Client Perspectives and Experiences With HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis

Abstract

Patient navigation is increasingly utilized to link and (re)engage persons with HIV to care. Understanding client experiences with HIV patient navigation can facilitate intervention design and translation of evidence to practice. We conducted a qualitative meta-synthesis of client experiences with HIV patient navigation. Data were analyzed using thematic synthesis. We identified seven relevant studies; all collected data via in-depth interviews with persons with HIV who participated in HIV patient navigation. Four interrelated themes emerged from analysis that pertain to (1) the complexity of the health and social service environment and the holistic approaches taken by the navigator, (2) the profound significance of the client–navigator relationship, (3) client reluctance to end the navigation program, and (4) client self-efficacy and feelings of hope and psychological change as a result of their navigation experience. The unifying theme across all studies was the value and impact of the client–navigator relationship on client experience and quality of life. Programs should consider hiring navigators who possess strong relational skills and are peers of the clients, and clearly delineating the role of the navigator. Research should examine the impact of the client–navigator relationship on client outcomes and further investigate how participating in patient navigation affects client self-efficacy, client resiliency, and the role of posttraumatic growth to achieve improved HIV outcomes. This review underscores the significance of the relationship within intensive, multilevel interventions for individuals and communities marginalized and isolated from health and social service systems.

Examining How Health Navigation Affects Mental Health Among Gay, Bisexual, and Other Men Who Have Sex with Men Living with Human Immunodeficiency Virus in Guatemala

“…In a metasynthesis of qualitative data on health navigation among PLHIV, participants from several studies described increased anxiety as navigation interventions ended and they worried about a future without a navigator. 35 This highlights the importance of preventing dependency on navigators and having an intentional off-boarding process for interventions that include these relational components. 21,35 Contrary to our hypothesis, higher levels of informational navigator support were significantly associated with improved anxiety, but not emotional or instrumental navigator support.…”

“…35 This highlights the importance of preventing dependency on navigators and having an intentional off-boarding process for interventions that include these relational components. 21,35 Contrary to our hypothesis, higher levels of informational navigator support were significantly associated with improved anxiety, but not emotional or instrumental navigator support. Although emotional support has been found to be particularly important to the mental health of sexual minorities, our results mirror findings from another navigation intervention among racial and ethnic minorities living with HIV in the United States that highlighted the importance of informational support over other types of support on a variety of health outcomes.…”

HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis of Navigators’ Experiences

“…We also found that without clear program guidance, navigators struggle with determining how long they should engage with their client. This can be especially difficult when clients are hesitant to exit the navigation program or end the relationship with their navigator (Roland et al, 2020). Navigators need to define and maintain professional boundaries (Phillips et al, 2014), and programs have an obligation to support and help navigators set boundaries and avoid burnout (Ferrante et al, 2011).…”

Patient-Identified Markers of Quality Care: Improving HIV Service Delivery for Older African Americans

“…Second, supportive, healthy, loving relationships between providers and patients can be emphasized within patient-centered healthcare practices. Relationship-focused healthcare is the cornerstone of patient-navigation trends, which monitor and facilitate ideal healthcare progression [32][33][34]. Furthermore, relationship promotion for aging populations has been shown to enhance the quality of life, offering increases in patient self-efficacy and resiliency [9,31,[34][35][36][37][38].…”

“…Relationship-focused healthcare is the cornerstone of patient-navigation trends, which monitor and facilitate ideal healthcare progression [32][33][34]. Furthermore, relationship promotion for aging populations has been shown to enhance the quality of life, offering increases in patient self-efficacy and resiliency [9,31,[34][35][36][37][38]. Third, compassionate-based care can be achieved through bolstering the patient voice, while offering a host of physiological and psychological benefits [31].…”