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Table 1 Overview of study phases, methods, and timeline

From: “Improving Native American elder access to and use of health care through effective health system navigation”

  Phase 1: Convening AIE Advisory Board and Training AIE Consultants Phase 2: Semi-structured Interviews and CM with AIEs (Aims 1 and 2) Phase 3: Semi-structured Interviews and CM with Key Stakeholders (Aim 3) Phase 4: Development, Implementation, and Evaluation of AIEONG (Aim 4)
Participant Category • AIE leaders and allies (n = 20; 8 Advisory Board members and 12 AIE Consultants) • AIEs (n = 96–144; 24–36 per region)
• Sample stratified by age and gender to ensure adequate representation for men and women aged 55–64 and 65+
• Outreach workers (n = 12)
• Healthcare staff/providers (n = 12)
• Public-sector administrators (n = 12)
• Tribal leaders (n = 12)
• AIE Navigators (n = 16; 8 in P1 and 8 in P2)
• AIEs (n = 48; 12 per region)
• Healthcare staff/providers (n = 48; 12 per region)
Sampling and Recruitment Strategy • Reputational case selection (candidates identified based on recommendations from members of research team and local experts from NMICoA) [86] • Stratified purposive sample (candidates selected from AI senior centers, healthcare settings, AIE Consultant referrals, and advertising to capture variations in the target population) [67] • Reputational case selection (candidates identified based on recommendations from local experts from NMICoA, healthcare support groups, and tribal programs) [86] AIE Navigators:
• Reputational case selection (candidates identified based on recommendations from local experts and interest in implementing AIEONG) [86]
AIEs and healthcare staff/providers:
• List sampling (candidates selected from master lists that will be compiled from attendance records of individuals who participate in AIEONG-related activities or have contact with an AIE Navigator)
Inclusion Criteria AIE Advisory Board:
• Expertise and experience related to AIE health and insurance issues
• Willingness and ability to participate in AIE Advisory Board activities
AIE Consultants:
• Language and communication skills
• Availability for training and data collection activities
• History of sustained community involvement
• Age 55+
• Identifying as AI
• Able to consent and complete study procedures
• For CM subset, able to read in English
• Individuals who champion, develop, implement, and/or engage in outreach, enrollment, and service delivery planning or provision to AIEs AIE Navigators:
• Working in health and insurance outreach to AIEs in a variety of healthcare settings (IHS, tribally-run 638 programs, senior centers).
AIEs:
• Age 55+
• Identifying as AI
• In contact with an AIE Navigator
• Able to consent and complete study procedures
• Able to read in English
Healthcare staff/providers:
• Working in a healthcare or social service profession
• Interacting with AIEs as part of their jobs
• In contact with an AIE Navigator
Data Collection Method N/A • AIE Health Questionnaire (AIEHQ) (Quantitative)
• Semi-structured view (Qualitative)
• CM (with a subset of 48 AIEs)
• Demographic survey (Quantitative)
• Semi-structured interview (Qualitative)
• CM
Period 1 AIE Navigators:
• Pre- and post-evaluation interviews
• Monthly rating questionnaire
Period 2 AIE Navigators:
• Pre- and post-evaluation interviews
AIEs and healthcare staff/providers:
• Focus groups
Goals AIE Advisory Board:
• Community oversight of study goals and progress
• Approve data collection procedures
• Prioritize data analysis plans
• Help interpret findings
• Guide development and evaluation of AIEONG
AIE Consultants:
• Increase local participation in study
• Enhance cultural and linguistic relevance
• Ensure ethical data collection procedures
• Offer essential content expertise
AIEHQ and Interview:
• Compare health, healthcare and insurance access and utilization, health satisfaction, health literacy, etc., among AIEs and other aging U.S. populations
• Understand key issues affecting help-seeking, health care, access, and satisfaction for AIEs at all SEM levels
CM:
• Further explore issues identified in interviews
• Generate relevant action items to improve health access and utilization for AIEs
Survey and Interview:
• Understand key issues affecting help-seeking, health care, access, and satisfaction for AIEs from the perspective of key stakeholders at all SEM levels
CM:
• Further explore issues identified in interviews
• Generate relevant action items to improve health access and utilization for AIEs
• Promote healthcare literacy, access, and use for AIEs
• Develop a replicable and culturally tailored model to enhance health system navigation among underserved populations
Timeline Convene Advisory Board:
• Months 1–60
Train research assistants and AIE Consultants:
• Months 1–9
• Months 9–24 • Months 9–24 AIEONG Planning and Training:
• Months 24–30
AIEONG Feasibility Assessment:
• Months 33–39; Months 45–51