Community Outreach & Patient Empowerment (COPE) for Navajo Living with Chronic Diseases

COPE (Community Outreach and Patient Empowerment) is a formal collaboration between the Navajo Nation Community Health Representative (CHR) Program, Gallup and Shiprock Service Units of the Indian Health Services (IHS), and Brigham and Women's Hospital. COPE objectives are 1) to provide the CHRs with training, support and resources, 2) to improve the health of patients with poorly-controlled chronic conditions, and 3) to prevent diabetes mellitus and other chronic conditions by working with high-risk families. COPE has three components: 1) CHR training focused on health education and health promotion; 2) enhanced communication between CHRs and providers; and 3) Health Promotion Package for COPE clients (i.e. patients with uncontrolled chronic conditions). Health education covers topics such as diabetes, nutrition, and alcohol use. Competency assessment and training by Navajo-speaking IHS providers ensures that CHRs deliver high-quality, consistent information. Health promotion training covers counseling techniques such as motivational interviewing. IHS physicians perform patient home visits to provide one-on-tone training and facilitate communication with primary providers. Regular meetings between CHRs and providers are intended to form linkages between clinic- and community-based teams. CHRs visit COPE clients every two weeks over 12-18 months to deliver structured teaching sessions. Interactive flipcharts use culturally appropriate visual images and Motivational Interviewing techniques to cover topics such as diabetes basics, hypertension, medication adherence, nutrition, diet and exercise. COPE evaluation includes clinical indicators and health utilization of COPE clients, and formal feedback from CHRs, providers, and educators.