Patient Navigation in Medically Underserved Areas


The recognition of the distinct health and socioeconomic circumstances of people who live in resource-poor, medically underserved communities is a necessary step in the process of developing successful interventions to reduce health disparities. Medically underserved areas (MUAs), often in areas with high percentages of racial/ethnic minorities, are communities characterized by a confluence of multiple levels of disadvantage: too few primary care providers, high rates of poverty, and poor population health. As a consequence of residence, medically underserved women experience disparities at almost every step in the process of prevention, detection, treatment, and survival of cancer, representing a complex interaction between social determinants of health, behavioral risk factors, and system access to timely and high quality care. Our overall objectives are to:

  • Implement and assess the effects of a patient navigation program to improve access to timely and appropriate preventive, diagnostic, and treatment services for breast cancer care among medically underserved women in Chicago
  • Assess the role of government-supported community health centers on breast cancer diagnosis in Chicago

To achieve these objectives, we propose a trial, randomized at the patient level within each of three selected hospitals:

  1. A community-based hospital in an established designated MUA with a mature FQHC (those MUAs designated on or before 1995)
  2. A community-based hospital in newly designated MUA with a new FQHC system (established after 2005)
  3. A community-based hospital in a non-designated but eligible MUA area without any FQHC

We propose the following specific aims:

  1. To assess the relative effect of navigation on breast cancer care.
  2. To assess the interaction of living in a medically underserved area and navigation on breast cancer care.
  3. To assess the relative effect of living in an MUA on breast cancer care as measured by the IBCCEDP and 5-year retrospective study hospital data.

Research Partner(s)

Holy Cross Hospital
Roseland Community Hospital
Trinity Hospital

Funding Agency

National Cancer Institute of the National Institutes of Health (Grant No. 2P50CA106743)


Principal Investigator
Elizabeth A Calhoun, PhD, MEd


Richard E. Barrett, PhD
Richard T. Campbell, PhD
Julie S. Darnell, PhD, MHSA
Carol Estwing Ferrans, PhD, RN, FAAN

Start date
End date
About this grant

This is a project within a center grant, the Center for Population Health and Health Disparities, 2.

Cathy Kaliel of Holy Cross Hospital; Joy West, MD of Roseland Community Hospital; and Thomas Summerfelt, PhD of Trinity Hospital are project directors.

Related publications

Molina Y, Kim S, Berrios N, Calhoun EA. Medical mistrust and patient satisfaction with mammography: the mediating effects of perceived self-efficacy among navigated African American women. Health Expect. 2015 Dec;18(6):2941-50. [See abstract.]

Tejeda S, Darnell JS, Cho YI, Stolley MR, Markossian TW, Calhoun EA. Patient barriers to follow-up care for breast and cervical cancer abnormalities. J Womens Health (Larchmt). 2013 Jun;22(6):507-17. [See abstract.]