Implementation of a Bilingual and Bicultural Navigation Program for Hispanic Children of Traumatic Brain Injuries

Research Objectives: To identify institutional contextual factors (e.g. structures, processes, culture, resources, etc.) in hospital settings that facilitate or hinder the implementation of bilingual and bicultural navigation programs for caregivers of Hispanic children with traumatic brain injuries.

Design: This is a qualitative study using the Consolidated Framework for Implementation Research (CFIR) framework to guide the identification of barriers and facilitating factors for the implementation of bilingual and bicultural navigation programs for families of children with TBI. We conducted semi-structured interviews with personnel involved in implementing the 1st BIEN program.

Setting: The study takes place with personnel involved in implementing the 1st BIEN program in hospital settings. 1st BIEN represents the first patient navigation program for Hispanic children with traumatic brain injuries. The participating sites for this program were Harborview Medical Center and Seattle Children’s Hospital in Seattle, Washington; Doernbecher Children’s Hospital in Portland, Oregon; Primary Children’s Hospital in Salt Lake City, Utah; and Children’s Medical Center in Dallas, Texas.

Participants: We used purposive sampling to recruit patient navigators and stakeholders (e.g. physicians, hospital administrators, etc.) involved in the implementation of the 1st BIEN project and other cultural navigation programs at participating institutions. A research assistant contacted eligible participants by email or was introduced to potential participants via email by a 1st BIEN staff member. Eligible participants were individuals involved in the implementation of the 1st BIEN project or another cultural navigation program at their institution.

Interventions: 1st BIEN is a culturally and linguistically appropriate brain injury education and navigation intervention, aimed to improve parental health literacy and self-efficacy, optimize access and adherence to rehabilitation, and ultimately improve health outcomes among Hispanic children.

Main Outcome Measures: Facilitators and barriers to implementing a bilingual and bicultural navigation program for caregivers of Hispanic children with TBIs.

Results: Participants identified key facilitators which included the program's, adaptability to patient needs, bilingual/bicultural patient navigator’s skills, and alignment with organizational values. Barriers included restrictive healthcare regulatory policies hindering interinstitutional work, incomplete medical records, and gaps in behavioral support training.

Conclusions: These findings offer insights for developing and optimizing patient navigation programs in pediatric TBI care. Such programs have the potential to improve access to care and reduce disparities for Hispanic children with brain injuries.

Author(s) Disclosures: The authors declare that they have no conflicts of interest.