Navigation provided by community health workers: Expanding the cancer navigator model to chronic disease

Background: In 2008, the Health Resources and Services Administration (HRSA) funded the Patient Navigator Outreach and Chronic Disease Prevention Demonstration Program (PNDP). Under PNDP, grantees developed navigator programs targeting chronic diseases among health disparities populations. In the past, community health workers (CHW) have worked extensively as navigators to improve early cancer detection in underserved communities. Under this model, navigators addressed patients' barriers to cancer screening and follow-up by providing education, linkages to resources, and services coordination. Under PNDP, the navigator model was extended to chronic diseases other than cancer. This presentation describes the revised model. Methods: The cross-site evaluation collected quantitative information regarding navigator encounters, barriers to care, and referrals. Site visits yielded information about common themes and procedures. Results: PNDP provided full navigator services for 4,366 patients, 66% of whom were diagnosed with a chronic disease. On average, navigators engaged in 6.5 interactions per patient. Surprisingly, 31 percent of interactions addressed no specific barrier. In 23 percent of cases, navigators facilitated referrals to more than one type of medical care provider (specialist, diagnostic testing, or primary care). Education was a critical component, and the importance of lifestyle in successful treatment of chronic disease led grantees to train navigators in strategies to facilitate behavior change. Conclusion: CHWs' cultural competence and community knowledge are critical to successful navigation for both chronic disease and cancer. However, there are important differences between navigator models. Future programs should take these differences into consideration.