The following is a summary of “Recommendations for post-implementation adaptations to optimize family navigation in pediatric primary care: a qualitative study with parents and navigators,” published in the June 2023 issue of Primary Care by Levinson et al.
Family Navigation (FN) is an evidence-based care management intervention intended to reduce disparities in access to care by providing families with individualized support and care coordination. Initial findings indicate that FN is effective, but its efficacy is substantially influenced by contextual (e.g., setting) and individual (e.g., ethnicity) variables. To better understand how FN could be modified to address this variation in efficacy, researchers set out to investigate both navigators’ and families’ proposed modifications to FN. This study was a qualitative investigation embedded within a larger randomized clinical trial of FN to increase access to autism diagnostic services in urban pediatric primary care practices serving low-income, racial, and ethnic minority families in Massachusetts, Pennsylvania, and Connecticut. The Framework for Reporting Adaptations and Modifications-Expanded (FRAME) was used to conduct key informant interviews with a purposive sample of parents of children who received FN (n = 21) and navigators (n = 7). The interview researchers verbatim transcribed and coded using framework-guided rapid analysis to classify proposed adaptations to FN.
Parents and navigators proposed 38 modifications in four areas: intervention content (n = 18), intervention context (n = 10), 3) training and evaluation (n = 6), and 4) implementation and scale-up (n = 4). The most frequently endorsed adaptation recommendations centered on content (e.g., increasing the duration of FN, providing parents with additional education on autism, and parenting children with autism) and implementation (e.g., increasing access to navigation). However, inquiries researchers designed to elicit negative feedback, parents and navigators researchers enthusiastic about FN. This study builds upon previous research on the efficacy and implementation of FN programs by identifying specific areas for adaptation and improvement. Parents’ and navigators’ suggestions have the potential to inform the enhancement of existing navigation programs and the creation of new programs for similarly underserved populations. Adaptation (cultural and otherwise) is essential in health equity, making these findings crucial. Ultimately, transformations must be evaluated to ascertain their clinical and implementation efficacy.