Do lay health advisors effectively improve access to cardiac services among women?

Objectives: Lay health educators trained as patient navigators (PN) have improved use of cancer services among under-served populations by overcoming access barriers, but little is known about the effectiveness of navigators to improve access to cardiac services such as outpatient cardiac rehabilitation (OCR). Despite compelling evidence of the public health benefits of OCR, enrollment is low, and disproportionately for women. Building on an academic-community partnership among 6 community-based OCR programs and an academic team, this study assessed if navigators differentially impacted OCR awareness and enrollment rates between male and female cardiac patients, compared to Usual Care (UC).

Methods: Eligible patients were consented during inpatient cardiac care and randomly assigned to PN (n= 90) or UC (n=91). Navigators (2 African American women) were trained using role plays and content-specific instruction to provide education and support during face-to-face and phone-based contact with PN patients. Awareness of OCR was assessed by telephone at 12-weeks post-hospitalization, and OCR programs confirmed OCR enrollment.

Results: Both genders were 5 times more aware of OCR in PN compared to UC. There were no differential effects of awareness between genders. PN males were more likely to enroll in an OCR program compared to UC males (24.6% vs. 3.3%, P=0.004). PN did not have a significant effect on enrollment among women (14.3% of UC vs. 21.9% of PN women enrolled).

Conclusions: Lay educators significantly improved OCR awareness for both men and women. Navigation significantly improved OCR enrollment for men, but was not successful to overcome barriers among women.