics that includes the ethics of care and solidarity and that recognizes the moral identity of socially excluded persons, reaffirming their position of equality in society. Relational autonomy therefore provides a broader conception by including the influence of living conditions in decisions. For this reason, the CANCERLESS project opts for a dialogue with those affected to incorporate their preferences and values into decisions about cancer prevention.

Abstract CT272: A cluster randomized trial to evaluate a church-based navigation model to increase breast cancer screening in Korean women (Faith In Action!): Trial in progress

Abstract Background: Breast cancer is the most commonly diagnosed cancer among Korean American women and incidence in this group is rising. Advanced-stage disease is more frequent among Korean women diagnosed with breast cancer than in other ethnicities due to low adherence to screening. Lower socioeconomic status, cultural barriers, perceived norm, distrust of healthcare system, and lack of awareness and culturally tailored communication on benefits of screening contribute to low screening utilization. Church settings offer important platforms for education as a majority of Korean American women &amp;gt;50 years regularly attend church services. Thus, the objective of this trial was to evaluate the efficacy of a culturally tailored intervention “Faith in Action!” on breast cancer screening adherence rates among Korean American women. Methods: A parallel cluster randomized trial with staggered roll-out will be conducted to evaluate the efficacy of the “Faith in Action!” intervention, a church-based small group education and lay health navigator program, delivered by trained church members, on breast cancer screening among Korean American women (NCT05298605). This study was designed and conducted in partnership with a Community Advisory Board. Trial enrollment began in July 2022 and is ongoing. Twenty-four total Korean churches in Los Angeles were randomized within blocks of 8 churches to either intervention or waitlist control conditions in a 1:1 ratio. Using a train-the-trainer approach, lay navigators from the Korean Church community nominated by church leadership are trained and certified to deliver the Faith in Action! intervention to study participants over a 6-month program period. Participants at churches randomized to the waitlist control group receive an educational presentation on physical activity and nutrition and, after 6-month follow-up, are invited to receive the Faith in Action! intervention. Eligible participants include women of Korean descent, ages 45-75 years, who: attend a participating church, do not have a breast cancer diagnosis, and did not receive mammogram in the last 2 years. The primary outcome is adherence to breast cancer screening guidelines within 6 months from end of program. Secondary outcomes include adherence to breast cancer screening within 1 year and participant knowledge about breast cancer screening practices. Qualitative interviews will be conducted to assess participants’ knowledge and barriers surrounding cancer screening decisions and program acceptability. To date, 16 churches (149 total participants) have been enrolled in the study and are being followed. It is expected that findings from this research will inform community-based efforts to increase breast cancer screening adherence among Korean American women and improve understanding of screening barriers in this group that is disproportionately impacted by breast cancer, while building capacity and opportunities for sustainability in the Korean faith community. Citation Format: Gillian Gresham, Christie Y. Jeon, Dong Hee Kim, Min Jung Sung, Laurel J. Finster, Marcio A. Diniz, Michael Fine, Zul Surani, Alison K. Herrmann, Jeong Yup Lee, Robert W. Haile. A cluster randomized trial to evaluate a church-based navigation model to increase breast cancer screening in Korean women (Faith In Action!): Trial in progress [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT272.

Using focus groups to inform a peer health navigator service for people who are transgender and gender diverse in Saskatchewan, Canada.

This study investigated healthcare access and quality for people who are transgender and gender-diverse (PTGD) in Saskatchewan (SK), Canada, to inform a larger project that was piloting two peer health navigators for PTGD. Two online focus groups were held. Nineteen participants were recruited to represent a broad range in age, gender and location in SK. Transcripts of the focus groups were analyzed using a thematic approach. The core theme that was identified was participants' desire for culturally safe healthcare. This core theme had two component themes: (1) systemic healthcare factors and (2) individual healthcare provider(HCP) factors. The healthcare system primarily acted as a barrier to culturally safe healthcare. HCPs could be either barriers or facilitators of culturally safe care; however, negative experiences outweighed positive ones. PTGD in SKface discrimination, with delays and barriers to care at all levels of the healthcare system. Peer health navigators can address some of these discrepancies; however, greater support is required for PTGD to be able to access culturally safe healthcare. People with lived experience/PTGD were involved in all stages of this project. They were included on the team as community researchers and co-developed the research project, conducted the focus groups, participated in the analyses and are co-authors. As well, both navigators and all the participants in the focus groups were also PTGD.

