Community Perceptions of the “Health Equity Navigators” Program: A Cross-Sectional Study in Rural and Underserved US Populations

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This study examines community perceptions of the Health Equity Navigators Program and identifies socio-demographic predictors of perceived helpfulness in improving healthcare access and navigation. Methods A cross-sectional survey was conducted among 269 adults residing in rural and urban medically underserved areas. Participants completed items assessing demographic characteristics, healthcare access, and perceived benefits of the “Health Equity Navigators” Program using a Likert scale. Descriptive statistics were used to summarize perceptions, and ordinal logistic regression models were applied to examine demographic predictors of agreement with the program’s ability to improve healthcare-seeking efficiency. Results The Majority of the participants (69.1%) live in rural areas, females (79.6%), and Black/African Americans (59.6%). Most participants agreed or strongly agreed that the program improved their knowledge (Mean = 4.0, SD = 0.8), awareness (Mean = 4.1, SD = 0.9), and ability to navigate healthcare services (Mean = 4.0, SD = 0.8). Perceptions were significantly more favorable when neutral responses were excluded (p < 0.0001). In adjusted models, males (OR = 2.07, 95% CI: 1.08–3.96) and unemployed individuals (OR = 2.00, 95% CI: 1.06–3.75) were significantly more likely to report high agreement, while African American/Black participants had lower odds of strong agreement compared to Non-Hispanic White participants (OR = 0.56, 95% CI: 0.34–0.92). Conclusions The “Health Equity Navigators” Program was positively received across demographic groups in the rural and underserved communities. However, differential perceptions by race and residential settings highlight the need to tailor health navigator models to the specific needs of the populations. A tailored program implementation is critical in addressing structural barriers and advancing health equity in medically underserved areas. Figures Figure 1 Background Access to timely, high-quality healthcare remains unevenly distributed in the United States, with rural and underserved populations experiencing significant and persistent barriers to care [1–3]. Multiple structural and contextual factors, including geographic isolation, provider shortages, socioeconomic disadvantage, and cumulative disadvantage, all contribute to continued variance in care access and health outcomes[4–6]. An estimated 66 million Americans reside in rural areas, where access to healthcare is often limited and specialty services are scarce. The burden of chronic disease, opioid use disorder, maternal health complications, and mental illness remains high in this population[4,7–9] These challenges are further compounded by logistical barriers such as inadequate transportation, limited broadband connectivity, limited access to nutritious affordable food, and insufficient health literacy resources.[8,10–12] Additionally, rural residents are more likely to be uninsured or underinsured and face difficulty navigating complex and fragmented healthcare systems[13,14] Collectively, these conditions contribute to delayed care-seeking, greater dependence on emergency services, and poorer health trajectories. In response to these challenges, community-based health interventions have increasingly focused on lay health workers and patient navigation models to enhance system engagement and resource access [15–18]. Health navigators connect patients and providers, helping individuals schedule appointments, understand treatment options, and access social services. “Health Equity Navigators” are trained individuals embedded within the community who help community members overcome healthcare access barriers, connect with resources to enhance equitable access to care, and promote improved health outcomes. This model offers a promising, trust-centered strategy guiding patients through complex healthcare environments, particularly in regions where mistrust of formal systems may undermine engagement. Integrating navigators into care teams has been associated with improved chronic disease management, reduced health disparities, and enhanced patient satisfaction, especially when the navigators share similar cultural or community backgrounds with those they serve[19–22] Despite the potential of the health navigator model to promote health, relatively few studies have investigated how community members perceive these programs and whether differences in perceptions exist across demographic groups. Understanding such perspectives is essential to tailoring health for all programs and ensuring they are responsive to the diverse needs of rural and underserved populations. This study aims to fill that gap by examining community perceptions of the “Health Equity Navigators” Program and exploring how perceived helpfulness of the program varies across demographic characteristics, including gender, race, education, and rural residence. Methods Study design and participants We conducted a cross-sectional survey from June 2023 to June 2024 among a convenience sample of adults (N = 269) recruited from rural and urban communities participating in the “Health Equity Navigators” Program across 12 counties in District 4 Public Health, Georgia, USA. The survey instrument used in this study was developed based on the community health needs assessment conducted in these 12 counties and informed by prior literature. An English-language version of the adapted survey has been uploaded as a supplementary file. Eligible participants were 18 years or older, English-speaking, and had prior exposure to or awareness of the Navigators program through outreach events or health promotion campaigns. This study was approved by the Mercer University Institutional Review Board (H2304079). All participants were informed about the study, and consent was obtained before their participation. No personally identifiable information was collected. As part of the program implementation, the Health Equity Navigators maintained systematic documentation, including detailed reports on participant engagement and field observations. Measures The primary outcome was the perceived helpfulness of the Health Equity Navigator Program in supporting efficient access to healthcare services, assessed using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Additional items assessed perceived improvement in knowledge, awareness, and attitudes related to healthcare access. Covariates Demographic covariates were categorized as follows: gender (female, male), age group (18–30, 31–49, 50–64, 65+), race (African American/Black, Non-Hispanic White, Other), education (< high school, high school diploma or GED, some college/associate degree, bachelor’s or higher), employment (employed, unemployed, retired), and residential setting (rural, urban). Self-reported access to a primary care provider was included as a contextual factor. Program Documentation The Health Equity Navigators systematically documented all program activities as part of the implementation process. This included maintaining structured records of participant engagement, tracking outreach efforts, and logging field observations. Field notes captured both logistical challenges and successful strategies used during community engagement. Additionally, navigators collected qualitative feedback from participants and community members to identify emerging issues and guide program refinement. These programmatic records served as a critical contextual data source to inform ongoing evaluation and adaptation efforts. Statistical analysis We used descriptive statistics to summarize participant characteristics and perceptions of the navigator program. Likert scale responses were analyzed as continuous variables, with mean scores calculated with and without neutral responses. We then estimated ordinal logistic regression models to assess predictors of perceived helpfulness in seeking healthcare more efficiently. Independent variables included gender, age group, race, education, employment status, and residential setting. Significance was assessed at the p < 0.05 level. All analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC). Results A total of 269 individuals participated in the study. As shown in Table 1 , most respondents identified as female (79.6%) and were predominantly within the age ranges of 31–49 years (33.1%) and 50–64 years (30.5%). Nearly 60% of participants identified as African American or Black, 33.1% as Non-Hispanic White, and 7.3% as belonging to other racial or ethnic backgrounds, including Hispanic, Asian, and Pacific Islander. Educational attainment indicates 13.0% had less than a high school diploma, while 29.4% held a bachelor’s degree or higher. Most participants lived in rural areas (69.1%) and were employed (63.6%). Additionally, most participants (88.1%) cited healthcare providers as their primary source of health information. Over three-quarters (78.1%) reported access to a primary care provider. About one-third of participants (32.3%) were familiar with the term “Health Equity Navigators”, and 33.5% had heard of the program. Table 1 Demographic information of the study participants (N = 269) Characteristics N (%) Gender Female 214 (79.6) Male 55 (20.5) Age group, yrs. 18–30 52 (19.3) 31–49 89 (33.1) 50–64 82 (30.5) 65 and up 46 (17.1) Race African American/ Black 160 (59.6) 20 (7.3) Non-Hispanic White 89 (33.1) Education level Less than high school 35 (13.0) High school diploma or GED 55 (20.4) Some college or associate degree 100 (37.2) Bachelor’s degree or higher 79 (29.4) Residential setting Rural 186 (69.1) Urban 83 (30.9) Employment Status Employed 157 (63.6) Retired 41 (16.6) Unemployed 49 (19.8) Primary Source of Health Information Healthcare provider ¥ 237 (88.1) Other € 32 (11.9) Knows about “Health Equity Navigators” (yes) 87 (32.3) Heard about Health Equity Navigator Program Yes) 90 (33.5) Has access to primary care provider (yes) 210 (78.1) ꙽ Other includes Hispanic, Asian, and Pacific Islander ¥ Healthcare providers include doctors and nurses € Others include the Local Department of Health, church, family members, friends, etc. Participants’ perceptions of the “Health Equity Navigators” Program were generally positive (Table 2 ). Participants rated the program positively across multiple dimensions. On a 5-point Likert scale, mean ratings for perceived program helpfulness ranged from 4.0 to 4.1 across items when neutral responses were