Table 1 Overview of study phases, methods, and timeline

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