Implementation of culturally targeted patient navigation system for screening colonoscopy in a direct referral system

Abstract

Low-income minorities often face system-based and personal barriers to screening colonoscopy (SC). Culturally targeted patient navigation (CTPN) programs employing professional navigators (Pro-PNs) or community-based peer navigators (Peer-PNs) can help overcome barriers but are not widely implemented. In East Harlem, NY, USA, where approximately half the residents participate in SC, 315 African American patients referred for SC at a primary care clinic with a Direct Endoscopic Referral System were recruited between May 2008 and May 2010. After medical clearance, 240 were randomized to receive CTPN delivered by a Pro-PN (n = 106) or Peer-PN (n = 134). Successful navigation was measured by SC adherence rate, patient satisfaction and navigator trust. Study enrollment was 91.4% with no significant differences in SC adherence rates between Pro-PN (80.0%) and Peer-PN (71.3%) (P = 0.178). Participants in both groups reported high levels of satisfaction and trust. These findings suggest that CTPN Pro-PN and Peer-PN programs are effective in this urban primary care setting. We detail how we recruited and trained navigators, how CTPN was implemented and provide a preliminary answer to our questions of the study aims: can peer navigators be as effective as professionals and what is the potential impact of patient navigation on screening adherence?

Fig. 1.

Study flow chart (East Harlem, NY, USA; May 2008–May 2010).

Fig. 2.

Trust in navigator and message and source credibility scales. ^aAnderson LA, Dedrick RF. Development of the Trust in Physician Scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep 1990;67:1091-1100; ^bHerek, G. M., Gillis, J. R., et al. Culturally sensitive AIDS educational videos for African American audiences: effects of source, message, receiver, and context. Am J Community Psychol 1998;26;705-743; ^cNational Cancer Institute. Health Information National Trends Survey 2005 (HINTS 2005). Bethesda, MD. National Cancer Institute 2005. http://hints.cancer.gov/docs/hints_report.pdf; ^dMade PN-specific; ^eScores were reverse-coded in SPSS.