Background: Appalachia ranges from southern New York to Mississippi and includes areas with pronounced health disparities, poverty, and elevated rates of cancer and other chronic diseases. Health disparities in Appalachia are compounded by income and educational levels lower than those in urban and suburban populations. There are no known patient navigation training programs specific to rural and Appalachian populations. Patient navigation is a patient-centered strategy designed to help patients overcome barriers to obtaining needed healthcare. However, to be effective, patient navigators must be aware of cultural and community factors that influence access to care. Rural and Appalachian populations have cultural characteristics that influence healthcare interactions and decisions related to obtaining healthcare as well as place-based characteristics such as geographic isolation and long distances to cancer care coupled with limited access to transportation.
Objectives: (1) Participants at this presentation will be able to describe Appalachia and identify factors associated with health disparities; (2) Participants will be able to list guiding concepts for planning patient navigation training for Appalachia and rural communities; and (3) Participants will be able to describe the value of developing a culturally effective navigation training that focuses on the unique needs of this population.
Methods: In collaboration with the Appalachian Regional Commission and the Centers for Disease Control and Prevention, we developed a culturally effective navigation training program that focuses on the specific population issues and needs. The program consists of day-long workshops composed of modules providing information on patient navigation and its history; cultural characteristics of rural and Appalachian populations; intersection of culture and health; communication issues; navigation for screening and follow-up for breast, cervical, colorectal, and lung cancer; and community assessment. The workshops include didactic instruction, case study review, resource review, and group activities. Evaluation includes pre-post assessment and participation evaluations of instruction and the learning environment. Additional assessment of the perceived utility of the workshop and interest in additional training is carried out through online follow- up at 3, 6, 9, and 12 months.
Results: A total of 20 workshops including 334 participants have been conducted from August 2016 through June 2018. The workshops have been provided in 9 Appalachian states in conjunction with a range of community partners. Participants’ background varied widely and included individuals assigned to patient navigator roles at their places of employment with training in nursing, social work, and public health education. Of the 334 participants, 127 (38%) reported previous patient navigation training. The overall mean pretest score was 79% and increased to 83% on the posttest (t = 3.8; P = .002).
Conclusion: In the follow-up assessments participants indicated that they valued the content, found the workshop content useful for their practice, and that they were interested in additional training in patient navigation. The training raised issues they had not previously thought about for their practice. Suggestions for future training include assisting patients with financial issues related to cancer care, pediatric navigation, motivational interviewing, survivorship care planning, and training focusing on navigation for additional cancer sites such as head and neck. Many navigators practice in isolation. For example, navigators working in small rural communities often don’t have opportunities to interact with the navigators in large cancer centers to which they frequently refer their patients. The workshop gave them the chance to connect and put a face with a name. Participants indicated that the workshops offered, for many, a rare opportunity to meet individuals from current referral sites, discuss shared challenges and strategies, network, and identify future partners.