Navigating the healthcare service “Black Box”: Individual competence and fragmented system

CSCW research has investigated how people at workplace and organizational settings gain knowledge required for work, but less is known regarding how “organizational outsiders” obtain knowledge about organizations and organizational landscapes that provide a service. Gaining knowledge about service landscapes is particularly difficult because they are often complex, non-transparent, and fragmented. We address this gap through an interview study of 19 U.S. parents regarding how they navigated health services for their young children, and how they gained competence in navigation practices. We describe a similar process all participants went through including four inherently iterative stages: Seeking and integrating knowledge, decision-making, encountering breakdowns, and repairing and reflecting. We further elucidate what constitutes navigational competence, or the creation of resources about how to navigate, for our participants. We discuss how our study could advance understanding of navigation practices, and the importance for HCI design to support these complex yet essential navigation practices and the accumulation of navigational competence.