Health Fairs Service Program in Increasing Health Care Access in Taxi Drivers

PRIMARY OBJECTIVE:

I. To use a three-arm cluster randomized controlled trial to compare the effectiveness of: Screening Health Fair alone (Control); versus Screening Health Fair and Navigation Case Management (Health Fairs + NCM); versus Screening Health Fair, Mobile Technology and Taxi health Improvement Promoters (TIPs) (Health Fairs + mTech/TIPs) on increasing the proportion of drivers with a usual primary care provider at 3, 6 and 12 months post-health fair.

SECONDARY OBJECTIVES:

I. To estimate the incremental costs and cost-effectiveness of the Navigator Case Management and Mobile Technology/TIPs interventions compared with the Screening Health Fair alone.

II. To further compare the effectiveness of the interventions on improving health care access, utilizing the health access questions from the National Health Interview Survey, Medical Expenditure Panel Survey and Behavioral Risk Factor Surveillance System (BRFSS) at 3, 6 and 12 months post-health fair.

III. To compare the effectiveness of the Taxi Health Access Intervention for Linkages and Lifestyle (HAILL) interventions at 1 year post-health fair on

IIIa: Improving rates of lung and colorectal cancer screening, in those who meet screening guidelines.

IIIb. Decreasing waist circumference among those with abdominal obesity.

IIIc. Reducing body mass index [BMI] among those who are overweight or obese at baseline.

IIId. Improving blood pressure control among drivers with baseline elevated blood pressures.

IIIe. Maintenance of screening parameters (BMI, waist circumference, blood pressure) in those who were within the normal range at intake (those who are not overweight or obese, have a normal waist circumference, and have normal blood pressures).

IV. To describe participant characteristics, including demographics, health behavior profiles (physical activity, and alcohol and tobacco use), migration-related health profile, and quality of life (perceived stress) by primary care provider (PCP) uptake at one year post health fair.

OUTLINE: Participants are randomized to 1 of 3 arms.

ARM I (HEALTH FAIR-CONTROL): Participants attend health fair and undergo weight, height, waist circumference, blood pressure, cholesterol and glucose screening at baseline. Participants are provided discussion of the results with a clinician and information on how to access the health care system. Participants with abnormal blood pressure readings or other health needs are followed up by health fair staff within 2 weeks and may extend up to 3 months.

ARM II (HEALTH FAIR + NCM): Participants attend health fair and undergo weight, height, waist circumference, blood pressure, cholesterol, and glucose screening at baseline. Participants interact with professional health care navigator case manager and are followed up within 1-3 days or at least once a month by the case manager to assist with appointment making and keeping, provide referrals if needed, encourage drivers to attend PCP and/or screening appointments, encourage drivers to seek health insurance if the driver has none, and encourage medication adherence.

ARM III (HEALTH FAIR + mTECH + TIPs): Participants attend health fair and undergo weight, height, waist circumference, blood pressure, cholesterol, and glucose screening at baseline. Participants are provided discussion of the results with a clinician. Participants also receive appointment reminders for their primary care visit though Mosio text messages within 1 week, 2 days, and 1 day prior to their appointment and receive screening/health promotion reminders twice weekly after their primary care visit. Participants are followed up weekly or at least once a month by an assigned TIP to encourage drivers to select and visit a PCP and answer any questions related to the study, or to health care access, exercise, or nutrition.

After completion of study, patients are followed up at 3, 6, and 12 months.