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

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

Assumptions Inputs Activities/ Outputs Outcomes Impact
Promote healthcare literacy among AIEs of diverse cultural backgrounds
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.”
Educate staff/providers within healthcare delivery systems serving AIEs in reservation and non-reservation communities.
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.”
Encourage the inclusion of AIE perspectives in development of healthcare policy.
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.