Access to Health Care
Conditions
Brief summary
This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.
Detailed description
This five-year project was developed by investigators from the Behavioral Health Research Center of the Southwest (BHRCS), a center of the Pacific Institute of Research and Evaluation (PIRE), the Health Committee of the New Mexico Indian Council on Aging (NMICoA), and the University of New Mexico (UNM). The project combines qualitative and quantitative interviews with concept-mapping (CM) techniques and focus groups to study insurance coverage, help-seeking behavior, and the healthcare experiences of American Indian Elders (AIEs) in New Mexico (NM). Practical knowledge grounded in the actual perspectives of AIEs and other key stakeholders may improve healthcare practices and policies for a population largely excluded from national and state discussions of health reform. The study data will also inform the adaptation and development of culturally tailored programming to enrich understanding and facilitate negotiation of a changing landscape of healthcare by AIEs. Our four specific aims are to: 1. Assess how AIEs understand, access, maintain, and use insurance coverage. 2. Characterize AIE help-seeking and healthcare experiences in dominant service delivery settings, i.e., Indian Health Service (IHS), tribally-run 638 facilities, and managed care programs. 3. Identify and compare factors that affect AIE access to health care as perceived by multiple stakeholders, i.e., AIEs, outreach workers (OWs), healthcare staff and providers, public sector administrators, and tribal leaders. 4. Develop and assess implementation feasibility of a structured intervention for OWs that promotes enhanced patient navigation, in addition to healthcare literacy, access, and usage among AIEs.
Interventions
BEHAVIORALSeasons of Care App
A web-based mobile application (app) called the Seasons of Care Elder Navigation Guide will assist elders, their families/caregivers, healthcare providers, outreach workers, and other community members in navigating healthcare and insurance systems. The app has the added advantage of being easy to update to respond to future changes in health care and insurance, and sustainable because it is not dependent on intensive training, developing, and retaining of individuals in professional navigation positions.
Sponsors
University of California, San Diego
University of New Mexico
Pacific Institute for Research and Evaluation
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Navigators Inclusion Criteria: * Working in a health and health insurance outreach * Routinely interacting with AIEs as part of their jobs * Primary service region includes target AIEs.
Exclusion criteria
* Not Routinely interacting with AIEs as part of their jobs * Not willing to be trained in or use the Seasons of Care app American Indian Elders (AIEs) Inclusion * Age 55+ * Identifying as AI * Able to read in English * Able to consent and complete study procedures * Interacted with Navigator Exclusion ● Individuals who cannot read in English or who have not interacted with a pilot test Navigator will not be eligible to participate Healthcare Staff/providers Inclusion * Individuals who have been in contact with a pilot test Navigator * Work in a healthcare facility that serves AIEs in one of our 4 regions Exclusion ● Individuals who have not interacted with a pilot test Navigator or do not work in a healthcare facility serving our primary population, will not be eligible to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| User Evaluation Survey | Once at the end of P2 (Month 8 of 8) | A semi-structured, in-person interview (or focus group, depending on availability) with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app to assess experiences with, and effects of, the Seasons of Care app; suggestions to improve the Seasons of Care app |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Navigator Pre- and Post-Evaluation Interview | Month 1 and 4 (of 8) for P1 Navigators; Month 5 and 8 (of 8) for P2 Navigators | A semi-structured, in-person interview comprised of open-ended questions to assess navigator's confidence and experiences with communicating health information to AIEs and healthcare providers; perceptions of the Seasons of Care app |
Other
| Measure | Time frame | Description |
|---|---|---|
| User Evaluation Demographic Survey | Once at the end of P2 (Month 8 of 8) | A demographic survey with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app |
| Feasibility Questionnaire | Assessed monthly for 4 months; participants' ratings for each category were averaged. Average ratings per participant for each category is reported here. | A written questionnaire to assess navigator's experiences with, and effects of, Seasons of Care Guide |
Countries
United States
Participant flow
Recruitment details
We used reputational case selection to identify potential participants who were individuals who provided healthcare navigation services to Elders as part of their everyday work. We approached individuals or administrators at community organizations, healthcare facilities, and tribal agencies with an email or in-person description of the study and an invitation to participate. We followed up at each site with up to three emails, visits, or phone calls.
