Barriers and Enablers for Implementing Health Navigators in Paediatric and Adolescent Oncology in Chile: Local Insights From a Qualitative Study

Roberts, Antonia; Vezzani, Francisca; Campaña, Carla; Cabieses, Báltica; Obach, Alexandra; Espinoza, Manuel

Barriers and Enablers for Implementing Health Navigators in Paediatric and Adolescent Oncology in Chile: Local Insights From a Qualitative Study

Articles in Press

Document Type : Original Article

Authors

Antonia Roberts ¹^{, 2}

Francisca Vezzani ¹^{, 2}

Carla Campaña ¹^{, 2}

Báltica Cabieses ¹^{, 3}^{, 2}

Alexandra Obach ¹^{, 2}

Manuel Espinoza ²^{, 4}

¹ Centro de Salud Global Intercultural (CeSGI) ICIM, Facultad de Medicina Clínica Alemana y Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile

² Center for Cancer Prevention and Control (CECAN), FONDAP 152220002, ANID, Santiago, Chile

³ Department of Health Sciences, University of York, York, UK

⁴ School of Public Health, LKS Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China

Abstract

Background
Childhood cancer poses significant public health challenges globally, with survival disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). In response, the World Health Organization (WHO) launched the CureAll initiative to strengthen childhood cancer care. Despite being a HIC with a national oncology network, Chile faces fragmentation and unequal resource distribution similar to challenges in LMICs. The country recently introduced the role of gestores oncológicos, inspired by international health navigator models, to support patients and families through care coordination. This study describes the implementation of health navigators in paediatric and adolescent oncology in Chile from the perspective of healthcare professionals and health navigators, emphasising barriers and enablers to introduce this role in healthcare.

Methods
A qualitative multiple case study was conducted through 30 semi-structured interviews with health navigators and healthcare professionals from public hospitals across Chile. Participants were purposively selected to capture diverse experiences. Interviews were analysed using content analysis, supported by triangulation and reflexivity to ensure rigour.

Results
Barriers to implementation include structural issues, such as the lack of a national role definition and resource limitations, and team dynamics challenges linked to poor integration into clinical teams. Enablers included team openness to new roles and proactive strategies to introduce the navigator within the team, as well as individual qualities of navigators such as initiative, communication skills, and prior experience in paediatric oncology. Participants recommended that health navigators be full-time management roles focused exclusively on paediatrics. Key competencies include leadership, empathy, coordination, and organisational skills.

Conclusion
Implementing health navigators aligns with the CureAll strategy by improving care coordination and system responsiveness in paediatric oncology. This experience in Chile highlights how barriers, particularly at the team dynamics level, can be addressed through communication and role clarity, offering valuable insights for other Latin American countries pursuing similar models of care.

Keywords

Paediatric and Adolescent Oncology

Health Navigators

Care Coordination

Chile

1. Institute for Health Metrics and Evaluation. GBD Compare. 2021. https://vizhub.healthdata.org/gbd-compare/. Accessed May 5, 2025.

2. World Bank. World Bank Country and Lending Groups. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups. Accessed November 19, 2025.

3. Ortiz R, Vásquez L, Giri B, et al. Developing and sustaining high-quality care for children with cancer: the WHO Global Initiative for Childhood Cancer. Rev Panam Salud Publica. 2023;47:e164. doi:10.26633/RPSP.2023.164

4. Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K. Social determinants of mental health: where we are and where we need to go. Curr Psychiatry Rep. 2018;20(11):95. doi:10.1007/s11920-018-0969-9

5. World Health Organization. CureAll Framework: WHO Global Initiative for Childhood Cancer Increasing access, advancing quality, saving lives. 2021. https://iris.who.int/bitstream/handle/10665/347370/9789240025271-eng.pdf?sequence=1. Accessed May 5, 2025.

6. Ministerio de Salud. Plan Nacional de Cáncer Infantoadolescente 2023-2028. https://www.iccp-portal.org/system/files/plans/Plan-Nacional-de-Ca%CC%81ncer-Infantoadolescente-2023-2028.pdf. Accessed May 5, 2025.

7. Becerril-Montekio V, Reyes J de D, Manuel A. Sistema de salud de Chile. Salud Publica Mex. 2011. https://www.scielosp.org/pdf/spm/v53s2/09.pdf. Accessed May 5, 2025.

