1. Patient Navigation, Community Based Participatory Research and Asian Health Disparities Karen Freund MD MPH Professor and Vice Chair of Medicine Tufts Medical Center Tufts University School of Medicine

2. Goal of today’s talk Patient Navigation to address health disparities Why community participation in patient navigation research was critical to its success What are the important health issues for Asian American women today?

3. Theoretical Model of Factors that Influence Disparities PreventionScreeningTreatment PATIENTPROVIDER SYSTEM BIOLOGIC Diagnosis Morbidity and Mortality

4. Patient Navigation as a Systems Intervention to Address Diagnostic Delays PreventionScreeningTreatment PATIENTPROVIDER SYSTEM BIOLOGIC Diagnosis Morbidity and Mortality

5. OUTREACH PATIENT NAVIGATION REHABILITATION Abnormal Finding Resolution Initial Contact Conclude Navigation Abnormal finding/diagnosis to resolution Eliminate critical delivery gap for populations experiencing disparities Abnormal results/ Diagnosis Diagnosis TreatmentSurvivorship General Framework of Patient Navigation

6. Patient Navigators Address Individual Patient Barriers Translate medical next steps and what to expect into lay language Promote understanding of healthcare system pathways Understand the patient’s health belief system Coaching and cultural, emotional and psychosocial support Assistance with physical needs and other barriers to care Facilitate referrals to community resources and social services

7. Breast Screening Abnormalities Cervical Screening Abnormalities Impact of Patient Navigation Intervention on those with Diagnostic Resolution in 1 Year

8. Does everyone need navigation? Is there a subset of patients who benefit? Can we determine who benefits a priori Reduce resources for the same benefit

9. Who benefits the most from navigation? Navigation eliminated the gap for these vulnerable populations ▫ Low income ▫ Unmarried ▫ Unstable housing ▫ Unemployed Navigation also benefited those with: ▫ Multiple health care problems ▫ Social and legal barriers to care

10. Why was patient navigation successful? Partnership between the research team and community stakeholders

11. What is Community Based Participatory Research (CBPR)? A true community-academic partnership Goal of improving health in the community

12. Community Based Participatory Research Asks the right questions Advises on methods that will work Interprets the findings based on knowledge of community Uses the findings to benefit the community Researchers Community members Change

13. How was CBPR critical to success of patient navigation? Helped understand barriers to care Aligned important stakeholders to help Helped design a study that could be completed in multiple community health centers Once the results were in, we worked together to find resources for ongoing support

14. What do investigators need to do? Ask questions Support the community efforts in the research ▫ Provide resources once the research is funded Ask for help to interpret the findings Use the stakeholder group to disseminate results

15. Asian Health Disparities in Women today What are the important health questions?

16. Boston’s Chinatown Cancer leading cause of death among Asian American women Breast Cancer most common cancer in Chinese American women High rates of liver and stomach cancer Fifth largest Chinese population Most densely settled neighborhood 56% foreign born 62% linguistically 62% linguistically isolated

17. Asian Cancer Disparities Foreign born Asian populations have the greatest unmet needs during cancer care Foreign born Asian populations have greater miscommunication about goals of cancer treatment

18. Asian Diabetes Disparities More diabetes, metabolic diseases at lower weight ▫ Overweight and obesity redefined for Asian populations

19. Asian Mental Health Disparities Least likely to be screened for depression Present with physical symptoms Although patients understand their symptoms to have emotional cause, less likely to receive treatment

20. Asian Health Disparities Challenge of heterogeneity One size does not fit all Different challenges for different sub populations Barriers to care often greater in foreign born Asian American women Disease risks may or with place of birth

21. What we hope to gain today Community perspective ▫ Important health needs among Asian American women ▫ Challenges ▫ Solutions Academic perspective ▫ Interventions to test solutions ▫ Methods to evaluate the interventions