The Navegantes para la Salud Primary Care Access and Navigation Intervention: Role Conceptualization, Implementation, and Assessment

Purpose: Timely and appropriate access to primary care is essential to both the maintenance and improvement of population health. In the United States, federally qualified health centers (FQHCs) provide primary care services for underserved communities, which includes Hispanics with limited-English-proficiency. Community health workers, known as promotores de salud in Spanish, are recognized as an essential link between underserved communities and the formal healthcare system.  In nursing, the navigator role often refers to individualized assistance provided to patients with a specific health condition or in a specialized setting. Building on and combining aspects of both the community health worker and nurse navigator roles, we designed a Navegante para Salud (Health Navigator) intervention that combined elements of community outreach, community engagement, patient education, and navigational support, with the aim of improving access to and appropriate, timely utilization of community health clinics among Hispanic women and children in rural and urban settings in the state of South Carolina.

Methods: We recruited and selected three bilingual Hispanic women from the local community who participated in an on-site, hands-on training program for 3 months; subsequently they implemented the Navegante intervention over a period of 12 months. Initially we did identify divergent role expectations among both staff and patients, including the expectation that Navegantes serve as on-site language interpreters for clinic encounters, despite having held informational sessions with clinic staff prior to the initiation of the Navegante intervention. Over the course of the intervention, the Navegantes refined and expanded their roles as they gained experience in navigating multiple systems, developed working relationships with clinic staff, and formed relations and networks with other health and social services providers beyond the primary care setting.  

Results: To assess the impact of the Navegante intervention on access and utilization of FQHC clinics among Hispanic women and children, at the completion of the 12-month intervention we examined healthcare access and utilization data for the pregnant women and their dependents who had received navigational support; we then compared these data with a similar group Hispanic patients who had been seen at the same FQHC clinics during the previous year.

Conclusion: This model of culturally and linguistically appropriate health systems navigational support that incorporates key aspects of the community health worker and nurse navigator roles is an approach that could be applied with other populations and settings around the globe.