included and from 4.3 to 4.4 when neutral responses were excluded (all p-values < 0.0001). Participants most strongly agreed that the program improved their awareness of health-related resources in the community (Mean = 4.1, SD = 0.9 with neutral; Mean = 4.4, SD = 0.8 without neutral) and enhanced their ability to seek healthcare services more efficiently (Mean = 4.0, SD = 0.8 with neutral; Mean = 4.3, SD = 0.7 without neutral). The stratified figure (Fig. 1) shows differences in the perceived helpfulness of the “Health Equity Navigators” Program between rural and urban residents. Compared to rural participants, urban participants consistently rated the program more favorably across all domains, with a higher mean Likert score than rural participants. Table 2 Participants' perception ratings for the helpfulness of the “Health Equity Navigators” Program Scale Mean scale score a , when “Neutral” is included Mean (SD) Mean scale score b , when “Neutral” is absent Mean (SD) Test of equal distributions P-value Knowledge of the Health Equity Navigator Program 2.9 (1.3) 2.8 (1.5) < .0001 Improve knowledge of health-related resources in the community 4.0 (0.8) 4.3 (0.9) < .0001 Improve awareness of health-related resources in my community 4.1 (0.9) 4.4 (0.8) < .0001 Improve attitude about access to healthcare services 4.0 (0.8) 4.3 (0.7) < .0001 Increase the ability to seek healthcare services more efficiently 4.0 (0.8) 4.3 (0.7) < .0001 a Likert scale was used ranging from 1 = “Strongly disagree” to 5 = “Strongly agree” b Likert scale was used ranging from 1 = “Strongly disagree” to 4 = “Strongly agree” and neutral was excluded Results of the ordinal regression analysis to identify demographic predictors of higher Likert scale ratings for the statement “The Health Equity Navigators Program will help people seek healthcare services more efficiently” (Table 3 ). The result showed that males (OR = 2.07, 95% CI: 1.08–3.96) and unemployed individuals (OR = 2.00, 95% CI: 1.06–3.75) had greater odds of reporting strong agreement with the program’s helpfulness in seeking healthcare more efficiently. Although African American/Black respondents reported high agreement (79.3%), they had lower odds of the strongest agreement levels (OR = 0.56, 95% CI: 0.34–0.92) compared to non-Hispanic White participants. No significant differences in the mean Likert scores were observed by age, education, or rural/urban residence in the adjusted model. Table 3 Results of the Ordinal Logistic Regression showing predictors of Likert score responses of whether the “Health Equity Navigators” Program helps people seek healthcare services more efficiently Characteristics Rate of respondents who answered “agree” or “strongly agree”, % (95% CI) Odds Ratios 95% CI Gender Female 72.4 (65.4–79.5) 2.07 1.08–3.96 Male (ref) 90.9 (82.9–98.9) - - Age group, yrs. 18–30 78.9 (66.4–91.3) 0.60 0.23–1.48 31–49 73.0 (62.2–83.8) 0.98 0.42–2.26 50–64 75.6 (64.9–86.3) 1.23 0.55–2.73 65 and up (ref) 80.4 (67.7–93.2) - - Race African American/Black 79.3 (72.3–86.4) 0.56 0.34–0.92 75.0 (53.1–96.9) 0.89 0.35–2.26 Non-Hispanic White (ref) 70.8 (59.6–82.0) - - Education level Less than High School 88.6 (77.4–99.8) 1.04 0.42–2.57 High School Diploma or GED 72.7 (58.9–86.5) 0.96 0.49–1.89 Some College or Associate Degree 76.0 (66.4–85.6) 1.10 0.62–1.92 Bachelor’s Degree or Higher (ref) 73.4 (62.1–84.8) - - Residential setting Rural 73.4 (62.1–84.8) 0.73 0.44–1.22 Urban (ref) 79.5 (69.8–89.3) - - Employment Status Unemployed 73.0 (60.1–85.8) 2.00 1.06–3.75 Retired 75.6 (61.7–89.4) 0.82 0.38–1.75 Employed (ref) 77.7 (70.3–85.1) - - ꙽ Other includes Hispanic, Asian, and Pacific Islander Table 4 presents key practice considerations based on documentation compiled by the Health Equity Navigators. Findings suggest that tailoring outreach strategies according to gender and employment status contributed to increased participant engagement. Cultural alignment also played an essential role, as differences in race and ethnicity were associated with varying levels of trust and perceived program value. In geographically isolated communities, flexible service delivery models, such as mobile health units and improved digital access, were necessary to reduce access barriers. Workforce capacity-building emerged as a critical area, particularly the need to equip navigators with cultural responsiveness and effective communication skills. Embedding navigators within care delivery teams may support better coordination and continuity of services. Finally, long-term program effectiveness will depend on strong local partnerships and sustained financial support to facilitate continued implementation and impact. Table 4 Practice Implications of the “Health Equity Navigators” Program Practice Area Implication Program Engagement Tailor outreach and engagement strategies by gender and employment status. Cultural Relevance Address racial/ethnic differences in trust and perceived value of programs. Rural Adaptation Modify program delivery for rural communities (e.g., mobile units, broadband access). Workforce Development Invest in navigator training with a focus on cultural humility and health literacy. Integration with Primary Care Embed navigators in care coordination teams to strengthen service continuity. Sustainability Leverage local partnerships and funding to support long-term implementation. Discussion This study assessed perceptions of the “Health Equity Navigators” Program among a diverse sample from rural and underserved populations. Findings suggest broad support for the program’s impact on improving awareness of healthcare resources, attitudes toward access, and navigation skills. These results are consistent with existing evidence showing that community health workers (CHWs) and peer navigators improve engagement with healthcare systems, reduce delays in treatment, and enhance patient empowerment in low-resource settings[15,19–24] By providing personalized support and leveraging culturally competent communication, navigators help mitigate both logistical and psychological barriers to care[21,25–27] Their effectiveness is further enhanced when programs are embedded within existing community networks, such as churches, schools, or grassroots organizations[22,28] While the Health Equity Navigators Program is generally well-received, perceptions of its usefulness appear to be shaped by participants’ social context and prior healthcare experiences. Notably, African American/Black participants reported lower ratings of the program’s effectiveness compared to other racial groups. This finding may reflect longstanding concerns rooted in historical and ongoing inequities, including negative interactions with healthcare systems, underrepresentation in clinical teams, and broader issues of mistrust in health-related initiatives[29–32] These responses should not be viewed as resistance but as meaningful insights that point to opportunities for program improvement. Integrating culturally responsive approaches, ensuring diverse and representative navigator staffing, and maintaining open, sustained channels for community feedback are essential to building trust and enhancing the program’s relevance. Conversely, higher levels of agreement regarding the program’s effectiveness were observed among male and unemployed participants. This suggests that the program may be particularly impactful for individuals less connected to traditional healthcare systems or who face economic barriers to care[4,33] Strengthening community engagement through advisory boards, hiring staff with lived experience, and co-developing outreach strategies with local residents can further increase program uptake and improve health equity outcomes. Although rural participants comprised most of our study population, our findings revealed that urban participants favorably perceived the positive impact of the “Health Equity Navigators” Program more than their rural counterparts across all measured domains in our study. Possible factors explaining this observation among urban residents may include greater access to healthcare infrastructure and support services in the urban areas, which may enhance participants’ ability to engage with and benefit from the program. In contrast, rural participants often face structural barriers, including limited transportation options, fewer healthcare providers, and digital connectivity issues, that may hinder full participation in the program. Second, prior research suggests that rural populations may exhibit greater skepticism toward externally developed health interventions, particularly when those programs are not perceived as culturally aligned or locally tailored [34–37] These contextual factors may have contributed to lower satisfaction ratings among rural participants and underscore the need for geographically responsive adaptations. Future efforts should focus on enhancing infrastructure in rural areas, increasing navigator presence, and co-developing program components with community stakeholders to strengthen trust and program relevance. The “Health Equity Navigators” Program demonstrates strong potential to address structural barriers to care in rural and underserved populations, particularly when implementation strategies are responsive to each community's distinct social and cultural characteristics. Our findings show that participant engagement increased significantly when outreach efforts were tailored according to gender and employment status. This pattern is consistent with community health research, underscoring that tailored interventions that acknowledge specific groups' unique needs, priorities, and lived experiences are more likely to gain trust and participation [38] For example, gender-tailored strategies may better align with the caregiving responsibilities and time constraints commonly reported by women in rural households, while also addressing the social stigma that may deter men from seeking care. Likewise, unemployed individuals may experience fewer logistical barriers, such as time conflicts or insurance concerns, and may be more responsive to navigator-led support that offers assistance navigating fragmented health and social service systems [39,40]. When outreach and messaging reflect the socioeconomic realities of the target population, programs are better equipped to overcome barriers related to mistrust, perceived irrelevance, or systemic exclusion. These findings support a growing consensus in public health that effective interventions must go beyond “one-size-fits-all” models and instead prioritize equity through