Table 2 Preliminary logic model of Seasons of Care American Indian Elder Outreach and Navigation Guide (AIEONG)

On individual and social support levels, AIEs/families may lack knowledge of rights and coverage options under public insurance plans, and encounter difficulties getting and understanding information to make informed decisions.

• AIE Navigators trained in applying the AIEONG.

• AIE Navigators recognize how cultural issues and aging processes affect health literacy for AIEs.

• Information on AIE rights, coverage, and health literacy.

• Strategies for making this information accessible and meaningful to AIEs.

• AIE Navigators develop accessible content regarding rights, coverage options, and implications for group presentations and one-on-one consultations with AIEs/families.

• AIE Navigators hold group presentations and one-on-one consultations with AIEs/families to share accurate information on coverage options and enrollment.

• AIEs and families know more about their rights and coverage/healthcare options.

• AIEs successfully enroll in public insurance programs.

• AIEs understand how their insurance works.

• AIEs stay insured.

• Increased use of healthcare services and decreased AIE health disparities.

• Shift in individual attitudes, beliefs, and behaviors to create a “Culture of Coverage.”

At organization and community levels, AIEs are likely to encounter barriers within healthcare settings, i.e., lack of knowledge among staff/providers, which can reduce AIE access to insurance and healthcare services.

• AIE Navigators trained in skills to educate staff/providers about effective outreach with AIEs.

• Information on application, eligibility determination/ enrollment processes.

• Information on cultural, organizational, and bureaucratic barriers specific to health care.

• List of resources (including training opportunities) for staff/ providers on health reform and AIE health literacy.

• AIE Navigators undertake informational outreach with staff/providers in IHS, tribally-run 638 programs, and other facilities.

• AIE Navigators educate staff/providers about common barriers, their implications for insurance/healthcare access, and processes to enroll AIEs in public insurance programs.

• AIE Navigators offer advice and/or conduct role plays with staff/providers to enhance skills in communicating and presenting health information to AIEs.

• AIE Navigators provide staff/providers with resources (e.g., training options).

• More competency and self-efficacy to engage AIEs among staff/providers.

• Increased access to resources (i.e., training and knowledge of evidence-based health literacy strategies) for staff/providers.

• Reduction in barriers most encountered by AIEs in healthcare settings.

• Enhanced response of staff/providers in healthcare systems to the unique needs of AIEs.

• More effective outreach and services to AIEs. Shift in organizational and community attitudes, beliefs, and behaviors to create a “Culture of Coverage.”

AIEs/families/OWs may lack experience in sharing feedback and input into insurance options and healthcare systems for aging AIs on the policy level.

• AIE Navigators trained to identify community-based partners (e.g., nonprofit, voluntary and professional).

• Information on AIE views and experiences with insurance and healthcare systems.

• List of strategies to remove barriers from insurance and healthcare systems among AIEs.

• List of policymakers, healthcare executives, and tribal leaders who create or manage policy regarding AIE health care.

• AIE Navigators undertake informational outreach with community partners to enlist AIE support.

• AIE Navigators create social spaces where AIEs, families, and community partners meet to share experiences and identify policy issues.

• AIE Navigators collaborate with AIEs, families, and partners to enact strategies to address policy issues.

• AIE Navigators, AIEs, families, and partners target policymakers, healthcare executives, and tribal leaders for education on insurance/healthcare issues.

• More access to support systems for AIEs and families.

• More attention to AIE-specific issues in policy formulation.

• More involvement of AIEs/families in policy development.

• Development of healthcare policy that contributes to a “Culture of Coverage,” and addresses healthcare disparities of AIEs.