Expanding Care-Delivery: A SWOT Analysis of the Community Health Aide Program in Three Oklahoma Tribes

American Indians and Alaska Natives have lower life expectancies, and poorer oral health compared to other US populations. These negative health outcomes are somewhat preventable with routine care, but provider shortages, proximity to health services, and other factors create barriers. The Community Health Aide Program (CHAP) is a multidisciplinary system of certified mid-level behavioral, medical, and dental providers working alongside licensed providers to increase access to quality care. The objective was to evaluate benefits and challenges of integrating the CHAP model within existing Tribal health systems.

De-identified data from open-ended responses related to CHAP expansion efforts in three Tribal Nations residing in Oklahoma were qualitatively analyzed using a SWOT analysis framework. Themes were developed deductively under the umbrella of Strengths, Weaknesses, Opportunities, and Threats. Five subthemes commonly affecting existing Tribal healthcare systems were identified. A special emphasis on dental healthcare was highlighted.

99 strengths (36.4%), 52 weaknesses (19.1%), 69 opportunities (25.4%), and 52 threats (19.1%) were identified. Subthemes included: Interprofessional and Community Connections and Programs (n = 88); Technology, Physical Infrastructure, and Resource Capacity (n = 80); Workforce Staffing and Efficiency (n = 49); Scope of Administrative Coordination, Budget, and Funding (n = 30); and Cultural Responsiveness (n = 25). Specific to dental healthcare were 59 strengths (n = 20), weaknesses (n = 11), opportunities (n = 21), and threats (n = 7).

CHAP has historically proven to be a successful healthcare delivery model for underserved populations. More strengths and opportunities than weaknesses and threats regarding the integration and expansion of CHAP to improve medical, behavioral, and dental healthcare access were identified.