cultural and contextual alignment [41] Incorporating tailored outreach into navigator programs not only enhances engagement but also improves the likelihood of achieving lasting impact in communities historically marginalized by traditional healthcare delivery systems. This study’s strengths include its community-based focus and multivariate analysis of subgroup differences. The sample included substantial representation of African American/Black individuals, rural residents, and those with varied employment and education backgrounds, supporting diverse perspectives. However, there are limitations to consider. The cross-sectional design limits inferences about causality or longitudinal change. Self-reported measures are subject to recall bias and social desirability, particularly in community health evaluations. In addition, the study did not include qualitative data that might have provided richer insight into the nuanced ways participants interact with and interpret the program’s value. Finally, while the sample was geographically diverse, generalizability may be limited outside similarly structured communities. Further longitudinal and qualitative research is needed to evaluate program mechanisms, sustainability, and health outcomes over time. Conclusions This study highlights the potential of health equity navigator programs to improve healthcare access, resource awareness, and patient engagement across diverse populations. While perceptions were broadly positive, subgroup differences suggest that such programs must be tailored to address the unique needs of rural communities, racial minorities, and economically vulnerable individuals. As healthcare systems seek scalable, community-based strategies to close persistent access gaps, navigator models rooted in trust, cultural competence, and local relevance will be increasingly critical in advancing health equity. Abbreviations CHWs: Community health workers CI: Confidence interval Ref: reference SD: Standard deviation Declarations Authors and Affiliations Department of Family Medicine and Rural Health, Florida State University College of Medicine, 1115 W. Call St., Tallahassee, FL 32306, United States Department of Community Medicine, Mercer University School of Medicine, Columbus, GA 31901, United States. Ransome Eke Department of Community Medicine, Mercer University School of Medicine, Columbus, GA 31901, United States. Jones Aneesa Department of Family Medicine and Rural Health, Florida State University College of Medicine, 1115 W. Call St., Tallahassee, FL 32306, United States Shermeeka Hogans-Mathews Department of Family Medicine and Rural Health, Florida State University College of Medicine, 1115 W. Call St., Tallahassee, FL 32306, United States Joedrecka Brown Speights Ethics approval and consent to participate: The research was approved by the Mercer University Institutional Review Board (H2304079). Participants electronically signed consent forms. The study was conducted following the guidelines of the Declaration of Helsinki. All participants were informed about the study, and consent was obtained before their participation. Consent for publication: Not applicable Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: The study was supported by funding from the Georgia District 4 Public Health—CDC Annex 737 COVID-19 health equity grant. Authors' contributions: RE led the conceptualization, study design, data analysis, and manuscript drafting. AJ contributed to data collection and community engagement activities, facilitated participant recruitment, interpreted findings, and revised manuscripts. SH contributed to interpreting results and critically reviewed and revised the manuscript for intellectual content. JBS critically reviewed and revised the manuscript for intellectual content. All authors read and approved the final manuscript before submission. Acknowledgements: We want to thank the Georgia District 4 Public Health Equity Navigators for their contributions during the project OR: Adjusted Odds ratio References Dickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. The Lancet [Internet]. 2017 [cited 2025 May 4];389:1431–41. Available from: https://www.thelancet.com/action/showFullText?pii=S0140673617303987 Hart LG, Salsberg E, Phillips DM, Lishner DM. Rural Health Care Providers in the United States. The Journal of Rural Health [Internet]. 2002 [cited 2025 May 4];18:211–31. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1748-0361.2002.tb00932.x Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015;129:611–20. Mongelli F, Georgakopoulos P, Pato MT. Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States. https://doi.org/101176/appi.focus20190028 [Internet]. 2020 [cited 2025 May 4];18:16–24. Available from: https://psychiatryonline.org/doi/10.1176/appi.focus.20190028 Clove D. Healthcare Access Disparities among Rural Populations in the United States. Ballard Brief [Internet]. 2023 [cited 2025 May 4];2023. Available from: https://scholarsarchive.byu.edu/ballardbrief/vol2023/iss1/5 Maganty A, Byrnes ME, Hamm M, Wasilko R, Sabik LM, Davies BJ, et al. Barriers to rural health care from the provider perspective. Rural Remote Health. 2023;23. Bureau UC. 2020 Census Urban Areas Facts. [cited 2025 May 5]; Available from: https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural/2020-ua-facts.html Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: A systematic literature review. BMC Health Serv Res [Internet]. 2019 [cited 2025 May 5];19:1–17. Available from: https://link.springer.com/articles/10.1186/s12913-019-4815-5 Lister JJ, Weaver A, Ellis JD, Himle JA, Ledgerwood DM. A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States. Am J Drug Alcohol Abuse [Internet]. 2020 [cited 2025 May 5];46:273–88. Available from: https://www.tandfonline.com/doi/abs/10.1080/00952990.2019.1694536 Valentín-Sívico J, Canfield C, Low SA, Gollnick C. Evaluating the impact of broadband access and internet use in a small underserved rural community. Telecomm Policy. 2023;47:102499. Aljassim N, Ostini R. Health literacy in rural and urban populations: A systematic review. Patient Educ Couns. 2020;103:2142–54. Elmes MB. Economic Inequality, Food Insecurity, and the Erosion of Equality of Capabilities in the United States. Bus Soc [Internet]. 2018 [cited 2025 May 5];57:1045–74. Available from: https://journals.sagepub.com/doi/full/10.1177/0007650316676238 Nganje W, Addey KA. Health Uninsurance in rural America: A partial equilibrium analysis. Health Econ Rev [Internet]. 2019 [cited 2025 May 5];9:1–15. Available from: https://link.springer.com/articles/10.1186/s13561-019-0234-x MacDougall H, Mork D, Hanson S, Smith CH. Rural-urban differences in health care unaffordability. The Journal of Rural Health [Internet]. 2024 [cited 2025 May 5];40:376–85. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jrh.12788 Cardarelli R, Bausch G, Murdock J, Chyatte MR. Return-on-Investment (ROI) analyses of an inpatient lay health worker model on 30-day readmission rates in a rural community hospital. The Journal of Rural Health. 2018;34:411–22. Berini CR, Bonilha HS, Simpson AN. Impact of Community Health Workers on Access to Care for Rural Populations in the United States: A Systematic Review. J Community Health [Internet]. 2022 [cited 2025 May 5];47:539–53. Available from: https://link.springer.com/article/10.1007/s10900-021-01052-6 McKenney KM, Martinez NG, Yee LM. Patient navigation across the spectrum of women’s health care in the United States. Am J Obstet Gynecol. 2018;218:280–6. Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, et al. Patient navigation: State of the art or is it science? Cancer. 2008;113:1999–2010. Ranaghan C, Boyle K, Meehan M, Moustapha S, Fraser P, Concert C. Effectiveness of a patient navigator on patient satisfaction in adult patients in an ambulatory care setting: a systematic review. JBI Database System Rev Implement Rep [Internet]. 2016 [cited 2025 May 5];14:172–218. Available from: https://journals.lww.com/jbisrir/fulltext/2016/08000/effectiveness_of_a_patient_navigator_on_patient.15.aspx Braun KL, Thomas WL, Domingo JLB, Allison AL, Ponce A, Haunani Kamakana P, et al. Reducing cancer screening disparities in medicare beneficiaries through cancer patient navigation. J Am Geriatr Soc. 2015;63:365–70. Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer [Internet]. 2011 [cited 2025 May 5];117:3541–50. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.26264 Mistry SK, Harris E, Harris M. Community Health Workers as Healthcare Navigators in Primary Care Chronic Disease Management: a Systematic Review. J Gen Intern Med [Internet]. 2021 [cited 2025 May 5];36:2755–71. Available from: https://link.springer.com/article/10.1007/s11606-021-06667-y Lorhan S, Cleghorn L, Fitch M, Pang K, McAndrew A, Applin-Poole J, et al. Moving the agenda forward for cancer patient navigation: Understanding volunteer and peer navigation approaches. Journal of Cancer Education. 2013;28:84–91. Ali-Faisal SF, Colella TJF, Medina-Jaudes N, Benz Scott L. The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials. Patient Educ Couns. 2017;100:436–48. Shommu NS, Ahmed S, Rumana N, Barron GRS, McBrien KA, Turin TC. What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review. Int J Equity Health [Internet]. 2016 [cited 2025 May 5];15:1–12. Available from: https://link.springer.com/articles/10.1186/s12939-016-0298-8 Fischer SM, Sauaia A, Kutner JS. Patient Navigation: A Culturally Competent Strategy to Address Disparities in Palliative Care. J Palliat Med [Internet]. 2007 [cited 2025 May 5];10. Available from: www.liebertpub.com Dohan D, Schrag D. Using navigators to improve care of underserved patients: Current practices and approaches. Cancer. 2005;104:848–55. Lalji R, Koh L, Francis A, Khalid R, Guha C, Johnson DW, et al. Patient navigator programmes for children and adolescents with chronic diseases. Cochrane Database of Systematic Reviews [Internet]. 2024 [cited 2025 May 5];2024. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014688.pub2/full Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men. Behavioral Medicine [Internet]. 2019 [cited 2025 May 5];45:102–17. Available from: https://www.tandfonline.com/doi/abs/10.1080/08964289.2019.1585327 Nair L, Adetayo OA. Cultural Competence and Ethnic Diversity in Healthcare. Plast Reconstr Surg Glob Open [Internet]. 2019 [cited 2025 May 5];7:E2219. Available from: https://journals.lww.com/prsgo/fulltext/2019/05000/cultural_competence_and_ethnic_diversity_in.43.aspx Murray TM. Trust in African Americans’ Healthcare Experiences. Nurs Forum (Auckl) [Internet]. 