Crossing waters, crossing divides: A qualitative exploration of patient navigation experiences in Philippine Island communities

Abstract

Navigating healthcare systems registers unique challenges in geographically isolated areas, where physical barriers and spatial inequities influence access to care. Patient navigation is well positioned to address these persistent health disparities, however, services remain scant in island communities of the Philippines. This study employs a situated intersectionality framework to investigate how place intersects with individual characteristics and social resources to drive patient navigation experiences in these geographically disadvantaged areas, examining the dynamic interactions between physical isolation, digital connectivity, social networks, and healthcare access. Through a relational understanding of health and place, this study utilized purposive sampling to invite participants for four focus group discussions and six key informant interviews. Thematic analysis revealed several key dimensions of patient navigation in this geographical context, including how digital navigation services help overcome geographical barriers while simultaneously creating new forms of inequality based on technological access and capability; how community resources and social capital create virtual bridges to mainland healthcare facilities; and how navigation services reduce the temporal and economic burdens unique to island settings. The analysis demonstrated how these factors interact differently across demographic groups and spatial locations within the island context. These findings elucidate how geographical context cuts through individual and social factors to create both opportunities and constraints in healthcare navigation, demonstrating the value of situated intersectionality in understanding how multiple forms of disadvantage traverse within specific spatial contexts. Recommendations include place-sensitive institutionalization of patient navigation services, strategic investment in geographically distributed technological infrastructure, and strengthening community-based navigation support systems to ensure effectiveness and sustainability of such endeavors in island communities.