Meeting a Need: Culturally Sensitive, Standardized Training for Patient Navigators in Appalachia

Background: For all cancer sites combined, incidence rates among both men and women in the Appalachian region are higher than US rates. The higher rates are related to socio-economic factors; health behaviors, particularly tobacco use; lower cancer screening rates; difficulties accessing care; and increased environmental exposure to carcinogens. Aspects of Appalachian lifestyle and culture, such as limited access to health care, a fatalistic view of cancer, and issues of health literacy may also contribute. Patient navigation (PN) has been demonstrated to increase access to cancer screening and treatment, particularly among the underserved. Navigators work with patients to overcome access barriers, offer peer counseling, provide linkages to financial and community resources, and provide culturally appropriate patient education. While PN may be especially useful in Appalachia, there is a lack of standardized training for navigators in this region. The objective of this project, funded by the Centers for Disease Control and Prevention and the Appalachian Regional Commission, is to build a PN training infrastructure in Appalachia to provide navigators with standardized, culturally-specific training.

Methods: We partnered with academic organizations, state and local health departments, and community organizations to design and implement a PN curriculum appropriate for the unique needs of navigators in Appalachia. Eight-hour training sessions began in August 2016 and will continue through September 2017. Training sessions are evaluated and follow-up assessment is carried out 3, 6, 9 and 12 months post-training. 

Results: As of September 2016, 76 navigators attended trainings, and 73 (96%) had completed course evaluations. A total of 79% of navigators stated this was the first navigation training they had attended. Participants rated training modules separately. Modules that the largest number of participants rated as “informative and useful” were Financial Issues (91% of 70; n=64), and Community Needs Assessment and Resources (87% of 72; n=63). Qualitative results indicate that navigators valued connecting with those from different contexts and settings within their local area.

Conclusions: Given the participants’ lack of previous PN training, this project is filling a need. As the PN workforce gains skills, the cancer incidence rates may decrease in this population. Providing infrastructure for local trainings to bring together navigators based in rural communities with those based in large cancer centers will help bridge the gap between these settings. This training system can serve as a model for other populations experiencing disparities in cancer and other chronic diseases.