2015 [cited 2025 May 5];50:285–92. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/nuf.12120 Cuevas AG, O’Brien K, Saha S. African American experiences in healthcare: “I always feel like I’m getting skipped over.” Health Psychology. 2016;35:987–95. Mursa R, Patterson C, Halcomb E. Men’s help-seeking and engagement with general practice: An integrative review. J Adv Nurs [Internet]. 2022 [cited 2025 May 5];78:1938–53. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15240 Abdul S, Cosmos Maha C, Kolawole TO. Revolutionizing community health literacy: The power of digital health tools in rural areas of the US and Africa. GSC Advanced Research and Reviews [Internet]. 2024 [cited 2025 May 5];19:286–96. Available from: https://doi.org/10.30574/gscarr.2024.19.2.0189 Schiffelbein JE, Carluzzo KL, Hasson RM, Alford-Teaster JA, Imset I, Onega T. Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population. J Prim Care Community Health [Internet]. 2020 [cited 2025 May 5];11. Available from: https://journals.sagepub.com/doi/full/10.1177/2150132720930544 Brzezinski A, Kecht V, Van Dijcke D, Wright AL. Science skepticism reduced compliance with COVID-19 shelter-in-place policies in the United States. Nature Human Behaviour 2021 5:11 [Internet]. 2021 [cited 2025 May 5];5:1519–27. Available from: https://www.nature.com/articles/s41562-021-01227-0 Lister JJ, Joudrey PJ. Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption. The Journal of Rural Health [Internet]. 2022 [cited 2025 May 5];39:18. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10084067/ Kreuter MW, Lukwago SN, Bucholtz DC, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav [Internet]. 2003 [cited 2025 May 5];30:133–46. Available from: https://pubmed.ncbi.nlm.nih.gov/12693519/ Hoven H, Backhaus I, Gero K, Kawachi I. Characteristics of employment history and self-perceived barriers to healthcare access. Eur J Public Health [Internet]. 2023 [cited 2025 May 5];33:1080–7. Available from: https://dx.doi.org/10.1093/eurpub/ckad178 Artiga S, Orgera K, Pham O. Disparities in Health and Health Care: Five Key Questions and Answers. 2020 [cited 2025 May 5]; Available from: https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html. Betancourt JR, Green AR, Carrillo JE, Ii OA-F. Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care. Public Health Reports. 2003;118:293–302. Additional Declarations No competing interests reported. Supplementary Files Eke4132023HENPIRBSurveyQuestions.3.24.2023.docx Cite Share Download PDF Status: Published Journal Publication published 03 Dec, 2025 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 18 Jul, 2025 Reviews received at journal 11 Jul, 2025 Reviews received at journal 08 Jul, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviewers agreed at journal 27 Jun, 2025 Reviewers agreed at journal 25 Jun, 2025 Reviewers invited by journal 25 Jun, 2025 Editor assigned by journal 25 Jun, 2025 Editor invited by journal 17 Jun, 2025 Submission checks completed at journal 16 Jun, 2025 First submitted to journal 16 Jun, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6865483","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477843499,"identity":"69e48ae4-e2ce-4b44-a466-f71d8d96f35a","order_by":0,"name":"Ransome Eke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIie3PP0vDQBzG8SccxOV33Hql0tdwEIhDxL6YQrJcRBCKiEOnuMRdX4bLzZGDTLFdhS5175BSEBf/pIKDQ866Odx3uoP7wHOAz/evIwQrgOFgtruF+xGmdoSqP5BQ7kWOrh9tu9HHEGTry6eLBCQahXZqe8lhc5oO7kyKwU2RLnWTgaRWwe28n0jomHFjoRYUL/PCYixJMV44iFhHW24+MF6Il/P83X4NY28u0s0YclNB8TJk+awj0IoFTrKOu79MSDZ1NNR1RiTTs4dynjmG6ajdmJORKCfPW32VjEjY+9XrNOkl39GPQ/Xre5/P5/M5+wSqKkvAtHhM6AAAAABJRU5ErkJggg==","orcid":"","institution":"Florida State University College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Ransome","middleName":"","lastName":"Eke","suffix":""},{"id":477843500,"identity":"0c91bf08-05b5-4d3f-93fc-c40e7f3984fd","order_by":1,"name":"Jones Aneesa","email":"","orcid":"","institution":"Mercer University","correspondingAuthor":false,"prefix":"","firstName":"Jones","middleName":"","lastName":"Aneesa","suffix":""},{"id":477843501,"identity":"6129d08c-43c9-4c1e-922c-5ca24609d32c","order_by":2,"name":"Shermeeka Hogans-Mathews","email":"","orcid":"","institution":"Florida State University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Shermeeka","middleName":"","lastName":"Hogans-Mathews","suffix":""},{"id":477843502,"identity":"594cca36-90b5-49e5-a2bd-ed228bd9499f","order_by":3,"name":"Joedrecka Brown Speights","email":"","orcid":"","institution":"Florida State University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Joedrecka","middleName":"Brown","lastName":"Speights","suffix":""}],"badges":[],"createdAt":"2025-06-10 17:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6865483/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6865483/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12889-025-25294-4","type":"published","date":"2025-12-03T15:57:40+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85753615,"identity":"e9c77f1f-0375-4da3-98c6-e90f9476e46a","added_by":"auto","created_at":"2025-07-01 10:33:08","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":71732,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6865483/v1/4161edb551a50b34d943ddcb.png"},{"id":97724613,"identity":"28246144-3ba4-4b3d-b330-d64870879ab2","added_by":"auto","created_at":"2025-12-08 16:12:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":851334,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6865483/v1/03a271f3-db1e-4c0d-ad84-0545570ffdca.pdf"},{"id":85753616,"identity":"e0b90eca-862d-4bfa-b4a1-a706cc6a1f6e","added_by":"auto","created_at":"2025-07-01 10:33:10","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":29425,"visible":true,"origin":"","legend":"","description":"","filename":"Eke4132023HENPIRBSurveyQuestions.3.24.2023.docx","url":"https://assets-eu.researchsquare.com/files/rs-6865483/v1/f0f709c9334f8053cf5a088d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community Perceptions of the “Health Equity Navigators” Program: A Cross-Sectional Study in Rural and Underserved US Populations","fulltext":[{"header":"Background","content":"\u003cp\u003eAccess to timely, high-quality healthcare remains unevenly distributed in the United States, with rural and underserved populations experiencing significant and persistent barriers to care [1\u0026ndash;3]. Multiple structural and contextual factors, including geographic isolation, provider shortages, socioeconomic disadvantage, and cumulative disadvantage, all contribute to continued variance in care access and health outcomes[4\u0026ndash;6]. An estimated 66\u0026nbsp;million Americans reside in rural areas, where access to healthcare is often limited and specialty services are scarce. The burden of chronic disease, opioid use disorder, maternal health complications, and mental illness remains high in this population[4,7\u0026ndash;9] These challenges are further compounded by logistical barriers such as inadequate transportation, limited broadband connectivity, limited access to nutritious affordable food, and insufficient health literacy resources.[8,10\u0026ndash;12] Additionally, rural residents are more likely to be uninsured or underinsured and face difficulty navigating complex and fragmented healthcare systems[13,14] Collectively, these conditions contribute to delayed care-seeking, greater dependence on emergency services, and poorer health trajectories.\u003c/p\u003e \u003cp\u003eIn response to these challenges, community-based health interventions have increasingly focused on lay health workers and patient navigation models to enhance system engagement and resource access [15\u0026ndash;18]. Health navigators connect patients and providers, helping individuals schedule appointments, understand treatment options, and access social services. \u0026ldquo;Health Equity Navigators\u0026rdquo; are trained individuals embedded within the community who help community members overcome healthcare access barriers, connect with resources to enhance equitable access to care, and promote improved health outcomes. This model offers a promising, trust-centered strategy guiding patients through complex healthcare environments, particularly in regions where mistrust of formal systems may undermine engagement. Integrating navigators into care teams has been associated with improved chronic disease management, reduced health disparities, and enhanced patient satisfaction, especially when the navigators share similar cultural or community backgrounds with those they serve[19\u0026ndash;22]\u003c/p\u003e \u003cp\u003eDespite the potential of the health navigator model to promote health, relatively few studies have investigated how community members perceive these programs and whether differences in perceptions exist across demographic groups. Understanding such perspectives is essential to tailoring health for all programs and ensuring they are responsive to the diverse needs of rural and underserved populations. This study aims to fill that gap by examining community perceptions of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program and exploring how perceived helpfulness of the program varies across demographic characteristics, including gender, race, education, and rural residence.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy design and participants\u003c/p\u003e \u003cp\u003eWe conducted a cross-sectional survey from June 2023 to June 2024 among a convenience sample of adults (N\u0026thinsp;=\u0026thinsp;269) recruited from rural and urban communities participating in the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program across 12 counties in District 4 Public Health, Georgia, USA. The survey instrument used in this study was developed based on the community health needs assessment conducted in these 12 counties and informed by prior literature. An English-language version of the adapted survey has been uploaded as a supplementary file. Eligible participants were 18 years or older, English-speaking, and had prior exposure to or awareness of the Navigators program through outreach events or health promotion campaigns. This study was approved by the Mercer University Institutional Review Board (H2304079). All participants were informed about the study, and consent was obtained before their participation. No personally identifiable information was collected. As part of the program implementation, the Health Equity Navigators maintained systematic documentation, including detailed reports on participant engagement and field observations.