“Being a ‘professional friend’: an exploration of the functioning and impacts of health navigation to improve access to healthcare for migrant women

Migrant women often experience poorer health than other populations, in part due to inequalities in healthcare access. Health navigation is a person-centred intervention to address barriers to accessing healthcare. This research project sought to characterise health navigation as an intervention for migrant women, elucidate its theoretical mechanisms, explore the impact of health navigators and their relationships with migrant women, as well as develop a model of how health navigation can improve access to healthcare. A systematic integrative review revealed the complexity of navigation for migrant women in terms of its roles, processes and characteristics. However, there were significant gaps in knowledge of perceptions of health navigation in a UK context, of the role of shared characteristics and experiences between health navigators and migrant women, and of the intervention's theoretical mechanisms.

To address these gaps, a multiple, instrumental case study was carried out at three navigation programmes within two contrasting organisational contexts in England. Semi-structured interviews (n = 31) were conducted with migrant women service users, health navigators, healthcare professionals, and social support professionals; additionally, organisational documents (n = 11) were examined. Data from interviews and documents were analysed using reflexive thematic analysis. Health navigation was found to be diverse, flexible and needs-driven, ultimately increasing service users’ knowledge and promoting their empowerment - although structural factors shaped their degree of success. Health navigation was also perceived to have increased access to social and community services and reduced migrant women’s social isolation, while delivering a range of benefits and challenges for other stakeholders. Successful delivery of health navigation for migrant women required a trusting and nuanced relationship with a female health navigator. While challenges remain in delivering health navigation, there is scope for improved policies and practices which can ensure greater sustainability of health navigation programmes while advocating for structural change.