Navigating health and social care systems: professional tensions, cross-sector effects, and methodological complexities in navigation research and practice

There is increasing impetus to help individuals navigate health and social care systems. Though the development and effectiveness of navigator roles have long been explored in health and sociological research, evaluations of navigation are typically narrow in focus and oriented to individual outcomes, quantitative metrics, or barriers and enablers in implementation. Investigating the structural effects of navigation, especially across disparate contexts and sectors, presents significant challenges for researching navigation. To explore these challenges, this article presents a critical interpretive synthesis of qualitative literature on navigation spanning health and social care. Twenty qualitative studies were included, with analysis organised across four themes: (1) <i>modalities of navigation practice</i>; (2) <i>epistemic authority and professional identity</i>; (3) <i>authorising navigation in and through place</i>; (4) <i>situating navigation and its effects in systems</i>. We conceptualise navigation as operating via dual modalities of <i>structural</i> and <i>interpretative</i> practice, and argue this conceptualisation facilitates closer critical attention to the relational and situated practices often obscured in accounts of navigators' work. We also highlight a need for strengthened research designs that reflect the complexities of care systems and consider the effects of navigation across multiple sectors. We finally reflect on emerging challenges posed by digital and algorithmic tools in navigation.