Journal Article

Improving Native American elder access to and use of health care through effective health system navigation

Lujan, Ron, Lujan, Erik, Jaramillo, Elise Trott, Bly, Roxane Spruce, Sommerfeld, David H., Debenport, Erin K., Willging, Cathleen E., Verney, Steven P.

2018

Overview

Background Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care. Methods 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. Discussion The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities. Trial registration This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / American Indians / Community-Based Participatory Research / Female / governance and law / Health Administration / Health aspects / Health care industry / Health care policy / Health Care Reform / Health Informatics / Health insurance / Health literacy / Health policy / Health services / Health Services Accessibility - organization & administration / Health Services Accessibility - standards / Health Services for the Aged - organization & administration / Health Services for the Aged - standards / Health Services, Indigenous - organization & administration / Health Services, Indigenous - standards / Healthcare access / Healthcare Disparities / Healthcare organization / Humans / Indians, North American / Insurance coverage / Insurance reform / Laws, regulations and rules / Male / Medical Assistance / Medicine / Medicine & Public Health / Middle Aged / Minority & ethnic groups / Mixed methods research / Native Americans / Nursing Research / Older people / Patient Acceptance of Health Care / Planning / Public Health / Qualitative Research / reform / Study Protocol / United States - epidemiology