Pre-assignment details
Due to the complete closure of tribal communities during the COVID-19 pandemic, zero participants were enrolled and assigned in the American Indian Elders (AIEs) and Healthcare Providers/Staff Arms/Groups, respectively.
Participants by arm
| Arm | Count |
|---|---|
| Navigators AIE Navigators will use the Seasons of Care app in the context of their everyday outreach work with AIEs over two four-month intervention periods (P1 and P2). Their goal will be to facilitate health literacy to shift attitudes, beliefs, and behaviors to create a Culture of Coverage for AIEs at individual, organizational/community, and policy levels. Separated by distance, the AIE Navigators will receive coaching as necessary, using virtual meeting space, to help refine their implementation skills from a member of the research team with experience in AIE health outreach.
Seasons of Care App: A web-based mobile application (app) called the Seasons of Care Elder Navigation Guide will assist elders, their families/caregivers, healthcare providers, outreach workers, and other community members in navigating healthcare and insurance systems. The app has the added advantage of being easy to update to respond to future changes in health care and insurance, and sustainable because it is not dependent on intensive training, developing, and retaining of individuals in professional navigation positions. | 16 |
| American Indian Elders (AIEs) Elders will be exposed to the Seasons of Care app when they reach out to navigators for assistance navigating the healthcare system.
Seasons of Care App: A web-based mobile application (app) called the Seasons of Care Elder Navigation Guide will assist elders, their families/caregivers, healthcare providers, outreach workers, and other community members in navigating healthcare and insurance systems. The app has the added advantage of being easy to update to respond to future changes in health care and insurance, and sustainable because it is not dependent on intensive training, developing, and retaining of individuals in professional navigation positions. | 0 |
| Healthcare Providers/Staff This cohort will be exposed to the Seasons of Care app via navigators and their patients.
Seasons of Care App: A web-based mobile application (app) called the Seasons of Care Elder Navigation Guide will assist elders, their families/caregivers, healthcare providers, outreach workers, and other community members in navigating healthcare and insurance systems. The app has the added advantage of being easy to update to respond to future changes in health care and insurance, and sustainable because it is not dependent on intensive training, developing, and retaining of individuals in professional navigation positions. | 0 |
| Total | 16 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Phase 2 | Unable to complete due to other duties during COVID-19 pandemic | 3 | 0 | 0 |
| Phase 2 | Vacated position | 1 | 0 | 0 |
Baseline characteristics
| Characteristic | Total | Navigators |
|---|---|---|
| Age, Continuous | 36 years | 36 years |
| Comfort using Seasons of Care Guide Comfortable using the Seasons of Care Guide in their work | 10 Participants | 10 Participants |
| Comfort using Seasons of Care Guide Confident that they would become comfortable with the Seasons of Care Guide over time | 5 Participants | 5 Participants |
| Comfort using Seasons of Care Guide Felt that the Seasons of Care Guide was no different than other resources they already used | 1 Participants | 1 Participants |
| Confidence communicating with Elders Comfortable communicating with AIEs about health and healthcare issues | 16 Participants | 16 Participants |
| Confidence communicating with Elders Comfortable communicating with AIEs about health insurance | 11 Participants | 11 Participants |
| Confidence communicating with Elders Experienced challenges communicating with AIEs about difficult or taboo topics | 4 Participants | 4 Participants |
| Confidence communicating with Elders Experienced language barriers communicating with AIEs | 5 Participants | 5 Participants |
| Confidence communicating with Elders Uncomfortable communicating AIEs about insurance due to lack of knowledge | 3 Participants | 3 Participants |
| Confidence communicating with healthcare providers Comfortable communicating with healthcare providers due to regular experience doing so | 12 Participants | 12 Participants |
| Confidence communicating with healthcare providers Comfortable communicating with healthcare providers when receiving referrals to help AIEs | 7 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 4 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 12 Participants | 12 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 12 Participants | 12 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 0 Participants | 0 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants |
| Race (NIH/OMB) White | 3 Participants | 3 Participants |
| Sex: Female, Male Female | 12 Participants | 12 Participants |
| Sex: Female, Male Male | 4 Participants | 4 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 16 | 0 / 0 | 0 / 0 |
| other Total, other adverse events | 0 / 16 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 16 | 0 / 0 | 0 / 0 |
Outcome results
Primary
User Evaluation Survey
A semi-structured, in-person interview (or focus group, depending on availability) with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app to assess experiences with, and effects of, the Seasons of Care app; suggestions to improve the Seasons of Care app
Time frame: Once at the end of P2 (Month 8 of 8)
Population: Due to the complete closure of tribal communities during the COVID-19 pandemic, no data were collected for this outcome measure.
