title: American Indian and Alaska Native Cancer Patients' Perceptions of a Culturally Specific Patient Navigator Program.
abstract: Lack of access to care, funding limitations, cultural, and social barriers are challenges specific to tribal communities that have led to adverse cancer outcomes among American Indians/Alaska Natives (AI/AN). While the cancer navigator model has been shown to be effective in other underserved communities, it has not been widely implemented in Indian Country. We conducted in-depth interviews with 40 AI/AN patients at tribal clinics in Idaho and Oregon. We developed the survey instrument in partnership with community members to ensure a culturally appropriate semi-structured questionnaire. Questions explored barriers to accessing care, perceptions of the navigator program, satisfaction, and recommendations. AI/AN cancer patients reported physical, emotional, financial, and transportation barriers to care, but most did not feel there were any cultural barriers to receiving care. Navigator services most commonly used included decision making, referrals, transportation, scheduling appointments, and communication. Satisfaction with the program was high. Our study provides a template to develop a culturally appropriate survey instrument for use with an AI/AN population, which could be adapted for use with other indigenous patient populations. Although our sample was small, our qualitative analysis facilitated a deeper understanding of the barriers faced by this population and how a navigator program may best address them. The results reveal the strengths and weakness of this program, and provide baseline patient satisfaction numbers which will allow future patient navigator programs to better create evaluation benchmarks.
authors.affiliation: Northwest Portland Area Indian Health Board, 918 NE Rosa Parks Way, Portland, OR, 97211, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Grimes
authors.affiliation: Northwest Portland Area Indian Health Board, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA. jdankovchik@npaihb.org.
authors.forename: Jenine
authors.initials: J
authors.lastname: Dankovchik
authors.affiliation: College of Public Health and Human Sciences, Oregon State University, 6430 SE Ogden St., Portland, OR, 97206, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Cahn
authors.affiliation: Northwest Tribal Epidemiology Center, 2121 SW Broadway, Suite 300, Portland, OR, 97201, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Warren-Mears
mesh_terms: D000328:Adult; D000368:Aged; D000072957:Alaska Natives / Q000523:psychology*; D001294:Attitude to Health / Q000208:ethnology; D054521:Cultural Competency; D005260:Female; D006801:Humans; D007061:Idaho; D007198:Indians, North American / Q000523:psychology*; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009369:Neoplasms / Q000208:ethnology* / Q000523:psychology; D009922:Oregon; D062526:Patient Navigation / Q000379:methods* / Q000458:organization & administration / Q000592:standards; D017060:Patient Satisfaction / Q000208:ethnology*; D036301:Qualitative Research; D055815:Young Adult
keywords: Indigenous; Qualitative; Satisfaction; Survey; Tribal