A Mixed-Method Study Exploring the Resource Needs and Practice Experiences of a Cross-Sector, Statewide Service Navigation Workforce

Background: Health and social inequality are associated with multiple adverse life course experiences including poor physical and mental health, substance abuse, and family violence. Early and routine engagement with culturally responsive and person-centered health and social care can prevent these adversities, however large sections of the population experience barriers accessing such services.

Purpose: Recently, new interventions have been developed which specifically aim to reduce barriers and facilitate access to needed services. These interventions have been referred to interchangeably as patient navigation, family navigation, and service navigation, and are delivered by a range of helping professionals across a variety of practice settings. Evidence for service navigation is promising with respect to service access, engagement, and clinical and functional outcomes. However, adoption and implementation of efficacious navigation practices is not widespread nor well understood. To help address this gap in knowledge, this study explores the resource needs and practices experiences of a statewide, cross-sector service navigation workforce.

Methods: Navigators, supervisors, and administrators from two statewide cross-sector list-servs were invited to complete an electronic survey and optional one-hour follow-up interview. The survey included a 19-item, 7-point scale measuring the perceived relevance of different empirically supported service navigation practices (alpha=.94), a 19-item, 7-point scale measuring the need for resources in these areas (alpha=.96), the Generalized Self-Efficacy Scale (alpha=.82), and Evidence-Based Practices Attitudes Scale (total alpha=.85, subscale alpha range=.61-.93). Six demographic items were also collected. Follow-up interviews utilized a semi-structured format to explore the participants practice context, resource needs, and opportunities for innovation.

Statistical analysis included frequency and descriptive statistics for survey constructs, and Chi-Square test and ANOVA for mean values of study constructs by participant demographic characteristics. Qualitative analysis included a hybrid inductive deductive thematic analysis. Data were collected in parallel and analyzed concurrently.

Results: Ninety-one individuals completed the survey. Participants were service navigators (75.8%), supervisors (15.4%) and administrators (8.8%). The mean respondent age was 42 (SD=11.9) years. The sample primarily identified as female (93.4%) and racial/ethnic minority (56.0%). Participants held favorable attitudes towards evidence-based practices (total mean=99.5, SD=14.4) and were heterogeneous with respect to feelings of self-efficacy in their work (mean=22.4, SD=3.4). The sample reported high perceived relevance (mean=118, SD=14.3) and need for additional resources (mean=91.7, SD=26.8) in empirically supported navigation practices. ANOVA and Chi-Square tests suggest ratings did not vary by respondent characteristics.

Thirteen follow-up interviews were conducted. The scope of navigation practices was diverse with respect to setting (community agencies, hospitals, churches), context (in-person, remote, hybrid), scope (targeted, holistic), and duration (single encounter, weeks, months). Resource needs were individual (strengthening knowledge), professional (collaboration with navigators across sectors), and structural (changing policy, increasing supply). Participants reported flexibility and openness to learning new practice methods.

Conclusion: While there was variability with regard to the approaches to service navigation, participants were aligned regarding the perceived relevance and need for resources in empirically supported navigation practices. Favorable attitudes towards evidence-based practices and openness to innovation suggest ideal conditions for community-based service navigation research and co-learning partnerships to reduce inequality and promote public health.