title: Design and implementation of a patient navigation system in rural Nepal: Improving patient experience in resource-constrained settings.
abstract: Patient navigation programs have shown to be effective across multiple settings in guiding patients through the care delivery process. Limited experience and literature exist, however, for such programs in rural and resource-constrained environments. Patients living in such settings frequently have low health literacy and substantially lower social status than their providers. They typically have limited experiences interfacing with formalized healthcare systems, and, when they do, their experience can be unpleasant and confusing. At a district hospital in rural far-western Nepal, we designed and implemented a patient navigation system that aimed to improve patients' subjective care experience. First, we hired and trained a team of patient navigators who we recruited from the local area. Their responsibility is exclusively to demonstrate compassion and to guide patients through their care process. Second, we designed visual cues throughout our hospital complex to assist in navigating patients through the buildings. Third, we incorporated the patient navigators within the management and communications systems of the hospital care team, and established standard operating procedures. We describe here our experiences and challenges in designing and implementing a patient navigator program. Such patient-centered systems may be relevant at other facilities in Nepal and globally where patient health literacy is low, patients come from backgrounds of substantial marginalization and disempowerment, and patient experience with healthcare facilities is limited.
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal.
authors.forename: Anant
authors.initials: A
authors.lastname: Raut
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal.
authors.forename: Poshan
authors.initials: P
authors.lastname: Thapa
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; University of Washington, Department of Anthropology, Seattle, WA, United States; University of Washington, Department of Global Health, Seattle, WA, United States; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, United States.
authors.forename: David
authors.initials: D
authors.lastname: Citrin
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, United States.
authors.forename: Ryan
authors.initials: R
authors.lastname: Schwarz
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal.
authors.forename: Bikash
authors.initials: B
authors.lastname: Gauchan
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal.
authors.forename: Deepak
authors.initials: D
authors.lastname: Bista
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal.
authors.forename: Bibhu
authors.initials: B
authors.lastname: Tamrakar
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, United States; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States.
authors.forename: Scott
authors.initials: S
authors.lastname: Halliday
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, United States; Harvard Medical School, Department of Medicine, Boston, MA, United States.
authors.forename: Duncan
authors.initials: D
authors.lastname: Maru
authors.affiliation: Possible, Bayalpata Hospital, Badelgada, Ridikot-2, Achham, Nepal; Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, United States; Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, United States.
authors.forename: Dan
authors.initials: D
authors.lastname: Schwarz
mesh_terms: D003695:Delivery of Health Care; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D009390:Nepal; D062526:Patient Navigation; D019035:Rural Health Services; D012424:Rural Population
keywords: Global health; Implementation research; Nepal; Patient navigation; Patient-centered care