Codesigning a Community Health Navigator program to assist patients to transition from hospital to community

Mark F. Harris; An Tran; Mamta Porwal; Parisa Aslani; John Cullen; Anthony Brown; Elizabeth Harris; Ben Harris-Roxas; Fiona Doolan-Noble; Sara Javanparast; Michael Wright; Richard Osborne; Regina Osten

doi:10.1071/PY24042

RESEARCH ARTICLE (Open Access)

Codesigning a Community Health Navigator program to assist patients to transition from hospital to community

Mark F. Harris ^A ^* , An Tran ^A , Mamta Porwal ^A , Parisa Aslani ^B , John Cullen ^C , Anthony Brown ^D , Elizabeth Harris ^A , Ben Harris-Roxas ^E , Fiona Doolan-Noble ^F , Sara Javanparast ^G , Michael Wright ^H , Richard Osborne ^I and Regina Osten ^J

+ Author Affiliations

- Author Affiliations

^A Centre for Primary Health Care and Equity, UNSW Sydney, Sydney, NSW 2052, Australia.

^B School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia.

^C Aged Health, Rehabilitation, General Medicine, Endocrinology, Chronic Care, Andrology, and Hospital in the Home, Sydney Local Health District and University of Sydney, Camperdown, NSW 2006, Australia.

^D Health Consumers New South Wales, Sydney, NSW 2000, Australia.

^E School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia.

^F Goldfields University Department of Rural Health, Curtin University, Kalgoorlie, WA 6430, Australia.

^G Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA 5042, Australia.

^H Centre for Health Economics Research and Evaluation, University of Technology Sydney, Haymarket, NSW 2007, Australia.

^I Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Vic 3122, Australia.

^J Centre Agency for Clinical Innovation, NSW Health, Queanbeyan, NSW 2065, Australia.

^* Correspondence to: m.f.harris@unsw.edu.au

Australian Journal of Primary Health 30, PY24042 https://doi.org/10.1071/PY24042

Submitted: 4 April 2024 Accepted: 2 September 2024 Published: 19 September 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

This study aimed to identify the potential roles for Community Health Navigators (CHNs) in addressing problems faced by patients on discharge from hospital to the community, and attitudes and factors which may influence their adoption.

Methods

Twenty-six qualitative interviews and an online codesign workshop were conducted with patients, nurses, general practice staff, health service managers, community health workers, general practitioners, medical specialists, and pharmacists in the Sydney Local Health District. Qualitative themes from the interviews and workshop transcripts were analysed inductively and subsequently grouped according to a socio-ecological model.

Results

CHNs could assist patients to navigate non-clinical problems experienced by patients on discharge through assessing needs, establishing trust, providing social and emotional support that is culturally and linguistically appropriate, engaging family and carers, supporting medication adherence, and helping to arrange and attend follow up health and other appointments. Important factors for the success of the CHNs in the performance and sustainability of their roles were the need to establish effective communication and trust with other healthcare team members, be accepted by patients, have access to information about referral and support services, receive formal recognition of their training and experience, and be supported by appropriate supervision.

Conclusions

This study was unique in exploring the potential role of CHNs in addressing problems faced by patients on discharge from Australian hospitals and the factors influencing their adoption. It informed training and supervision needs and further research to evaluate CHNs’ effectiveness and the acceptance of their role within the healthcare team.

Keywords: aged care, chronic disease, codesign, community health workers, healthcare navigation, hospital discharge, supervision, training.

References

Bronfenbrenner U (1977) Toward an experimental ecology of human development. American Psychologist 32(7), 513-531.
| Crossref | Google Scholar |

Brown O, Kangovi S, Wiggins N, Alvarado CS (2020) Supervision strategies and community health worker effectiveness in health care settings. NAM Perspectives 2020, 1-8.
| Crossref | Google Scholar |

Brunner-La Rocca H-P, Peden CJ, Soong J, Holman PA, Bogdanovskaya M, Barclay L (2020) Reasons for readmission after hospital discharge in patients with chronic diseases – information from an international dataset. PLoS ONE 15(6), e0233457.
| Crossref | Google Scholar | PubMed |

Cabassa LJ, Camacho D, Vélez-Grau CM, Stefancic A (2017) Peer-based health interventions for people with serious mental illness: a systematic literature review. Journal of Psychiatric Research 84, 80-89.
| Crossref | Google Scholar | PubMed |

Creswell JW, Poth CN (2016) ‘Qualitative inquiry and research design: choosing among five approaches.’ (Sage Publications)

Donetto S, Pierri P, Tsianakas V, Robert G (2015) Experience-based co-design and healthcare improvement: realizing participatory design in the public sector. The Design Journal 18(2), 227-248.
| Crossref | Google Scholar |

Gallagher R, Luttik M-L, Jaarsma T (2011) Social support and self-care in heart failure. Journal of Cardiovascular Nursing 26(6), 439-445.
| Crossref | Google Scholar | PubMed |

Ibrahim N, Thompson D, Nixdorf R, Kalha J, Mpango R, Moran G, Mueller-Stierlin A, Ryan G, Mahlke C, Shamba D, Puschner B, Repper J, Slade M (2020) A systematic review of influences on implementation of peer support work for adults with mental health problems. Social Psychiatry and Psychiatric Epidemiology 55, 285-293.
| Crossref | Google Scholar | PubMed |

