Implementing Patient Navigation Programs to Strengthen Integrated Care: A Scoping Review of Key Insights, Challenges, and Strategies

Background: Navigation programs are patient-centred service delivery models that guide individuals through complex healthcare systems, by addressing barriers and ensuring timely access to care that promote resiliency, recovery, and wellbeing. To optimize future sustainability of navigation services, it is essential to learn from past projects and apply rigourous implementation approaches.

 

Approach: We conducted a scoping review of navigation program implementations using the Consolidated Framework for Implementation Research (CFIR) to identify methods, contextual factors, and implementation barriers and facilitators. Searches across four electronic databases (Ovid MEDLINE, CINHAL, PsycINFO, and Embase) yielded 77 studies from an initial pool of 17,535 results. Using directed content analysis, we first applied the CFIR domains and constructs as the framework for deductive coding, and subsequently coded inductively within these CFIR constructs to create sub-categories. Diverse interest-holders (youth advisors, frontline navigation staff, and implementation researchers) provided input on and validated review findings.

 

Results: Across studies, integrated care was a core, embedded component for successful implementation within all CFIR domains. Within the Innovation domain, program implementation is most effective when designed for integration into existing health and social care systems. Team-based, co-designed approaches foster innovation and ensure relevance to local needs, with program funding oftentimes diverse and supported by multiple sources enhances implementation.

Key elements of the Outer Setting domain emphasize external partnerships and cross-sector collaborations. Programs that engage interest-holders across health systems, academic and research institutions, government and policymakers, and community-based organizations benefit from broader legitimacy, resource-sharing, and stronger support for future sustainability. In the Inner Setting domain, communication tools that support collaborative work, coupled with the presence of diverse, interdisciplinary teams facilitate implementation. Relational connections – within care teams, across service providers, and extending beyond immediate care – are integral to program success. Shared values, such as commitments to humanity and equity, reinforce “buy-in” and collective motivation.

 

Access to knowledge and information is strengthened by ongoing training, experiential learning, and role models and supervision, creating an environment of continuous learning and shared responsibility. Within the Individuals domain, successful programs encompass a diverse and unique team of professionals, coupled with community and lived experience perspectives. Individual capabilities, particularly skills in interpersonal relationships and cultural humility, are essential to establishing trust, patient engagement, and collaborative care.

 

The Implementation Processes domain emphasizes formal teaming structures (i.e., steering committees) that reinforce consistency and accountability. Open communication forums for sharing lessons and tailoring strategies facilitate adaptability and ongoing improvement, while collaborative problem-solving enables programs to respond effectively to contextual challenges.

 

Implications: Developing effective implementation strategies is essential for building navigation programs that strengthen integrated care and improve population health and wellbeing. Implementation success depends on relational, interdisciplinary, and co-designed approaches that embed navigation within broader care systems. Unexpectedly, culture emerged less prominently than anticipated, suggesting a need for deeper exploration of how culture and background influence implementation in future research. These findings inform policymakers and healthcare leaders on how to build sustainable, equity-oriented navigation programs that advance integrated care and population health.