Original Research

Sustainability of a Rural Volunteer Program (Nav-CARE): a case study


name here
Wendy Duggleby1
PhD, RN, Professor *

Barbara Pesut2 PhD, RN, Professor

name here
Grace Warner3
PhD, Associate Professor

name here
Cheryl Nekolaichuk4
PhD, R.Psych, Professor

name here
Lars K Hallstrom5
PhD, Professor and Director of the Alberta Center for Sustainable Rural Communities

Brittany Elliott6 MN, RN, Research Assistant

Jennifer Swindle7 PhD, Research Coordinator

Sunita Ghosh8 PhD, P.Stat., Associate Clinical Professor


1 Faculty of Nursing, University of Alberta Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada

2 School of Nursing, University of British Columbia Okanagan, 1157 Research Way, Kelowna, BC V2Y 1Y1, Canada

3 School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia B3H 4R2, Canada

4 Division of Palliative Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, c/o Palliative Institute, 404 Health Services Centre, 1090 Youville Drive West Edmonton, Alberta T6L 0A3, Canada

5 Department of Political Studies (Augustana Faculty) and Department of Resource Economics and Environmental Sociology, University of Alberta, Alberta T4V 2R3, Canada

6, 7 Faculty of Nursing, University of Alberta, Level 3, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta T6G 1C9, Canada

8 Alberta Health Services–Cancer Control Alberta; and Department of Medical Oncology and Department of Mathematical and Statistical Sciences, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2, Canada

ACCEPTED: 1 September 2020

early abstract:

Introduction: Nav-CARE (Navigation: Connecting Accessing Resourcing and Engaging) is an evidence-based program that was implemented over one year in a rural community in western Canada. Nav-CARE uses volunteers who are trained in navigation to facilitate access to resources and provide social support to older persons living in the community with serious illness such as cancer, congestive heart failure and chronic obstructive pulmonary disease. Following implementation in which Nav-CARE was found to be feasible, acceptable, and have positive outcomes, Nav-CARE was integrated into the local community-based hospice society program. Two years after a successful implementation it continued to be sustainable in this same rural community. The purpose of this study was to explore the key factors that facilitated the sustainability of  Nav-CARE in a rural hospice society.
Methods: A qualitative single case study design was used with multiple data sources collected at different times: a) pre-implementation, b) Nav-CARE program implementation (one-year time period), c) immediately post implementation and d) after implementation (6 months to 2 years). Data included individual interviews with community stakeholders (n=9), the study volunteer coordinator (n=1), hospice society coordinator (n-1) and Nav-CARE volunteers (n=9). As well it included meeting notes of volunteer debriefing sessions and meetings with stakeholders planning for sustainability of Nav-CARE that were held during the one-year implementation. Data were organized using the i-PARIHS (integrated Promoting Action on Research Implementation in Health Services) framework (a well known implementation framework). Once this organization was complete, data were analyzed using Yin’s qualitative case study approach.
Results: The findings from this case study suggested that key factors in facilitating  sustainability of a rural community intervention (Nav-CARE) were the organizational context (inner context) and facilitation (facilitator and facilitation processes). Additionally the inner context included: a)  the fit of Nav-CARE with the organization’s priorities, b) the absorptive capacity of the organization, and c) organizational structure and mechanisms to integrate Nav-CARE into current programs.  Furthermore the hospice society was well established and supported by the rural community. The role of the facilitator and the planned facilitation processes (training of volunteer navigators, ongoing support and planning events) were key factors in the sustainability of the Nav-CARE program. The findings found that the formal role of the facilitator in the implementation and sustainability of Nav-CARE in this rural community required skills and knowledge, as well as ongoing mentorship. As well the facilitation process for Nav-CARE included formal sustainability planning meetings involving stakeholders.
Conclusions: Using the i-PARIHS framework and a case study approach, key factors for facilitating sustainability were identified. The role of the facilitator, the facilitation processes and the characteristics of the organizational context were important for the sustainability of Nav-CARE. Future research is needed to understand how to assess and enhance an organization’s sustainability capacity and also the impact of additional facilitator training and mentoring. This study provides a foundation for future research and adds to the discussion of the issue of sustainability of evidence-based interventions in rural community settings.