Secondary
Navigator Pre- and Post-Evaluation Interview
A semi-structured, in-person interview comprised of open-ended questions to assess navigator's confidence and experiences with communicating health information to AIEs and healthcare providers; perceptions of the Seasons of Care app
Time frame: Month 1 and 4 (of 8) for P1 Navigators; Month 5 and 8 (of 8) for P2 Navigators
Population: Due to the complete closure of tribal communities during the COVID-19 pandemic, focus groups with AIEs and healthcare providers/staff were not completed. Three Navigators were unable to complete post-evaluation interviews due to changing responsibilities during the COVID-19 pandemic. One Navigator left their position before completing the post-evaluation interview.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Providers | Improved | 3 Participants |
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Providers | Improved but with some remaining barriers | 2 Participants |
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Providers | No change | 1 Participants |
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Providers | No response | 6 Participants |
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Elders | Improved | 5 Participants |
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Elders | Improved but with some remaining barriers | 0 Participants |
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Elders | No change | 3 Participants |
| Navigators | Navigator Pre- and Post-Evaluation Interview | Effects of Seasons of Care Guide on Communication with Elders | No response | 4 Participants |
Other Pre-specified
Feasibility Questionnaire
A written questionnaire to assess navigator's experiences with, and effects of, Seasons of Care Guide
Time frame: Assessed monthly for 4 months; participants' ratings for each category were averaged. Average ratings per participant for each category is reported here.
Population: Two Navigators were unable to complete any monthly questionnaires due to changing work responsibilities during the COVID-19 pandemic. One Navigator left their position before completing any questionnaires.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 4 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 4 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 3 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 1 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 0 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 1 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 0 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Looks appealing (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 3 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 2 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 6 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 1 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 1 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily navigate on first try (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 3 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 3 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 5 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 1 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 1 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily re-located info (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 5 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 1 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 6 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 1 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can find relevant info using Search (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 1 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 5 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 3 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 2 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 2 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Can easily find healthcare facilities (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 1 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 2 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 3 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 1 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 1 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 1 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 1 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 2 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 1 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | AIEs like using it (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 10 | 3 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 9 | 3 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 8 | 2 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 7 | 2 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 6 | 1 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 5 | 1 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 4 | 1 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful for working with AIEs | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 2 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 0 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 5 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 2 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 2 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 2 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 0 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Provides info not available elsewhere (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 2 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 1 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 6 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 2 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 2 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Useful tool for healthcare providers (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 0 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 10 | 2 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 9 | 2 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 8 | 4 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 7 | 0 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 6 | 0 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 5 | 1 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 4 | 3 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 3 | 0 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 2 | 0 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | 1 | 0 Participants |
| Navigators | Feasibility Questionnaire | Is helping AIEs access care and insurance (Average rating: 10=Strongly agree, 1=Strongly disagree) | Not rated | 1 Participants |
Other Pre-specified
User Evaluation Demographic Survey
A demographic survey with AIEs and healthcare providers who interacted with a navigator using the Seasons of Care app
Time frame: Once at the end of P2 (Month 8 of 8)
Population: Due to complete closure of tribal communities during the COVID-19 pandemic, no data were collected for this outcome measure.