An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods

BackgroundThe Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water. Design and settingThis 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels. InterventionThe intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination. In this study, CES will serve as home health navigators to deliver: 1) individualized feedback, 2) positive reinforcement, 3) teach-back moments, 4) decision-making skills, 5) navigation to resources, 6) self-management, and 7) repeated contact for shaping and maintenance of behaviors. Usual care includes information only with no access to individual meetings with CES. Measurable outcomesPre-specified primary outcomes include 1) adoption of treatment to reduce exposure to arsenic, nitrate, or lead in water which may include switching to bottled water and 2) engagement with well stewardship behaviors assessed at baseline, and post-6 and 12 months follow-up. Water quality will be measured at baseline and 12-month through household water tests. Secondary outcomes include increased health literacy scores and risk perception assessed at baseline and 6-month surveys. ImplicationsThe results will demonstrate the efficacy of a domestic well water safety program to disseminate to other CES organizations.Trial registration number: NCT05395663

Addressing COVID-19 Vaccine Hesitancy and Uptake Among African Immigrants: Lessons from a Community-Based Outreach Program.

In 2021, the African Cultural Alliance of North America (ACANA) implemented a community-based vaccine education and outreach program to decrease hesitancy and increase COVID-19 vaccine uptake among African immigrants in Philadelphia. The program had three components: (1) tailored messaging on the benefits of vaccines by trusted community health navigators in familiar languages/dialects, (2) use of educational/tabling events, and (3) establishment of a vaccine clinic in community settings. Using secondary data analysis, in-depth interviews, focus group discussions and a self-administered survey, we explored (i) the impact and effectiveness of the outreach program and extent of vaccine uptake, (ii) African immigrants' beliefs about the COVID-19 pandemic and the vaccine, and (iii) barriers and facilitators of vaccine knowledge, uptake, and hesitancy.Our analysis showed that ACANA's outreach program was effective in addressing several cultural, logistic, and systematic barriers to vaccine uptake. The program distributed 2000 educational/informational flyers,reached 3000 community members via social media campaigns,and an additional2320 through other person-to-person outreach events.The programwas effective and resulted inthe vaccination of 1265 community members over the course of the outreach. The impact of this outreach underscores the critical role of community-based organizations in addressing COVID-19 vaccine hesitancy and increasing vaccine uptake in underserved and minority communities. The paper concludes with suggestions and recommendations for using community-based outreach programs to increase COVID-19 vaccine uptake and decrease hesitancy.

Implementing A Digital Health Navigator: Strategies &amp; Experience in The Hospital Setting to alleviate Digital Equity

Background: The implementation of telemedicine and digital health technologies in healthcare has increased, but patients still need help adopting and utilizing these technologies. To address this, a Digital Health Navigator (DHN) program was implemented to evaluate the benefits of improving patients’ adoption.&#x0D; Objectives: To alleviate digital equity within hospitals, we introduced a holistic digital health navigator program designed to promote the utilization of digital tools among hospitalized patients. To implement a DHN program to improve patient adoption of digital portals to engage in healthcare. To learn from the program to further develop patient-facing portal education for hospitalized patients to expand to other hospitals.&#x0D; Methods: Over a period of thirty days, the DHN program conducted patient visits in two hospitals, on portal usage, collecting data, and adapting protocols based on patient feedback.&#x0D; Results: Feedback from patients indicated 98% of patients found the education and the DHN to be helpful. 92% recommend the UPMC Central PA Portal for accessing their healthcare information. The DHN program proves beneficial in promoting portal usage and addressing technological barriers experienced by patients. We provide strategies and recommendations on how to implement such a program.&#x0D; Discussion: We successfully implemented a digital health navigator program for hospitalized patients across two hospitals. Patients reported a positive perception and satisfaction with digital health navigator visits . Notably, our model overcomes challenges related to limited internet access and mitigates technology-related anxiety during hospital stays. The DHN program proved beneficial in promoting hospital portal usage and addressing technological barriers experienced by patients. Implementation and sustained adoption of digital technologies across a large healthcare organization can be achieved through a well-coordinated, team-based, and systematic approach with a DHN. We provide strategies and recommendations on how to implement such a program