\u003c/p\u003e \u003cp\u003eMeasures\u003c/p\u003e \u003cp\u003eThe primary outcome was the perceived helpfulness of the Health Equity Navigator Program in supporting efficient access to healthcare services, assessed using a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree). Additional items assessed perceived improvement in knowledge, awareness, and attitudes related to healthcare access.\u003c/p\u003e \u003cp\u003eCovariates\u003c/p\u003e \u003cp\u003eDemographic covariates were categorized as follows: gender (female, male), age group (18\u0026ndash;30, 31\u0026ndash;49, 50\u0026ndash;64, 65+), race (African American/Black, Non-Hispanic White, Other), education (\u0026lt;\u0026thinsp;high school, high school diploma or GED, some college/associate degree, bachelor\u0026rsquo;s or higher), employment (employed, unemployed, retired), and residential setting (rural, urban). Self-reported access to a primary care provider was included as a contextual factor.\u003c/p\u003e \u003cp\u003eProgram Documentation\u003c/p\u003e \u003cp\u003eThe Health Equity Navigators systematically documented all program activities as part of the implementation process. This included maintaining structured records of participant engagement, tracking outreach efforts, and logging field observations. Field notes captured both logistical challenges and successful strategies used during community engagement. Additionally, navigators collected qualitative feedback from participants and community members to identify emerging issues and guide program refinement. These programmatic records served as a critical contextual data source to inform ongoing evaluation and adaptation efforts.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eWe used descriptive statistics to summarize participant characteristics and perceptions of the navigator program. Likert scale responses were analyzed as continuous variables, with mean scores calculated with and without neutral responses. We then estimated ordinal logistic regression models to assess predictors of perceived helpfulness in seeking healthcare more efficiently. Independent variables included gender, age group, race, education, employment status, and residential setting. Significance was assessed at the p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 level. All analyses were conducted using SAS version 9.4 (SAS Institute, Cary, NC).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 269 individuals participated in the study. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, most respondents identified as female (79.6%) and were predominantly within the age ranges of 31\u0026ndash;49 years (33.1%) and 50\u0026ndash;64 years (30.5%). Nearly 60% of participants identified as African American or Black, 33.1% as Non-Hispanic White, and 7.3% as belonging to other racial or ethnic backgrounds, including Hispanic, Asian, and Pacific Islander. Educational attainment indicates 13.0% had less than a high school diploma, while 29.4% held a bachelor\u0026rsquo;s degree or higher.\u003c/p\u003e \u003cp\u003eMost participants lived in rural areas (69.1%) and were employed (63.6%). Additionally, most participants (88.1%) cited healthcare providers as their primary source of health information. Over three-quarters (78.1%) reported access to a primary care provider. About one-third of participants (32.3%) were familiar with the term \u0026ldquo;Health Equity Navigators\u0026rdquo;, and 33.5% had heard of the program.\u003c/p\u003e \u003ctable id=\"Tab1\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic information of the study participants (N\u0026thinsp;=\u0026thinsp;269)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e214 (79.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge group, yrs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u0026ndash;64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (30.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 and up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfrican American/ Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e160 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"51\" height=\"17\"\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20 (7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-Hispanic White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (33.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEducation level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLess than high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school diploma or GED\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSome college or associate degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100 (37.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eResidential setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e186 (69.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83 (30.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eEmployment Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePrimary Source of Health Information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealthcare provider\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e237 (88.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003csup\u003e\u0026euro;\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKnows about \u0026ldquo;Health Equity Navigators\u0026rdquo; (yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHeard about Health Equity Navigator Program Yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90 (33.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHas access to primary care provider (yes)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e210 (78.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e꙽ Other includes Hispanic, Asian, and Pacific Islander\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026yen;\u003c/sup\u003eHealthcare providers include doctors and nurses\u003c/p\u003e\n \u003cp\u003e\u003csup\u003e\u0026euro;\u003c/sup\u003eOthers include the Local Department of Health, church, family members, friends, etc.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\u003cp\u003eParticipants\u0026rsquo; perceptions of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program were generally positive (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Participants rated the program positively across multiple dimensions. On a 5-point Likert scale, mean ratings for perceived program helpfulness ranged from 4.0 to 4.1 across items when neutral responses were included and from 4.3 to 4.4 when neutral responses were excluded (all p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Participants most strongly agreed that the program improved their awareness of health-related resources in the community (Mean\u0026thinsp;=\u0026thinsp;4.1, SD\u0026thinsp;=\u0026thinsp;0.9 with neutral; Mean\u0026thinsp;=\u0026thinsp;4.4, SD\u0026thinsp;=\u0026thinsp;0.8 without neutral) and enhanced their ability to seek healthcare services more efficiently (Mean\u0026thinsp;=\u0026thinsp;4.0, SD\u0026thinsp;=\u0026thinsp;0.8 with neutral; Mean\u0026thinsp;=\u0026thinsp;4.3, SD\u0026thinsp;=\u0026thinsp;0.7 without neutral). The stratified figure (Fig.\u0026nbsp;1) shows differences in the perceived helpfulness of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program between rural and urban residents. Compared to rural participants, urban participants consistently rated the program more favorably across all domains, with a higher mean Likert score than rural participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants' perception ratings for the helpfulness of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean scale score\u003csup\u003ea\u003c/sup\u003e, when \u0026ldquo;Neutral\u0026rdquo; is included\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean scale score\u003csup\u003eb\u003c/sup\u003e, when \u0026ldquo;Neutral\u0026rdquo; is absent\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTest of equal distributions\u003c/p\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge of the Health Equity Navigator Program\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 (1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.8 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImprove knowledge of health-related resources in the community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImprove awareness of health-related resources in my community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.1 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.4 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImprove attitude about access to healthcare services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncrease the ability to seek healthcare services more efficiently\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.0 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.3 (0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003csup\u003ea\u003c/sup\u003eLikert scale was used ranging from 1 = \u0026ldquo;Strongly disagree\u0026rdquo; to 5 = \u0026ldquo;Strongly agree\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u003csup\u003eb\u003c/sup\u003eLikert scale was used ranging from 1 = \u0026ldquo;Strongly disagree\u0026rdquo; to 4 = \u0026ldquo;Strongly agree\u0026rdquo; and neutral was excluded\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eResults of the ordinal regression analysis to identify demographic predictors of higher Likert scale ratings for the statement \u0026ldquo;The Health Equity Navigators Program will help people seek healthcare services more efficiently\u0026rdquo; (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The result showed that males (OR\u0026thinsp;=\u0026thinsp;2.07, 95% CI: 1.08\u0026ndash;3.96) and unemployed individuals (OR\u0026thinsp;=\u0026thinsp;2.00, 95% CI: 1.06\u0026ndash;3.75) had greater odds of reporting strong agreement with the program\u0026rsquo;s helpfulness in seeking healthcare more efficiently. Although African American/Black respondents reported high agreement (79.3%), they had lower odds of the strongest agreement levels (OR\u0026thinsp;=\u0026thinsp;0.56, 95% CI: 0.34\u0026ndash;0.92) compared to non-Hispanic White participants. No significant differences in the mean Likert scores were observed by age, education, or rural/urban residence in the adjusted model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the Ordinal Logistic Regression showing predictors of Likert score responses of whether the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program helps people seek healthcare services more efficiently\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRate of respondents who answered \u0026ldquo;agree\u0026rdquo; or \u0026ldquo;strongly agree\u0026rdquo;, % (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOdds Ratios\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.4 (65.4\u0026ndash;79.