8. González C, Castillo-Laborde C, Matute I, eds. Estructura Y Funcionamiento Del Sistema De Salud Chileno. Santiago: Facultad de Medicina CAS-UDD; 2019.

9. World Banck Group. Data for Chile, High income | Data. https://data.worldbank.org/?locations=CL-XD. Accessed May 5, 2025.

10. Telles JP, Tuon F, Cunha A, Rocha JLL. The burden of limited resources in Latin America on healthcare quality and management. Lancet Reg Health Am. 2025;43:101014. doi:10.1016/j.lana.2025.101014

11. Garcia-Alcaraz C, Roesch SC, Calhoun E, et al. Exploring classes of cancer patient navigators and determinants of navigator role retention. Cancer. 2022;128(Suppl 13):2590-2600. doi:10.1002/cncr.33908

12. Wells KJ, Wightman P, Cobian Aguilar R, et al. Comparing clinical and nonclinical cancer patient navigators: A national study in the United States. Cancer. 2022;128 Suppl 13(Suppl 13):2601-2609. doi:10.1002/cncr.33880

13. Wells KJ, Valverde P, Ustjanauskas AE, Calhoun EA, Risendal BC. What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators. Patient Educ Couns. 2018;101(2):285-294. doi:10.1016/j.pec.2017.08.017

14. Ministerio de Salud. Plan Nacional de Cáncer 2018-2028. 2018. https://cdn.digital.gob.cl/filer_public/d3/0a/d30a1f5e-53d9-4a31-a4fe-e90d8d9a2348/documento_plan_nacional_de_cancer.pdf. Accessed February 1, 2025.

15. Ministerio de Salud. Plan Nacional de Cáncer 2022–2027. 2022. https://leydelcancer.minsal.cl/documentos/Marco-general-del-Plan-Nacional-de-Cancer-2022-2027.pdf. Accessed May 5, 2025.

16. Gödde K, Fügemann H, Desch A, et al. Development of a patient-oriented navigation model for patients with lung cancer and stroke in Germany. BMC Health Serv Res. 2022;22(1):785. doi:10.1186/s12913-022-08063-6

17. Fügemann H, Goerling U, Gödde K, et al. What do people with lung cancer and stroke expect from patient navigation? A qualitative study in Germany. BMJ Open. 2021;11(12):e050601. doi:10.1136/bmjopen-2021-050601

18. Porzig R, Neugebauer S, Heckmann T, Adolf D, Kaskel P, Froster UG. Evaluation of a cancer patient navigation program ("Onkolotse") in terms of hospitalization rates, resource use and healthcare costs: rationale and design of a randomized, controlled study. BMC Health Serv Res. 2018;18(1):413. doi:10.1186/s12913-018-3226-3

19. Battaglia TA, Fleisher L, Dwyer AJ, et al. Barriers and opportunities to measuring oncology patient navigation impact: Results from the National Navigation Roundtable survey. Cancer. 2022;128 Suppl 13:2568-2577. doi:10.1002/cncr.33805

20. Bernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: A systematic review. Cancer. 2019;125(16):2747-2761. doi:10.1002/cncr.32147

21. Canadian Partnership Against Cancer. Navigation: A Guide to Implementing Best Practices in Person-Centred Care Navigation: A Guide to Implementing Person-Centred Care. 2012. http://www.cancerview.ca/. Accessed May 5, 2025.

22. Alharahsheh HH, Pius A. A review of key paradigms: positivism VS interpretivism. Global Academic Journal of Humanities and Social Sciences. 2020;2(3):39-43.

23. Burns M, Bally J, Burles M, Holtslander L, Peacock S. Constructivist Grounded Theory or Interpretive Phenomenology? Methodological Choices Within Specific Study Contexts. Int J Qual Methods. 2022;21(1):160940692210777

24. Creswell J. Qualitative Inquiry and Research Design Choosing Among Five Approaches. Sage Publications; 2017.

25. Metropolitana A, Del X, Martínez-Salgado C. El muestreo en investigación cualitativa: principios básicos y algunas controversias. Cien Saude Colet. 2012;17(3):613-619.

26. Naderifar M, Goli H, Ghaljaie F. Snowball Sampling: A Purposeful Method of Sampling in Qualitative Research. Strides in Development of Medical Education. 2017;14(3):67670.

