Facilitators and Barriers to the Implementation of Bilingual and Bicultural Navigation Programs

Abstract

Background: Evidence-based interventions developed in research environments face challenges when translated to real-world clinical settings. Patient navigation programs are valuable for improving clinical outcomes among children, but knowledge gaps remain regarding contextual factors influencing the implementation of culturally tailored navigation programs. To address this gap, we examined factors that facilitate or hinder the implementation of a bilingual and bicultural navigation program for caregivers of Hispanic children with traumatic brain injuries.Methods: In-depth interviews were conducted with 12 personnel involved in implementing the 1st Brain Injury Education and Outpatient Navigation (BIEN) program for caregivers of Hispanic children with traumatic brain injuries within four states, and additional personnel working on similar programs within the same sites. The Consolidated Framework for Implementation Research (CFIR) guided the development of the interview guide and data analysis. We conducted a directed content analysis using deductive and inductive coding processes based on CFIR with two independent coders. Results: Participants identified facilitators and barriers across four domains: innovation, outer setting, inner setting, and individuals. Key facilitators included the program's relative advantage over existing practices, adaptability, patient navigator’s communication skills and experience, and alignment with organizational culture and values. Barriers were related to restrictive policies, insufficient office space, incomplete and delayed medical record documentation, and gaps in navigator training. Discussion: These findings offer insights to guide the development and optimization of patient navigation programs that address the unique needs of Hispanic children and families, supporting health systems in reducing access and outcome disparities for children with brain injuries.