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.07\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.08\u0026ndash;3.96\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.9 (82.9\u0026ndash;98.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group, yrs.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.9 (66.4\u0026ndash;91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.23\u0026ndash;1.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.0 (62.2\u0026ndash;83.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42\u0026ndash;2.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.6 (64.9\u0026ndash;86.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55\u0026ndash;2.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 and up (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.4 (67.7\u0026ndash;93.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfrican American/Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.3 (72.3\u0026ndash;86.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.34\u0026ndash;0.92\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"51\" height=\"17\"\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.0 (53.1\u0026ndash;96.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.35\u0026ndash;2.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Hispanic White (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.8 (59.6\u0026ndash;82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than High School\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88.6 (77.4\u0026ndash;99.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.42\u0026ndash;2.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh School Diploma or GED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.7 (58.9\u0026ndash;86.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u0026ndash;1.89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSome College or Associate Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.0 (66.4\u0026ndash;85.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.62\u0026ndash;1.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s Degree or Higher (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.4 (62.1\u0026ndash;84.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidential setting\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.4 (62.1\u0026ndash;84.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44\u0026ndash;1.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79.5 (69.8\u0026ndash;89.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.0 (60.1\u0026ndash;85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e2.00\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e1.06\u0026ndash;3.75\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.6 (61.7\u0026ndash;89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.38\u0026ndash;1.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed (ref)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.7 (70.3\u0026ndash;85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e꙽ Other includes Hispanic, Asian, and Pacific Islander\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents key practice considerations based on documentation compiled by the Health Equity Navigators. Findings suggest that tailoring outreach strategies according to gender and employment status contributed to increased participant engagement. Cultural alignment also played an essential role, as differences in race and ethnicity were associated with varying levels of trust and perceived program value. In geographically isolated communities, flexible service delivery models, such as mobile health units and improved digital access, were necessary to reduce access barriers. Workforce capacity-building emerged as a critical area, particularly the need to equip navigators with cultural responsiveness and effective communication skills. Embedding navigators within care delivery teams may support better coordination and continuity of services. Finally, long-term program effectiveness will depend on strong local partnerships and sustained financial support to facilitate continued implementation and impact.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePractice Implications of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePractice Area\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImplication\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgram Engagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTailor outreach and engagement strategies by gender and employment status.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultural Relevance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAddress racial/ethnic differences in trust and perceived value of programs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural Adaptation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModify program delivery for rural communities (e.g., mobile units, broadband access).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorkforce Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInvest in navigator training with a focus on cultural humility and health literacy.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntegration with Primary Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmbed navigators in care coordination teams to strengthen service continuity.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSustainability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeverage local partnerships and funding to support long-term implementation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed perceptions of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program among a diverse sample from rural and underserved populations. Findings suggest broad support for the program\u0026rsquo;s impact on improving awareness of healthcare resources, attitudes toward access, and navigation skills. These results are consistent with existing evidence showing that community health workers (CHWs) and peer navigators improve engagement with healthcare systems, reduce delays in treatment, and enhance patient empowerment in low-resource settings[15,19\u0026ndash;24] By providing personalized support and leveraging culturally competent communication, navigators help mitigate both logistical and psychological barriers to care[21,25\u0026ndash;27] Their effectiveness is further enhanced when programs are embedded within existing community networks, such as churches, schools, or grassroots organizations[22,28]\u003c/p\u003e \u003cp\u003eWhile the Health Equity Navigators Program is generally well-received, perceptions of its usefulness appear to be shaped by participants\u0026rsquo; social context and prior healthcare experiences. Notably, African American/Black participants reported lower ratings of the program\u0026rsquo;s effectiveness compared to other racial groups. This finding may reflect longstanding concerns rooted in historical and ongoing inequities, including negative interactions with healthcare systems, underrepresentation in clinical teams, and broader issues of mistrust in health-related initiatives[29\u0026ndash;32] These responses should not be viewed as resistance but as meaningful insights that point to opportunities for program improvement. Integrating culturally responsive approaches, ensuring diverse and representative navigator staffing, and maintaining open, sustained channels for community feedback are essential to building trust and enhancing the program\u0026rsquo;s relevance. Conversely, higher levels of agreement regarding the program\u0026rsquo;s effectiveness were observed among male and unemployed participants. This suggests that the program may be particularly impactful for individuals less connected to traditional healthcare systems or who face economic barriers to care[4,33] Strengthening community engagement through advisory boards, hiring staff with lived experience, and co-developing outreach strategies with local residents can further increase program uptake and improve health equity outcomes.\u003c/p\u003e \u003cp\u003eAlthough rural participants comprised most of our study population, our findings revealed that urban participants favorably perceived the positive impact of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program more than their rural counterparts across all measured domains in our study. Possible factors explaining this observation among urban residents may include greater access to healthcare infrastructure and support services in the urban areas, which may enhance participants\u0026rsquo; ability to engage with and benefit from the program. In contrast, rural participants often face structural barriers, including limited transportation options, fewer healthcare providers, and digital connectivity issues, that may hinder full participation in the program. Second, prior research suggests that rural populations may exhibit greater skepticism toward externally developed health interventions, particularly when those programs are not perceived as culturally aligned or locally tailored [34\u0026ndash;37] These contextual factors may have contributed to lower satisfaction ratings among rural participants and underscore the need for geographically responsive adaptations. Future efforts should focus on enhancing infrastructure in rural areas, increasing navigator presence, and co-developing program components with community stakeholders to strengthen trust and program relevance.