Implementation and sustainability of Bilingual Community Navigators providing navigation assistance to culturally and linguistically diverse (CALD) people in general practice

People from Culturally and Linguistically Diverse (CALD) backgrounds can experience health navigation challenges due to limited health literacy, language, and communication barriers thereby reducing access to health and social care service. General practitioners (GPs) can provide culturally responsive, coordinated care but struggle due to available time and other factors. International evidence demonstrates community health workers (CHWs) are effective in helping patients navigate health services, prevent admission, promote self-management and reduce health services demand. Bilingual Community Navigators (BCNs) can provide GP and patient support to improve communication, cultural understanding, screening, follow-up and appointment keeping. However, there is a gap in research on BCN integration and workforce development. In Australia this under development initiated a need assessment of general practices in Sydney and a co-design workshop with patients/families and stakeholders to identify navigation needs and solutions. Furthermore, a pilot study with three BCNs providing navigation support to 100 patients in two general practices demonstrating staff and patient feasibility and satisfaction.

This project evaluated the expanded implementation and sustainability of BCNs in primary care on patient satisfaction, service access and staff workloads. General practices were recruited providing care to languages other than English and BCNs recruited from matching cultural and language backgrounds. BCN logbooks and GPs, patients and BCNs interviews were analysed using Normalisation process theory (NPT) to understand implementation coherence, participant cognitive participation, collective action and reflexive monitoring.

BCNs were placed in Samoan (1), Arabic (2) and Chinese (2) practices. One Chinese practice and its BCN withdrew. One Arabic practice referred few patients and the BCNs relocated to the other practice. Overall, BCNs assisted 110 patients with referral to hospital outpatients, medical specialists, allied health professionals, community and social care services. Navigation issues included language, availability, cost, transport, legal, work, disability, social care, health literacy, financial support, mental illness, medication adherence and immigration. BCNs assisted to book appointments, access community resources; translating and explaining information.

Thirteen interviews were completed with GPs, BCNs, patients/ carers. The analysis produced themes that were grouped according to the NPT components: Coherence: GPs, practice staff, patients and their families saw clear benefits of BCNs providing navigation support to patients. Cognitive participation: Some GPs, staff and patients were motivated to make the BCNs placements successful. Others needed a better understanding of BCN competencies and scope of practice to be able to refer patients to the program. One felt that too few of patients needed BCN support to make placement worthwhile. Collective action: The GP’s endorsement of the BCN was critical to securing the trust of patients, and thus placement success. Reflexive monitoring: Incorporating BCNs into routine practice required frequent use and feedback on the results. This occurred in two practices but not for others because of work practices, and the practice population needs.

The study demonstrated BCN feasibility and acceptability with scope of practice expansion and refinement recommended to address patient social and chronic care needs. BCNs have an important emerging role in Australian primary care. Lessons learnt will support BCN implementation with work to develop sustainable systems.