Background Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. Methods Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. Results Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. Conclusions There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.

Objective: To identify the efficacy of group-based nutrition interventions to increase healthy eating, reduce nutrition risk, improve nutritional status, and improve physical mobility among community-dwelling older adults.Design: Systematic review. Electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO, and Sociological Abstracts were searched on July 15, 2020, for studies published in English since January 2010. Study selection, critical appraisal (using the Joanna Briggs Institute’s critical appraisal tools), and data extraction were performed in duplicate by two independent reviewers.Setting: Nutrition interventions delivered to groups in community-based settings were eligible. Studies delivered in acute or long-term care settings were excluded.Participants: Community-dwelling older adults aged 55+ years. Studies targeting specific disease populations or promoting weight loss were excluded.Results: Thirty-one experimental and quasi-experimental studies with generally unclear-high risk of bias were included. A broad range of interventions were identified, including nutrition education with behaviour change techniques (e.g., goal setting, interactive cooking demonstrations) (n=21), didactic nutrition education (n=4), interactive nutrition education (n=2), food access (n=2), and nutrition education with behaviour change techniques and food access (n=2). Group-based nutrition education with behaviour change techniques demonstrated the most promise in improving food and fluid intake, nutritional status, and healthy eating knowledge compared to baseline or control. The impact on mobility outcomes was unclear. Conclusions: Our findings should be interpreted with caution related to generally low certainty, unclear-high risk of bias, and high heterogeneity across interventions and outcomes in this body of literature. Quality research in group-based nutrition education for older adults is needed.

Background Physical activity and a healthy diet are important in helping to maintain mobility and quality of life with aging. Delivery of physical activity and nutrition interventions in a group setting adds the benefits of social participation. Objectives This umbrella review aims to identify group-based physical activity and nutrition interventions for community-dwelling older adults that improve mobility. Methods Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to April 28, 2020. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity and/or nutrition interventions, delivered in a group setting for community-dwelling older adults. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. Older adult/provider research partners informed data synthesis and results presentation. Results In total, 54 systematic reviews (1 high, 21 moderate, 32 low/critically low quality) were identified; 46 included physical activity only, and eight included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. Conclusions Multicomponent group-based physical activity interventions can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

Introduction: Despite the availability of clinical practice guidelines for cancer symptom management, cancer care providers do not consistently utilize them in practice. Oncology nurses in outpatient settings are well-positioned to use established guidelines to inform symptom assessment and management; however, issues concerning inconsistent implementation persist. This scoping review aims to identify and describe the components of implementation strategies that have been used to enhance the adoption, implementation, and sustainability of symptom management guidelines among specialized and advanced oncology nurses in cancer-specific outpatient settings. Factors influencing guideline implementation will also be identified. Methods and analysis: This scoping review will follow Joanna Briggs Institute methodology. Electronic databases CINAHL, Embase, Emcare, MEDLINE(R), and grey literature sources will be searched for studies published in English since the year 2000. Primary studies and grey literature reports of any design that include specialized or advanced oncology nurses practicing in cancer-specific outpatient settings will be eligible. Sources describing implementation strategies to enhance the adoption, implementation, and sustainability of cancer symptom management guidelines and/or factors influencing implementation will be included. Two reviewers will independently screen for eligibility and extract data. Data extraction will be guided by the Consolidated Framework for Implementation Research (CFIR). Data will be analyzed descriptively and synthesized according to CFIR constructs. Results will be presented through tabular/diagrammatic formats and narrative summary. Ethics and dissemination: Ethics approval is not required for this scoping review. Planned knowledge translation activities include a national conference presentation, peer-reviewed publication, academic social media channels, and dissemination within local oncology nursing and patient networks.