Health Navigators: Promoting cultural competence and health literacy to increase prevention and wellness in underserved communities

Accessing culturally competent and linguistically concordant health care services are a challenge for underserved immigrant and refugee communities. In immigrant populations, barriers to accessing care include unfamiliarity with the complex western health care system, as well as lower health literacy. Furthermore, socioeconomic factors contribute to the scarcity of health professionals emerging from and serving these communities. To address the lack of culturally competent primary care providers who speak the languages of many immigrant and refugee groups, Asian Health Services (AHS), a federally qualified community health center located in Oakland, California, established a health navigator model. At AHS, Health Navigators are critical members of team-based care in the clinical setting. They perform duties such as medical interpretation (for which they are specifically trained) and cultural navigation, coupled with the technical expertise of medical assisting, in the context of health coaching and patient health education during a medical visit with a primary care provider. Health navigators utilize skills of motivational interviewing, agenda setting, and action planning with the patients in three phases during the medical encounter: a pre-visit, a post-visit, and an in-between visit. The health navigator model at AHS encompasses ten different Asian languages and communities (Cantonese, Mandarin, Cambodian, Korean, Mongolian, Vietnamese, Burmese, Karen, Mien, and Tagalog), as well as English. Challenges to incorporating a Health Navigator model in the primary care environment include training personnel in the various aspects of the multifunctional role, developing an efficient clinical patient flow model, building community capacity from newly emerging immigrant and refugee communities to provide of pool of possible candidates for hiring, and increasing cultural sensitivity and awareness amongst the diverse workforce within the clinical setting. The health navigator model is a best practice that can be used in primary care to promote prevention and wellness by increasing cultural competency of the clinical team, and increasing health literacy among underserved, limited English proficient, immigrant and refugee populations.