Reflecting on the tensions faced by a community-based multicultural health navigator service

Abstract

The community navigator model was developed to assist four culturally and linguistically diverse communities (Sudanese, Burmese, Pacific Islander Group, Afghani) in south-east Queensland to negotiate the Australian health system and promote health. Using participatory action research, we developed the model in partnership with community leaders and members, the local health department and two non-governmental organisations. Following implementation, we evaluated the model, with the results published elsewhere. However, our evaluation revealed that although the model was accepted by the communities and was associated with positive health outcomes, the financial, social and organisational durability of the model was problematic. Ironically, this situation was inadvertently created by critical decisions made during the development process to enhance the durability and acceptability of the model. This paper explores these critical decisions, our rationale for making those decisions and the four hidden tensions that subsequently emerged. Using a reflective case study method to guide our analysis, we provide possible resolutions to these tensions that may promote the longevity and utility of similar models in the future. WHAT IS KNOWN ABOUT THE TOPIC?: The use of community navigators to assist culturally diverse communities to access health services is not new. Many benefits have been documented for communities, individuals and heath service providers following the use of such models. What is not well documented is how to maintain these models in a safe and cost-effective way within the Australian health system while respecting cultural and community practices and reducing the burden of service delivery on the navigators. WHAT DOES THIS PAPER ADD?: This paper provides a perspective on how the development of community-based service models inherently places them in a position of tension that must be resolved if they are to be long lasting. Four core tensions experienced during the development and implementation of our model in south-east Queensland are explored to develop potential resolutions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reducing the tensions inherent in culturally appropriate community-based service models will increase the durability of the approach. By addressing these tensions, we can create a more durable pool of community navigators that can facilitate community empowerment, self-governance of health issues and a sense of community ownership of health services.

‘Connecting tracks’: exploring the roles of an Aboriginal women's cancer support network

“…Aboriginal stakeholders, on the other hand, cited lack of support from mainstream services and funding as the main sustainability issues. This disconnect was a reflection of a broader tension between flexibility and structure, which is consistent with findings from Henderson and Kendall (). Fluidity and flexibility characterised the operations of the network.…”

“…Finally, the network provided practical and financial support to its members. Consistent with findings from a community navigator model implemented in Queensland among migrant communities (Henderson & Kendall 2014), flexibility and adaptability were essential characteristics of the network's grassroots approach to practical support delivery; however, MSPs raised issues of risk management and professional boundaries. In addition, the network was based on a volunteer model, and issues of out-of-pocket expenses incurred, availability of volunteers and supervision were also raised, which are consistent with other evidence on volunteer support programmes for people with cancer (Macvean et al 2008).…”

“…Operating in a regional setting, the network played multiple roles supporting Aboriginal women affected by cancer and their families. The network combined characteristics of peer-support programmesinsofar as it was run by women who had experienced cancer and it provided emotional and informational support (Hoey et al 2008)and 'community navigators' (Henderson & Kendall 2014) or 'cancer navigators' )insofar as the network provided instrumental and practical support to its clients, and engaged in culturally safe health promotion and education initiatives in the community.…”

The nurse navigator: An evolving model of care

“…Evaluation of the program revealed that the navigators felt they were acting as knowledge brokers; that they had been successful in building bridges within the community to improve health literacy and empower local CALD families (Henderson & Kendall, 2011). However, these Australian researchers also recommended maintaining a navigator-centric, grassroots role to avoid the program becoming overly bureaucratic (Henderson & Kendall, 2014).…”

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