Yeo Sarah, Lee Inseok, Ehiri John, Magrath Priscilla, Ernst Kacey, Kim Yu Ri, Alaofè Halimatou
The University of Arizona Cancer Center, Tucson, Arizona, United States of America.
Institute for Global Health, University College London, London, United Kingdom.
PLoS One. 2025 Jan 30;20(1):e0314057. doi: 10.1371/journal.pone.0314057. eCollection 2025.
The complex healthcare system in the United States (US) poses significant challenges for people, particularly minorities such as refugees. Refugees often encounter additional layers of challenges to healthcare navigation due to unfamiliarity with the system, limited health literacy, and language barriers. Despite their challenges, it is difficult to identify the gaps as few tools exist to measure navigation competency among this population and many conventional tools assume English proficiency, making them inadequate for refugees and other immigrants. To address this gap, this study developed and validated a HEalthCare NAvigation Competency (HECNAC) Scale tailored to refugees' needs. The scale development process followed three phases: domain identification through a literature review and stakeholder interviews (n = 15), content validation through the Delphi method (2 rounds, n = 12), and face validity assessment via cognitive interviews (2 rounds, n = 4). Based on a literature review and stakeholder interviews, the initial version of the scale was developed, including ten domains and 47 items. An introductory email concerning the scale and the Delphi process was subsequently sent to 21 eligible experts, including staff from refugee resettlement agencies, health care providers serving refugee communities, and refugees. Twelve experts completed the two rounds of the Delphi, resulting in a consensus on 39 items. After conducting cognitive interviews with 4 Afghan refugees, the scale was finalized with ten domains and 35 items. The finalized scale captures multifaceted aspects of healthcare navigation crucial for refugees, organized into domains such as health system knowledge, insurance, making an appointment, transportation, preparing for a visit, in the clinic, interpretation, medicine, medical bills, and preventive care. Overall, the HECNAC Scale represents a significant step towards understanding and assessing refugees' competencies in navigating the US healthcare system. It has the potential to guide tailored interventions and standardized training curricula and ultimately mitigate persistent barriers faced by refugees in accessing healthcare services.
美国复杂的医疗保健系统给人们带来了重大挑战，尤其是为难民等少数群体。由于对该系统不熟悉、健康素养有限以及语言障碍，难民在医疗保健导航方面往往会遇到更多层次的挑战。尽管面临这些挑战，但由于几乎没有工具来衡量这一人群的导航能力，而且许多传统工具都假定具备英语能力，因此难以识别其中的差距，这些工具对难民和其他移民并不适用。为了填补这一空白，本研究开发并验证了一种针对难民需求的医疗保健导航能力（HECNAC）量表。量表开发过程遵循三个阶段：通过文献综述和利益相关者访谈（n = 15）确定领域，通过德尔菲法（2轮，n = 12）进行内容验证，以及通过认知访谈（2轮，n = 4）进行表面效度评估。基于文献综述和利益相关者访谈，开发了量表的初始版本，包括十个领域和47个项目。随后，向21名符合条件的专家发送了一封关于该量表和德尔菲过程的介绍性电子邮件，这些专家包括难民安置机构的工作人员、为难民社区提供服务的医疗保健提供者以及难民。12名专家完成了两轮德尔菲调查，就39个项目达成了共识。在对4名阿富汗难民进行认知访谈后，该量表最终确定为十个领域和35个项目。最终确定的量表涵盖了对难民至关重要的医疗保健导航的多方面内容，分为健康系统知识、保险、预约、交通、就诊准备、在诊所、口译、药品、医疗账单和预防保健等领域。总体而言，HECNAC量表是朝着理解和评估难民在美国医疗保健系统中的导航能力迈出的重要一步。它有可能指导量身定制的干预措施和标准化培训课程，并最终减轻难民在获得医疗保健服务方面面临的持续障碍。
