How Do Older Adults With Multimorbidity Conceptualize Navigation Within the Healthcare System? A Phenomenographic Study

AIM: To identify and describe the different ways in which older adults with multimorbidity conceptualize navigation within the healthcare system. DESIGN: A qualitative phenomenographic study. METHODS: Individual face-to-face interviews were conducted in northern Sweden between June and September 2023 with 21 purposefully selected older adults (aged 74-75) with multimorbidity living in the community. All interviews were audio-recorded, transcribed, and analysed using the phenomenographic method to identify common ways of conceptualizing navigation within the healthcare system. FINDINGS: Analysis revealed three coexisting ways of understanding healthcare navigation: (1) relying on a predefined path (complying with and trusting the system), (2) overcoming system barriers (persisting through barriers with a sense of frustration), and (3) coordinating one's own healthcare (creatively managing fragmented healthcare with vigilant efforts to bridge the structural gap). CONCLUSIONS: Older adults conceptualize healthcare navigation as grounded in trust, marked by frustration, or driven by vigilance. These differing orientations suggest that navigation is approached less through individual abilities and more through underlying beliefs and understanding about the healthcare system. Some adapt while others must compensate for system gaps, which highlight the need for clearer pathways, better coordination, and stronger support for those least able to navigate on their own. REPORTING METHOD: Findings were reported following the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: Data were collected through patient interviews. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Understanding the different ways older adults with multimorbidity conceive of healthcare navigation can guide more responsive communication, assessment, and support. By integrating healthcare navigation support into routine clinical practice, healthcare professionals can help bridge gaps in understanding, reduce patient burden, and improve continuity, safety, and overall quality of healthcare. This can be achieved through healthcare coordination, patient education, and/or structured follow-up.