Tinkering with Care Navigation: Designing Public Health Programs to Respond to Moving Contexts

Patient navigators have emerged as key actors in mitigating health disparities in part due to expanding support in public health and increased federal support. Patient navigation is a health intervention designed to bridge access issues, integrate disjointed health systems, and ease structural inequalities for complex illnesses, namely cancer. Through an analysis of professional definitions, policy documents, and the perspectives of care navigators, this thesis explores how the patient navigation model is both a response to and a symptom of systemic inequities (Hunleth and Steinmetz 2022; Colvin and Swartz 2015). This thesis explores patient navigation by interrogating its evolving definitions and the active practices that shape it, revealing that attempts to singularly define navigation fail to capture its dynamic and relational nature. Instead, navigation is better understood as an iterative process shaped by social actors who actively refine their approaches to bridge structural gaps in healthcare.

Based on eight months of participant observation at a housing shelter in the US Midwest and interviews with public health professionals engaged in the active process of designing, implementing, and altering navigation pathways to cervical cancer screening for people experiencing homelessness, this study assesses care navigation in practice. Drawing on Henrik Vigh’s theory of navigation as movement within unstable environments (2009), I argue that public health professionals adapt their patient navigation strategies in response to changing conditions. I incorporate the concept of "tinkering"—an ongoing, responsive process of modifying existing structures, resources, models, and practices (Mol, Moser, and Pols 2010)—to highlight how these meso-level professionals actively adjust healthcare models to meet patient and organizational needs. By approaching patient navigation as a tinkering process, this thesis expands existing literature on navigation by examining the more granular actions, or shadow work, that people enact in response to or in anticipation of moving social formations. My focus on navigation as tinkering reveals efforts that remain unseen within dominant political and public health discourse. Care navigation in practice represents an adaptive strategy for designing community-based health programs, making abstract care models fit specific social realities, and working toward health justice through times of uncertainty.