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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