Improving the ‘Community Navigator Model’ to
address health inequalities in culturally and
linguistically diverse ( CALD) communities:
A reflective case study
Authors
Associate Professor Saras Henderson, School of
Nursing and Midwifery, Griffith University, QLD, Australia
(Presenter)
Professor Elizabeth Kendall, School of Human Services
and Social Work, Griffith University, QLD, Australia
Photos of Community Navigators & CALD community
members presented with permission
Surfers Paradise: Gold Coast
Queensland, Australia
Background
 The 2011 Australian National Health Reform via the Access
and Equity Policy highlights the need to improve health
services for all Australians.
 CALD communities experience lower access to care and
poorer health outcomes than the general population due to
difficulties navigating the Australian Health System.
 This leads to CALD communities only seeking health care
when their health condition has reached a crisis point which
is less than optimal.
 In response, the Community navigator Model was
developed and implemented in four CALD communities
(Sudanese, Burmese, Afghani, Pacific Islander) in Southeast QLD, Australia.
CALD community members
Refugee population in Queensland
The Community Navigator Model
Nine navigators were selected from the four CALD
communities and trained
The navigator’s role included:
 Accessing clients’ needs
 Facilitating health promotion
 Supporting community members to access GPs
and health services
 Engaging in cultural advocacy
 Supporting GPs to use interpreters
 Facilitating referrals to health services
The Navigators from Myanmar, Africa, Samoa
Pacific Islander and Afghani Navigators
The navigators
 Were employed within a Non -Government
Organisation involved in the model development
 Worked to support community members in
attempts to access health and social services and
create opportunities for communities to build
relationships with health professionals and service
providers
 Were paid and worked 11 hours/week
 Kept a record of their activities and outcomes
 Attended learning circles at the university to gain
knowledge about the Health Care System
Evaluation of the Navigator Model
showed:




It was accepted by the CALD communities
Was associated with positive health outcomes
Increase in the number of visits to the GP
Increase in CALD community members seeking
mental health services
ᵡ emergence of tensions that impacted on the financial,
social, and organisational durability of the model
affecting sustainability of the model. These tensions
needed to be resolved.
Methodology
Reflective Case Study guided by Donald Schön’s (1983)
5-step approach:
 Reflection-in–action (our learning and thinking during
the implementation process over 12 months) and
 Reflection-on- action (post evaluation that enabled us
to:
» Reflect on the initial decisions we made regarding
implementation;
» Identify tensions and deliberate on how we could
resolve these tensions.
Schön’s (1983) Five-step process of
reflection
Report
Respond
Relate
Reason
•Reconstruct
Method
 Asking a series of questions
» What worked in the model?
» What did not work in the model?
» What factors enhanced the model?
» What factors posed a barrier to the model?
 Consulting with others
» Stakeholders involved in the development of the
model
» Gate keepers of CALD communities
» Local health department
 Reviewing the navigators’ reports; interviews with the
navigators
Results
Through our reflections and discussions, despite the
positive outcomes, we identified four core areas of
tension which were:
1. Using a navigator-centric vs community centred
approach
2. Training of navigators vs the construction of a
learning culture
3. Supporting grassroots approaches vs managing risk
within a bureaucratic system
4. Maintaining the integrity of the model vs attracting
funds
Lessons learned: Possible solutions to
ensure sustainability
Tension 1
Using a navigator-centric approach
 We focused on navigators to formally and financially
acknowledge their work done in CALD communities
which led to work voluntarily done by community
members previously was now redirected to the
navigators= navigator exhaustion.
Solution:
 Need to focus on a community-centred approach and
promote whole-of-community involvement in assisting
each other to access health services (LeFebvre &
Franke, 2013).
Lessons learned: Possible
solutions to ensure sustainability
Tension 1 Solution cont’d:
 Navigators to stay in role for short time only and return
to the community.
 Term of navigator to be staggered so when one leaves
a new navigator takes up the paid role; eventually
building community capacity and increasing health
literacy in the community.
 Cyclic or apprentice model can prevent navigator
exhaustion while at the same time increasing the
number of experienced navigators in the community
and enhancing the community ownership of the
approach.
Lessons learned: Possible solutions to
ensure sustainability
Tension 2
Training only for navigators
 We conducted learning circles only for navigators
leading to the community perception that only the
navigators had the knowledge.
 Solution:
We need to build learning communities where learning
becomes a whole-of-community mandate and members
are then more likely to be proactive in seeking health
information rather than relying solely on the navigators.
Lessons learned: Possible
solutions to ensure sustainability
Tension 2 Solution cont’d:
 Demands on navigators will be reduced and health
literacy of community members will increase and the
success of the navigator role will be enhanced.
 Investment in community-based learning culture can
be less costly and more effective as the information
would be disseminated more widely.
 Easier to conduct a process similar to the learning
circle in an environment where community members
congregate such as local community halls, churches.
 Information can be provided on a needs basis
depending on the level of health literacy in the
community.
Lessons learned: Possible solutions to
ensure sustainability
Tension 3
 We supported grassroots approaches with role as the
cultural or community way of thinking and acting was
accepted by the community. The grassroots modus
operandi of communities conflicted with the
requirements and rules of the bureaucratic setting in
which we placed the navigators.
 Solution:
We needed to work closely with communities to
understand their modus operandi and to use this
understanding to put structures around the model to
manage risk within a bureaucratic system.
Lessons learned: Possible
solutions to ensure sustainability
Tension 3 Solution cont’d:
 Where appropriate one-to-one advising and supporting
rather than a broad-based health promotion mandate.
 Need to be aware that not all navigators are able to
adapt grassroots practices to suit bureaucratic
requirements. Support creativity and flexibility.
 Not assuming that allowing navigators to operate in
ways that suited their communities would
automatically enhance safety and acceptability.
 The need to mentor navigators through difficult
decision points so they can reach the best outcomes
for both the community and their employer.
Lessons learned: Possible solutions to
ensure sustainability
Tension 4
 We wanted to maintain the integrity of the model as a
community-based response to health promotion rather
than driven by the bureaucratic agenda. This was only
possible whilst funds were available. Flexible funding
was needed to sustain the model which was not
readily available leading to navigators becoming
frustrated and having to adopt practices as required by
the specific funding bodies. This led to the integrity of
the model being lost.
Lessons learned: Possible
solutions to ensure sustainability
 Solutions:
We needed to attract additional financial support in the
form of ongoing funds. Our reflection showed that whilst
there was enormous enthusiasm and optimism about the
opportunity for the community, change occurs slowly and
only with intense levels of financial and bureaucratic
support could the model be sustained.
 Paradoxically, the attainment of ongoing funds meant
the model became embedded within a minibureaucratic formal structure.
 The need to simultaneously build flexibility and
structure into the navigator role.
Conclusion
Our paper provides:
 A perspective on how the development of communitybased service models inherently places them in a
position of tension that must be resolved if they are to
be sustainable over time.
 Resolving tensions in culturally appropriate
community-based models can create a more durable
pool of community navigators that can facilitate
community empowerment, self-governance of health
issues and a sense of community ownership of health
services.