Date of Award

1-1-2019

Document Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Trace Kershaw

Abstract

Abstract

Objectives: Low-income and minority children experience worse health outcomes for reasons that are complex and multifactorial. The aims of this study were to examine the experiences of caregivers and providers who participated in a patient navigation program designed to address these disparities, and to understand how the program was impactful to participants.

Methods: As part of a larger pilot-stage intervention, we conducted a qualitative study using a modified Realist Evaluation approach. Between April and October 2018, we conducted semi-structured interviews of a group of caregivers who were enrolled in the intervention, and the providers who cared for these children. Each set of interviews was thematically coded according to the realist framework categories of context, mechanism and outcome.

Results: We interviewed 50 caregivers and 23 providers, and found the program both feasible to implement and acceptable to participants. Through analysis of these interviews, we identified five mechanisms central to the program’s effect. These essential components were (1) emotional support, (2) the guide serving as a liaison or information conduit, (3) facilitating communication, (4) addressing basic needs and (5) increasing familiarity with hospital environment. We developed two program theories, one for the way in which caregivers experienced the program and another for the way in which it was experienced by providers.

Conclusions: This study provided insight into mechanisms that power pediatric patient navigation programs, provided detail on which program elements were effective for families and how a program of supportive care like this one impacts provider attitudes and actions on an inpatient general medicine service.

Comments

This thesis is restricted to Yale network users only. It will be made publicly available on 08/28/2021

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