\u003c/p\u003e \u003cp\u003eThe \u0026ldquo;Health Equity Navigators\u0026rdquo; Program demonstrates strong potential to address structural barriers to care in rural and underserved populations, particularly when implementation strategies are responsive to each community's distinct social and cultural characteristics. Our findings show that participant engagement increased significantly when outreach efforts were tailored according to gender and employment status. This pattern is consistent with community health research, underscoring that tailored interventions that acknowledge specific groups' unique needs, priorities, and lived experiences are more likely to gain trust and participation [38] For example, gender-tailored strategies may better align with the caregiving responsibilities and time constraints commonly reported by women in rural households, while also addressing the social stigma that may deter men from seeking care. Likewise, unemployed individuals may experience fewer logistical barriers, such as time conflicts or insurance concerns, and may be more responsive to navigator-led support that offers assistance navigating fragmented health and social service systems [39,40]. When outreach and messaging reflect the socioeconomic realities of the target population, programs are better equipped to overcome barriers related to mistrust, perceived irrelevance, or systemic exclusion. These findings support a growing consensus in public health that effective interventions must go beyond \u0026ldquo;one-size-fits-all\u0026rdquo; models and instead prioritize equity through cultural and contextual alignment [41] Incorporating tailored outreach into navigator programs not only enhances engagement but also improves the likelihood of achieving lasting impact in communities historically marginalized by traditional healthcare delivery systems.\u003c/p\u003e \u003cp\u003eThis study\u0026rsquo;s strengths include its community-based focus and multivariate analysis of subgroup differences. The sample included substantial representation of African American/Black individuals, rural residents, and those with varied employment and education backgrounds, supporting diverse perspectives. However, there are limitations to consider. The cross-sectional design limits inferences about causality or longitudinal change. Self-reported measures are subject to recall bias and social desirability, particularly in community health evaluations. In addition, the study did not include qualitative data that might have provided richer insight into the nuanced ways participants interact with and interpret the program\u0026rsquo;s value. Finally, while the sample was geographically diverse, generalizability may be limited outside similarly structured communities. Further longitudinal and qualitative research is needed to evaluate program mechanisms, sustainability, and health outcomes over time.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights the potential of health equity navigator programs to improve healthcare access, resource awareness, and patient engagement across diverse populations. While perceptions were broadly positive, subgroup differences suggest that such programs must be tailored to address the unique needs of rural communities, racial minorities, and economically vulnerable individuals. As healthcare systems seek scalable, community-based strategies to close persistent access gaps, navigator models rooted in trust, cultural competence, and local relevance will be increasingly critical in advancing health equity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCHWs: Community health workers\u003c/p\u003e\n\u003cp\u003eCI: Confidence interval\u003c/p\u003e\n\u003cp\u003eRef: reference\u003c/p\u003e\n\u003cp\u003eSD: Standard deviation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors and Affiliations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Family Medicine and Rural Health, Florida State University College of Medicine, 1115 W. Call St., Tallahassee, FL 32306, United States\u003c/p\u003e\n\u003cp\u003eDepartment of Community Medicine, Mercer University School of Medicine, Columbus, GA 31901, United States.\u003c/p\u003e\n\u003cp\u003eRansome Eke\u003c/p\u003e\n\u003cp\u003eDepartment of Community Medicine, Mercer University School of Medicine, Columbus, GA 31901, United States.\u003c/p\u003e\n\u003cp\u003eJones Aneesa\u003c/p\u003e\n\u003cp\u003eDepartment of Family Medicine and Rural Health, Florida State University College of Medicine, 1115 W. Call St., Tallahassee, FL 32306, United States\u003c/p\u003e\n\u003cp\u003eShermeeka Hogans-Mathews\u003c/p\u003e\n\u003cp\u003eDepartment of Family Medicine and Rural Health, Florida State University College of Medicine, 1115 W. Call St., Tallahassee, FL 32306, United States\u003c/p\u003e\n\u003cp\u003eJoedrecka Brown Speights\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: The research was approved by the Mercer University Institutional Review Board (H2304079). Participants electronically signed consent forms. The study was conducted following the guidelines of the Declaration of Helsinki. All participants were informed about the study, and consent was obtained before their participation.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding: The study was supported by funding from the Georgia District 4 Public Health\u0026mdash;CDC Annex 737 COVID-19 health equity grant.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions: RE led the conceptualization, study design, data analysis, and manuscript drafting. AJ contributed to data collection and community engagement activities, facilitated participant recruitment, interpreted findings, and revised manuscripts. SH contributed to interpreting results and critically reviewed and revised the manuscript for intellectual content. JBS critically reviewed and revised the manuscript for intellectual content. All authors read and approved the final manuscript before submission.\u003c/p\u003e\n\u003cp\u003eAcknowledgements: We want to thank the Georgia District 4 Public Health Equity Navigators for their contributions during the project\u003c/p\u003e\n\u003cp\u003eOR: Adjusted Odds ratio\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDickman SL, Himmelstein DU, Woolhandler S. Inequality and the health-care system in the USA. The Lancet [Internet]. 2017 [cited 2025 May 4];389:1431\u0026ndash;41. Available from: https://www.thelancet.com/action/showFullText?pii=S0140673617303987\u003c/li\u003e\n\u003cli\u003eHart LG, Salsberg E, Phillips DM, Lishner DM. Rural Health Care Providers in the United States. The Journal of Rural Health [Internet]. 2002 [cited 2025 May 4];18:211\u0026ndash;31. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1748-0361.2002.tb00932.x\u003c/li\u003e\n\u003cli\u003eDouthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015;129:611\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eMongelli F, Georgakopoulos P, Pato MT. Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States. https://doi.org/101176/appi.focus20190028 [Internet]. 2020 [cited 2025 May 4];18:16\u0026ndash;24. Available from: https://psychiatryonline.org/doi/10.1176/appi.focus.20190028\u003c/li\u003e\n\u003cli\u003eClove D. Healthcare Access Disparities among Rural Populations in the United States. Ballard Brief [Internet]. 2023 [cited 2025 May 4];2023. Available from: https://scholarsarchive.byu.edu/ballardbrief/vol2023/iss1/5\u003c/li\u003e\n\u003cli\u003eMaganty A, Byrnes ME, Hamm M, Wasilko R, Sabik LM, Davies BJ, et al. Barriers to rural health care from the provider perspective. Rural Remote Health. 2023;23. \u003c/li\u003e\n\u003cli\u003eBureau UC. 2020 Census Urban Areas Facts. [cited 2025 May 5]; Available from: https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural/2020-ua-facts.html\u003c/li\u003e\n\u003cli\u003eCyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: A systematic literature review. BMC Health Serv Res [Internet]. 2019 [cited 2025 May 5];19:1\u0026ndash;17. Available from: https://link.springer.com/articles/10.1186/s12913-019-4815-5\u003c/li\u003e\n\u003cli\u003eLister JJ, Weaver A, Ellis JD, Himle JA, Ledgerwood DM. A systematic review of rural-specific barriers to medication treatment for opioid use disorder in the United States. Am J Drug Alcohol Abuse [Internet]. 2020 [cited 2025 May 5];46:273\u0026ndash;88. Available from: https://www.tandfonline.com/doi/abs/10.1080/00952990.2019.1694536\u003c/li\u003e\n\u003cli\u003eValent\u0026iacute;n-S\u0026iacute;vico J, Canfield C, Low SA, Gollnick C. Evaluating the impact of broadband access and internet use in a small underserved rural community. Telecomm Policy. 2023;47:102499. \u003c/li\u003e\n\u003cli\u003eAljassim N, Ostini R. Health literacy in rural and urban populations: A systematic review. Patient Educ Couns. 2020;103:2142\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eElmes MB. Economic Inequality, Food Insecurity, and the Erosion of Equality of Capabilities in the United States. Bus Soc [Internet]. 2018 [cited 2025 May 5];57:1045\u0026ndash;74. Available from: https://journals.sagepub.com/doi/full/10.1177/0007650316676238\u003c/li\u003e\n\u003cli\u003eNganje W, Addey KA. Health Uninsurance in rural America: A partial equilibrium analysis. Health Econ Rev [Internet]. 2019 [cited 2025 May 5];9:1\u0026ndash;15. Available from: https://link.springer.com/articles/10.1186/s13561-019-0234-x\u003c/li\u003e\n\u003cli\u003eMacDougall H, Mork D, Hanson S, Smith CH. Rural-urban differences in health care unaffordability. The Journal of Rural Health [Internet]. 2024 [cited 2025 May 5];40:376\u0026ndash;85. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jrh.12788\u003c/li\u003e\n\u003cli\u003eCardarelli R, Bausch G, Murdock J, Chyatte MR. Return-on-Investment (ROI) analyses of an inpatient lay health worker model on 30-day readmission rates in a rural community hospital. The Journal of Rural Health. 2018;34:411\u0026ndash;22. \u003c/li\u003e\n\u003cli\u003eBerini CR, Bonilha HS, Simpson AN. Impact of Community Health Workers on Access to Care for Rural Populations in the United States: A Systematic Review. J Community Health [Internet]. 2022 [cited 2025 May 5];47:539\u0026ndash;53. Available from: https://link.springer.com/article/10.1007/s10900-021-01052-6\u003c/li\u003e\n\u003cli\u003eMcKenney KM, Martinez NG, Yee LM. Patient navigation across the spectrum of women\u0026rsquo;s health care in the United States. Am J Obstet Gynecol. 2018;218:280\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eWells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E, et al. Patient navigation: State of the art or is it science? Cancer. 2008;113:1999\u0026ndash;2010. \u003c/li\u003e\n\u003cli\u003eRanaghan C, Boyle K, Meehan M, Moustapha S, Fraser P, Concert C. Effectiveness of a patient navigator on patient satisfaction in adult patients in an ambulatory care setting: a systematic review. JBI Database System Rev Implement Rep [Internet]. 2016 [cited 2025 May 5];14:172\u0026ndash;218. Available from: https://journals.lww.com/jbisrir/fulltext/2016/08000/effectiveness_of_a_patient_navigator_on_patient.15.aspx\u003c/li\u003e\n\u003cli\u003eBraun KL, Thomas WL, Domingo JLB, Allison AL, Ponce A, Haunani Kamakana P, et al. Reducing cancer screening disparities in medicare beneficiaries through cancer patient navigation. J Am Geriatr Soc. 2015;63:365\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eNatale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer [Internet]. 