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Review
. 2018 Jun 18;18(1):464.
doi: 10.1186/s12913-018-3182-y.

"Improving Native American elder access to and use of health care through effective health system navigation"

Cathleen E Willging  1   2 , David H Sommerfeld  3 , Elise Trott Jaramillo  4   5 , Erik Lujan  4 , Roxane Spruce Bly  4 , Erin K Debenport  6 , Steven P Verney  7 , Ron Lujan  4
Affiliations
Review

"Improving Native American elder access to and use of health care through effective health system navigation"

Cathleen E Willging et al. BMC Health Serv Res. .

Abstract

Background: Public insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.

Methods: This community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.

Discussion: The information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.

Trial registration: This protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404 . Registered June 6, 2018.

Keywords: American Indians; Health literacy; Healthcare access; Healthcare financing; Healthcare organization; Insurance reform; Mixed-methods research.

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Conflict of interest statement

Ethics approval and consent to participate

All procedures for this study, including recruitment, informed consent forms, data collection instruments, and dissemination of information, have been reviewed and approved by the Southwest Tribal Institutional Review Board under reference number SWT-2015-003.

Consent for publication

While this manuscript contains no individual data, it has been reviewed and approved by the Southwest Tribal Institutional Review Board under reference number SWT-2015-003.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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