27. Vázquez Navarrete M, Ferreira da Silva M, Mogollón Pérez A, Fernández de Sanmamed Santos M, Delgado Gallego M, Vargas Lorenzo I. Introducción a las técnicas cualitativas de investigación aplicadas en salud. Barcelona: Universidad Autónoma de Barcelona; 2006.

28. Lorenzoni L. Health systems characteristics: A survey of 21 Latin American and Caribbean countries. OECD Health Working Papers; 2019. https://www.oecd.org/en/publications/health-systems-characteristics_0e8da4bd-en.html. Accessed May 5, 2025.

29. Darby C, Christopher NV, Murray JL, De Silva A. Strategy on Measuring Responsiveness. GPE Discussion Paper Series; 2000:23.

30. Cerda AA, García LY, Rivera-Arroyo J, Riquelme A, Teixeira JP, Jakovljevic M. Comparison of the healthcare system of Chile and Brazil: strengths, inefficiencies, and expenditures. Cost Eff Resour Alloc. 2022;20(1):71. doi:10.1186/s12962-022-00405-9

31. Lenz-Alcayaga R, Páez-Pizarro L. Efficiency and productivity of the Chilean public health system between 2010 and 2019. Medwave. 2023;23(6. doi:10.5867/medwave.2023.06.2682

32. Goyeneche L, Bauhoff S. Efficiency of Health Systems in Middle-Income Countries and Determinants of Efficiency in Latin American and the Caribbean. 2023. https://publications.iadb.org/en/node/34428. Accessed May 5, 2025.

33. Cunningham U, De Brún A, McAuliffe E. Understanding what makes team interventions work: Learning from healthcare professionals. Int J Integr Care. 2019;19(4):310.

34. Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: key discoveries enabling safer, high-quality care. Am Psychol. 2018;73(4):433-450. doi:10.1037/amp0000298

35. Weller JM, Mahajan R, Fahey-Williams K, Webster CS. Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. Br J Anaesth. 2024;132(4):771-778. doi:10.1016/j.bja.2023.12.035

36. Karam M, Chouinard MC, Poitras ME, et al. Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review. Int J Integr Care. 2021;21(1):16. doi:10.5334/ijic.5518

37. Wells KJ, Valverde P, Ustjanauskas AE, Calhoun EA, Risendal BC. What are patient navigators doing, for whom, and where? A national survey evaluating the types of services provided by patient navigators. Patient Educ Couns. 2018;101(2):285-294. doi:10.1016/j.pec.2017.08.017

38. Varanasi AP, Burhansstipanov L, Dorn C, et al. Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable. Cancer. 2024;130(9):1549-1567. doi:10.1002/cncr.35147

39. Silbermann M, Pitsillides B, Al-Alfi N, et al. Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries. Ann Oncol. 2013;24 Suppl 7(Suppl 7):vii41-vii47. doi:10.1093/annonc/mdt265

40. Dadzie MA, Yarney J, Nyantakyi AY, Tackie JNO. A bright future for multidisciplinary approach to cancer care in the setting of limited resource. Transl Oncol. 2024;50:102124. doi:10.1016/j.tranon.2024.102124

41. Berardi R, Morgese F, Rinaldi S, et al. Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management. Cancer Manag Res. 2020;12:9363-9374. doi:10.2147/CMAR.S220976

42. CancerCare. Fact Sheet. The Value Of Oncology Social Workers. 2020. https://media.cancercare.org/publications/original/262-2020_Value_of_Oncology_Social_Worker.pdf. Accessed May 5, 2025.

43. Organismo andino de salud-Convenio Hipólito Unanue. ORAS-CONHU website. Hoja de Ruta para Mejorar la Atención del Cáncer en Niños, Niñas y Adolescentes en la Subregión Andina 2024-2030. 2023. http://www.orasconhu.org. Accessed February 1 2026.

44. Cotache-Condor C, Kantety V, Grimm A, et al. Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review. Pediatr Blood Cancer. 2023;70(3):e30175. doi:10.1002/pbc.30175

45. Martín Arribas MC, Feito Grande L, Júdez Gutiérrez J, J. de Abajo Iglesias F, Pamplos Ros T, Benedetto Terracini J. Recomendaciones sobre aspectos éticos de la investigación