2011 [cited 2025 May 5];117:3541\u0026ndash;50. Available from: https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.26264\u003c/li\u003e\n\u003cli\u003eMistry SK, Harris E, Harris M. Community Health Workers as Healthcare Navigators in Primary Care Chronic Disease Management: a Systematic Review. J Gen Intern Med [Internet]. 2021 [cited 2025 May 5];36:2755\u0026ndash;71. Available from: https://link.springer.com/article/10.1007/s11606-021-06667-y\u003c/li\u003e\n\u003cli\u003eLorhan S, Cleghorn L, Fitch M, Pang K, McAndrew A, Applin-Poole J, et al. Moving the agenda forward for cancer patient navigation: Understanding volunteer and peer navigation approaches. Journal of Cancer Education. 2013;28:84\u0026ndash;91. \u003c/li\u003e\n\u003cli\u003eAli-Faisal SF, Colella TJF, Medina-Jaudes N, Benz Scott L. The effectiveness of patient navigation to improve healthcare utilization outcomes: A meta-analysis of randomized controlled trials. Patient Educ Couns. 2017;100:436\u0026ndash;48. \u003c/li\u003e\n\u003cli\u003eShommu NS, Ahmed S, Rumana N, Barron GRS, McBrien KA, Turin TC. What is the scope of improving immigrant and ethnic minority healthcare using community navigators: A systematic scoping review. Int J Equity Health [Internet]. 2016 [cited 2025 May 5];15:1\u0026ndash;12. Available from: https://link.springer.com/articles/10.1186/s12939-016-0298-8\u003c/li\u003e\n\u003cli\u003eFischer SM, Sauaia A, Kutner JS. Patient Navigation: A Culturally Competent Strategy to Address Disparities in Palliative Care. J Palliat Med [Internet]. 2007 [cited 2025 May 5];10. Available from: www.liebertpub.com\u003c/li\u003e\n\u003cli\u003eDohan D, Schrag D. Using navigators to improve care of underserved patients: Current practices and approaches. Cancer. 2005;104:848\u0026ndash;55. \u003c/li\u003e\n\u003cli\u003eLalji R, Koh L, Francis A, Khalid R, Guha C, Johnson DW, et al. Patient navigator programmes for children and adolescents with chronic diseases. Cochrane Database of Systematic Reviews [Internet]. 2024 [cited 2025 May 5];2024. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD014688.pub2/full\u003c/li\u003e\n\u003cli\u003ePowell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical Mistrust, Racism, and Delays in Preventive Health Screening Among African-American Men. Behavioral Medicine [Internet]. 2019 [cited 2025 May 5];45:102\u0026ndash;17. Available from: https://www.tandfonline.com/doi/abs/10.1080/08964289.2019.1585327\u003c/li\u003e\n\u003cli\u003eNair L, Adetayo OA. Cultural Competence and Ethnic Diversity in Healthcare. Plast Reconstr Surg Glob Open [Internet]. 2019 [cited 2025 May 5];7:E2219. Available from: https://journals.lww.com/prsgo/fulltext/2019/05000/cultural_competence_and_ethnic_diversity_in.43.aspx\u003c/li\u003e\n\u003cli\u003eMurray TM. Trust in African Americans\u0026rsquo; Healthcare Experiences. Nurs Forum (Auckl) [Internet]. 2015 [cited 2025 May 5];50:285\u0026ndash;92. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/nuf.12120\u003c/li\u003e\n\u003cli\u003eCuevas AG, O\u0026rsquo;Brien K, Saha S. African American experiences in healthcare: \u0026ldquo;I always feel like I\u0026rsquo;m getting skipped over.\u0026rdquo; Health Psychology. 2016;35:987\u0026ndash;95. \u003c/li\u003e\n\u003cli\u003eMursa R, Patterson C, Halcomb E. Men\u0026rsquo;s help-seeking and engagement with general practice: An integrative review. J Adv Nurs [Internet]. 2022 [cited 2025 May 5];78:1938\u0026ndash;53. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15240\u003c/li\u003e\n\u003cli\u003eAbdul S, Cosmos Maha C, Kolawole TO. Revolutionizing community health literacy: The power of digital health tools in rural areas of the US and Africa. GSC Advanced Research and Reviews [Internet]. 2024 [cited 2025 May 5];19:286\u0026ndash;96. Available from: https://doi.org/10.30574/gscarr.2024.19.2.0189\u003c/li\u003e\n\u003cli\u003eSchiffelbein JE, Carluzzo KL, Hasson RM, Alford-Teaster JA, Imset I, Onega T. Barriers, Facilitators, and Suggested Interventions for Lung Cancer Screening Among a Rural Screening-Eligible Population. J Prim Care Community Health [Internet]. 2020 [cited 2025 May 5];11. Available from: https://journals.sagepub.com/doi/full/10.1177/2150132720930544\u003c/li\u003e\n\u003cli\u003eBrzezinski A, Kecht V, Van Dijcke D, Wright AL. Science skepticism reduced compliance with COVID-19 shelter-in-place policies in the United States. Nature Human Behaviour 2021 5:11 [Internet]. 2021 [cited 2025 May 5];5:1519\u0026ndash;27. Available from: https://www.nature.com/articles/s41562-021-01227-0\u003c/li\u003e\n\u003cli\u003eLister JJ, Joudrey PJ. Rural mistrust of public health interventions in the United States: A call for taking the long view to improve adoption. The Journal of Rural Health [Internet]. 2022 [cited 2025 May 5];39:18. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10084067/\u003c/li\u003e\n\u003cli\u003eKreuter MW, Lukwago SN, Bucholtz DC, Clark EM, Sanders-Thompson V. Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Educ Behav [Internet]. 2003 [cited 2025 May 5];30:133\u0026ndash;46. Available from: https://pubmed.ncbi.nlm.nih.gov/12693519/\u003c/li\u003e\n\u003cli\u003eHoven H, Backhaus I, Gero K, Kawachi I. Characteristics of employment history and self-perceived barriers to healthcare access. Eur J Public Health [Internet]. 2023 [cited 2025 May 5];33:1080\u0026ndash;7. Available from: https://dx.doi.org/10.1093/eurpub/ckad178\u003c/li\u003e\n\u003cli\u003eArtiga S, Orgera K, Pham O. Disparities in Health and Health Care: Five Key Questions and Answers. 2020 [cited 2025 May 5]; Available from: https://www.census.gov/data/tables/2017/demo/popproj/2017-summary-tables.html.\u003c/li\u003e\n\u003cli\u003eBetancourt JR, Green AR, Carrillo JE, Ii OA-F. Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care. Public Health Reports. 2003;118:293\u0026ndash;302.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6865483/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6865483/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth navigation programs are increasingly gaining attention as a promising strategy to promote healthcare access and reduce disparities, particularly in underserved and rural communities. This study examines community perceptions of the Health Equity Navigators Program and identifies socio-demographic predictors of perceived helpfulness in improving healthcare access and navigation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey was conducted among 269 adults residing in rural and urban medically underserved areas. Participants completed items assessing demographic characteristics, healthcare access, and perceived benefits of the \u0026ldquo;Health Equity Navigators\u0026rdquo; Program using a Likert scale. Descriptive statistics were used to summarize perceptions, and ordinal logistic regression models were applied to examine demographic predictors of agreement with the program\u0026rsquo;s ability to improve healthcare-seeking efficiency.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe Majority of the participants (69.1%) live in rural areas, females (79.6%), and Black/African Americans (59.6%). Most participants agreed or strongly agreed that the program improved their knowledge (Mean\u0026thinsp;=\u0026thinsp;4.0, SD\u0026thinsp;=\u0026thinsp;0.8), awareness (Mean\u0026thinsp;=\u0026thinsp;4.1, SD\u0026thinsp;=\u0026thinsp;0.9), and ability to navigate healthcare services (Mean\u0026thinsp;=\u0026thinsp;4.0, SD\u0026thinsp;=\u0026thinsp;0.8). Perceptions were significantly more favorable when neutral responses were excluded (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In adjusted models, males (OR\u0026thinsp;=\u0026thinsp;2.07, 95% CI: 1.08\u0026ndash;3.96) and unemployed individuals (OR\u0026thinsp;=\u0026thinsp;2.00, 95% CI: 1.06\u0026ndash;3.75) were significantly more likely to report high agreement, while African American/Black participants had lower odds of strong agreement compared to Non-Hispanic White participants (OR\u0026thinsp;=\u0026thinsp;0.56, 95% CI: 0.34\u0026ndash;0.92).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe \u0026ldquo;Health Equity Navigators\u0026rdquo; Program was positively received across demographic groups in the rural and underserved communities. However, differential perceptions by race and residential settings highlight the need to tailor health navigator models to the specific needs of the populations. A tailored program implementation is critical in addressing structural barriers and advancing health equity in medically underserved areas.\u003c/p\u003e","manuscriptTitle":"Community Perceptions of the “Health Equity Navigators” Program: A Cross-Sectional Study in Rural and Underserved US Populations","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 10:33:03","doi":"10.21203/rs.3.rs-6865483/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-18T11:40:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-11T21:21:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-08T15:04:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322952925868507823501870010148987328543","date":"2025-06-27T17:05:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78733633583178710734384658868379854379","date":"2025-06-27T16:27:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"19794225043067715497992477860839747217","date":"2025-06-25T13:11:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-25T05:56:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-25T05:49:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-17T05:10:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-16T16:54:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-06-16T16:52:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a9ef151-c80e-403a-a03d-32840901758f","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:08:45+00:00","versionOfRecord":{"articleIdentity":"rs-6865483","link":"https://doi.org/10.1186/s12889-025-25294-4","journal":{"identity":"bmc-public-health","isVorOnly":false,"title":"BMC Public Health"},"publishedOn":"2025-12-03 15:57:40","publishedOnDateReadable":"December 3rd, 2025"},"versionCreatedAt":"2025-07-01 10:33:03","video":"","vorDoi":"10.1186/s12889-025-25294-4","vorDoiUrl":"https://doi.org/10.1186/s12889-025-25294-4","workflowStages":[]},"version":"v1","identity":"rs-6865483","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6865483","identity":"rs-6865483","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}