Jack HE, Arabadjis SD, Sun L, Sullivan EE, Phillips RS (2017) Impact of community health workers on use of healthcare services in the United States: a systematic review. Journal of General Internal Medicine 32, 325-344.
| Crossref | Google Scholar | PubMed |

Jacob V, Chattopadhyay SK, Hopkins DP, Reynolds JA, Xiong KZ, Jones CD, Rodriguez BJ, Proia KK, Pronk NP, Clymer JM, Goetzel RZ (2019) Economics of community health workers for chronic disease: findings from community guide systematic reviews. American Journal of Preventive Medicine 56(3), e95-e106.
| Crossref | Google Scholar | PubMed |

Jam VA, McKay KL, Holmes JT (2019) Identifying medication management confidence and gaps in training among community health workers in the United States. Journal of Community Health 44(6), 1180-1184.
| Crossref | Google Scholar | PubMed |

Javanparast S, Windle A, Freeman T, Baum F (2018) Community health worker programs to improve healthcare access and equity: are they only relevant to low- and middle-income countries? International Journal of Health Policy and Management 7(10), 943-954.
| Crossref | Google Scholar | PubMed |

Kangovi S, Mitra N, Grande D, Huo H, Smith RA, Long JA (2017) Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial. American Journal of Public Health 107(10), 1660-1667.
| Crossref | Google Scholar | PubMed |

Kangovi S, Mitra N, Norton L, Harte R, Zhao X, Carter T, Grande D, Long JA (2018) Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: a randomized clinical trial. JAMA Internal Medicine 178(12), 1635-1643.
| Crossref | Google Scholar | PubMed |

King L, Harrington A, Nicholls S, Thornton K, Tanner E (2023) Towards reduction of preventable hospital readmission: older people and family members’ views on planned self-management of care at home. Journal of Clinical Nursing 32(15-16), 4599-4613.
| Crossref | Google Scholar | PubMed |

Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW (2007) Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA 297(8), 831-841.
| Crossref | Google Scholar | PubMed |

Krulic T, Brown G, Bourne A (2022) A scoping review of peer navigation programs for people living with HIV: form, function and effects. AIDS and Behavior 26(12), 4034-4054.
| Crossref | Google Scholar | PubMed |

Li JYZ, Yong TY, Hakendorf P, Ben-Tovim DI, Thompson CH (2015) Identifying risk factors and patterns for unplanned readmission to a general medical service. Australian Health Review 39(1), 56-62.
| Crossref | Google Scholar | PubMed |

Mistry SK, Harris E, Harris M (2021) Community health workers as healthcare navigators in primary care chronic disease management: a systematic review. Journal of General Internal Medicine 36(9), 2755-2771.
| Crossref | Google Scholar | PubMed |

Mistry SK, Harris E, Harris MF (2022) Learning from a codesign exercise aimed at developing a navigation intervention in the general practice setting. Family Practice 39(6), 1070-1079.
| Crossref | Google Scholar | PubMed |

Mistry SK, Harris E, Li X, Harris MF (2023) Feasibility and acceptability of involving bilingual community navigators to improve access to health and social care services in general practice setting of Australia. BMC Health Services Research 23(1), 476.
| Crossref | Google Scholar | PubMed |

Okasako-Schmucker DL, Peng Y, Cobb J, Buchanan LR, Xiong KZ, Mercer SL, Sabatino SA, Melillo S, Remington PL, Kumanyika SK, Glenn B, Breslau ES, Escoffery C, Fernandez ME, Coronado GD, Glanz K, Mullen PD, Vernon SW (2023) Community health workers to increase cancer screening: 3 Community Guide systematic reviews. American Journal of Preventive Medicine 64(4), 579-594.
| Crossref | Google Scholar | PubMed |

Parker SM, Aslani P, Harris-Roxas B, Wright MC, Barr M, Doolan-Noble F, Javanparast S, Sharma A, Osborne RH, Cullen J, Harris E, Haigh F, Harris M (2024) Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial. BMJ Open 14(2), e077877.
| Crossref | Google Scholar | PubMed |

Schleiff MJ, Aitken I, Alam MA, Damtew ZA, Perry HB (2021) Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education. Health Research Policy and Systems 19, 113.
| Crossref | Google Scholar |

Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, Perry HB (2018) What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Human Resources for Health 16(1), 39.
| Crossref | Google Scholar | PubMed |

Shommu NS, Ahmed S, Rumana N, Barron GRS, McBrien KA, Turin TC (2016) What is the scope of improving immigrant and ethnic minority healthcare using community navigators: a systematic scoping review. International Journal for Equity in Health 15, 6.
| Crossref | Google Scholar |

Topp SM, Edelman A, Taylor S (2018) “We are everything to everyone”: a systematic review of factors influencing the accountability relationships of Aboriginal and Torres Strait Islander health workers (AHWs) in the Australian health system. International Journal for Equity in Health 17, 67.
| Crossref | Google Scholar |

Wild E-M, Winter V, Ress V, Golubinski V (2022) What is the impact of introducing a non-clinical community health advice and navigation service on the demand for primary care in socially deprived areas? Evidence from an observational panel study with difference-in-differences design. BMJ Open 12(10), e061964.
| Crossref | Google Scholar | PubMed |

Willis A, Reed E, Pratt-Chapman M, Kapp H, Hatcher E, Vaitones V, Collins S, Bires J, Washington E-C (2013) Development of a framework for patient navigation: delineating roles across navigator types. Journal of Oncology Navigation & Survivorship 4(6), 20-26.
| Google Scholar |