Designing a patient-centered care navigation intervention within a healthcare system for SUD care: a qualitative study

Background Healthcare systems often struggle to provide timely access to care for patients with substance use disorder, and many patients do not successfully engage with treatment. Care navigation interventions have emerged as a strategy to help patients navigate complex health systems, address barriers to care, and improve treatment initiation and engagement, but little information exists about how to optimize these interventions within health system settings. In preparation for the Addressing Barriers to Care for Substance Use Disorder Trial, a hybrid effectiveness-implementation study conducted in a large integrated healthcare system, we undertook a series of design activities including piloting, stakeholder engagement, and iterative process redesign. As part of this broader effort, this qualitative study elicited the perspectives of patients and clinicians on barriers and facilitators to substance use treatment and ways to optimize the implementation of care navigation within the healthcare system’s mental health access center. Methods We conducted semi-structured interviews with 21 patients who sought treatment for substance use disorder and eight clinicians working in the mental health access center who assessed and referred patients to treatment. Interview transcripts were analyzed using the Rapid Group Analysis Process method, a novel rapid qualitative analysis method, to identify crosscutting themes related to care navigation. Results Analyses identified several crosscutting themes that conveyed ways that care navigators could help connect patients to substance use treatment: by communicating effectively with patients, by leveraging substance use disorder resources, by supporting patient motivation, and by addressing logistical barriers to treatment. These themes closely aligned with the study’s existing care navigation protocol. Findings also informed several refinements to improve the fit of care navigation within the health system’s existing workflows. Conclusions Identification of crosscutting themes via qualitative interviews confirmed the relevance of care navigation to the study population and helped optimize the intervention within the healthcare system. This study provides an example of how to incorporate stakeholder perspectives during intervention development and early implementation, particularly when adapting evidence-based approaches for new populations and settings. Trial registration The clinical trial referenced in this study was prospectively registered at www.clinicaltrials.gov (NCT06729957) on December 9, 2024.