TABLE 2.

Examples of Advantages and Disadvantages of Where Navigators Work

Factor	Clinical Setting		Community-Based Setting
	Advantages	Disadvantages	Advantages	Disadvantages
Cultural skills and language	Typically some cultural awareness and skills	Although required by law, clinical settings are unable to address the multitude of languages used by patients.	Tailored, appropriate cultural interventions, interactions, and communication patterns acceptable to the patients	Cannot provide 24/7 cultural or Native language speaker services
Access to screening and follow-up services	Usually has a long-term or established relationship with the clinics that provide screening, diagnosis, or follow-up care.	Internal politics of other healthcare providers who feel they have already been implementing the navigator duties	Flexibility to work with patients and help them attain help regardless of the service provider	Need formal agreements with healthcare facilities to be able to access services
Protocols	Protocols usually clearly specified (i.e., who, what, when, where, how, and how often)	Protocols may not be adaptable to meet the needs of patients or families	May or may not include protocols for how the Native navigator is to interact with patients and families	Intermittent funding likely to interfere with training and continuity of navigation services
Health benefits for navigators	Usually access to higher-quality benefits for the navigator (e.g., insurance)	Many of the navigators are expected to work for no salary or benefits.	Native navigators are paid and some may receive benefits, depending on number of hours worked.	Some community-based organizations are unable to provide benefits.
Transportation	Drivers (Community Health Representative if Indian Health Service/Tribal/Urban program) or access to a free clinical transportation system	Intermittent schedules and may not go to the communities where American Indians and Alaska Natives live	Some Native navigators have coverage to protect them in case of accidents when they pick up and transport patients and family members.	Many community-based organizations cannot provide supplemental automobile coverage.
Child care	Some clinics have a children’s play area with toys or videos.	Play area may be located away from patients; no super vision unless a family member watches the children	Children typically welcome in any Native setting	May not be a play area or supervision if family member or staff member is not available to watch children
Mobile van versus mammogram from clinic	If the van is from the clinic, films are delivered directly to the radiologist for reading.	Back-log of films for the radiologist to read; mobile films frequently put at the bottom of the pile	Van goes to Indian Health Service/Urban/Tribal clinics where patients feel the most comfortable; Native navigator can accompany them up until the mammogram is done; Native women blessing the equipment and women before and after screening	Vans must do about 18 mammograms a day to break even on their costs. Fewer vans exist because of cost; when a van does more than 20 screenings a day, later ones frequently have more errors and women have to come back for follow-up

Note. From Native Sister/Patient Navigation: American Indian/Alaska Native (p. 2), by B. Seals and L. Burhansstipanov, 2008, Lakewood, CO: Native American Cancer Research. Copyright 2008 by Native American Cancer Research. Reprinted with permission.