Cultural elements underlying the community health representative – client relationship on Navajo Nation

Gampa, Vikas; Smith, Casey; Muskett, Olivia; King, Caroline; Sehn, Hannah; Malone, Jamy; Curley, Cameron; Brown, Chris; Begay, Mae-Gilene; Shin, Sonya; Nelson, Anna Kasten

doi:10.1186/s12913-016-1956-7

Cited by 20 publications

(39 citation statements)

References 15 publications

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“…The unique, close-knit relationship between the CHR and their client serves as a key component in the CHR's ability to impart knowledge of health management strategies. We have previously described the intimate link of trust between the CHR and their client [24] from the perspective of the CHR; the findings of this paper confirm that CHR clients view this relationship in a very similar wayas a vital bond that provides emotional support and a lifeline to services for individuals who are often marginalized from formal healthcare services due to limited access and mistrust. This finding is confirmed in literature that demonstrates that CHRs are more effective when they are respected by the community they serve [25].…”

Section: Discussionsupporting

confidence: 66%

Qualitative evaluation of a community health representative program on patient experiences in Navajo Nation

Lalla

Salt

Schrier

et al. 2020

BMC Health Serv Res

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Background: Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturallyappropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs) of clients who consent to receiving the COPE intervention (COPE clients) using a qualitative methods evaluation. Methods: Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes. Results: Clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educated their family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. Conclusion: The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes. Trial registration: clinicaltrials.gov: NCT03326206. Registered 9/26/2017 (retrospectively registered).

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Section: Discussionsupporting

confidence: 66%

Qualitative evaluation of a community health representative program on patient experiences in Navajo Nation

Lalla

Salt

Schrier

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

“…The unique, close-knit relationship between the CHR and their client serves as a key component in the CHR's ability to impart knowledge of health management strategies. We have previously described the intimate link of trust between the CHR and their client [24] from the perspective of the CHR; the findings of this paper confirm that CHR clients view this relationship in a very similar way -as a vital bond that provides emotional support and a lifeline to services for individuals who are often marginalized from formal healthcare services due to limited access and mistrust. This finding is confirmed in literature that demonstrates that CHRs are more effective when they are respected by the community they serve [25].…”

Section: Discussionsupporting

confidence: 65%

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

Lalla

Salt

Schrier

et al. 2019

Preprint

Self Cite

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

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“…The search did not produce any articles using the term boundary spanners for community-based people (in contrast with health management literature, as noted above). People fulfilling boundary-spanning roles in the community were described as “engaged insider” [ 43 ], “bridging role within the clinic” [ 54 ], “cultural bridge” [ 38 , 41 , 52 , 59 ], “nexus” [ 46 ], “intermediary” [ 27 ], “connector” [ 48 , 63 , 65 ] “psychosocial bridge” [ 48 ] and “trusted liaison” [ 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…Where health services use community-based boundary spanners as a solution to a workforce shortage problem [ 46 , 62 , 65 , 67 ], the boundary spanners are valued due to physical location in the marginalised community setting where it is difficult to recruit health workers. In the articles related to a connection or trust discrepancy between the health service and the community, their similarity to the community members being served is the reason for the health service using them [ 38 , 43 , 50 , 54 , 56 , 57 , 64 ].…”

Section: Resultsmentioning

confidence: 99%

Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

2018

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BackgroundHealth services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community—those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries.MethodsA scoping review methodology was applied to peer-reviewed articles to answer the question: “How do health services identify, recruit and use boundary spanners and what are the outcomes?” The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services.FindingsWe identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs.ConclusionsCommunity boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes.Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.

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Cultural elements underlying the community health representative – client relationship on Navajo Nation

Cited by 20 publications

References 15 publications

Qualitative evaluation of a community health representative program on patient experiences in Navajo Nation

Qualitative evaluation of a community health representative program on patient experiences in Navajo Nation

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

Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature

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