Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol

Introduction

The global population is ageing at an unprecedented rate due to a combination of declining fertility rates and increasing life expectancy. According to the World Health Organisation approximately 1.4 billion of the population are currently over the age of 60 years, which is set to double to 2.1 billion by 2050 (United Nations, 2019; WHO, 2022). This demographic shift is primarily driven by reduced birth rates, improved healthcare, and advancements in disease prevention, leading to longer life spans (Christensen et al., 2009). While increased longevity is a sign of medical and social progress, it is also accompanied by a rise in multi-morbidity, defined as the co-existence of two or more chronic conditions, which poses significant challenges to healthcare systems and social care systems worldwide (Marengoni et al., 2011). Ageing with multiple morbidities presents substantial challenges such as increased healthcare needs, higher risk of disability, cognitive decline, reduced quality of life, and heightened mortality risk (Barnett et al., 2012).

With rising healthcare costs (Hayes et al., 2024; Trépel et al., 2024) service providers have increasingly sought ways to better support older adults with complex needs (Burke et al., 2018; Demiris et al., 2020; Government of Ireland, 1988). In doing so, there has been a growing recognition that traditional healthcare models fail to address the broader determinants of health, such as social support, housing, nutrition and access to community resources (Kimberlee, 2015; Kingsfund, 2017; Polley et al., 2017). These factors play a critical role in shaping health outcomes and overall well-being yet historically, these have been overlooked in favour of a disease-centred approach (Giebel et al., 2022; Williams et al., 2023). As a result, many older adults experience a poorer quality of life despite having medical care, as their social and environmental needs remain unmet (Husk et al., 2019). To address this gap, there has been a shift towards more holistic and integrated care models that emphasise person-centred approaches, social prescribing, and community-based interventions for older adults (Chatterjee et al., 2018; Pescheny et al., 2020).

Social prescribing connects individuals with complex needs to community-based non-medical support services (Bickerdike et al., 2017; Kiely et al., 2022). Community connectors, an operational model of social prescribing, is grounded in the principles of holistic and person-centred care (Polley et al., 2017). It recognises that medical care alone is insufficient for improving quality of life and that community-based interventions are essential in promoting well-being and independence among the older population (Giebel et al., 2022; Littleford & Kralik, 2010). A Community Connector is a non-medical professional who is typically based in the community setting. However, this can vary internationally as demonstrated in the UK where Community Connectors appear to be embedded within primary care settings. Despite such variables, Community Connectors address wider social determinants of health through non-medical interventions and the development of an individualised and collaborative health and well-being plan, while offering support to connect with community services (Wilson et al., 2025). Preliminary evidence has suggested that the Community Connector initiative has the potential to address broader determinants of health by enhancing social connections, improving mental and physical health and increasing utilisation of health services (Prendergast & Alexander, 2023; Wallace et al., 2020). However, despite its potential benefits, significant barriers exist due to the lack of a standardised approach in implementing such models.

While Community Connectors share the common goal of addressing social determinants of health, there are key differences in how they operate globally. A significant challenge is the lack of a clear definition due to variations in their structure and implementation (Kiely et al., 2022). For instance, in the United Kingdom they are known as link workers formally embedded in the National Health Service (NHS, 2019), while in Australia (Larson et al., 2024; Sharman et al., 2022) and New Zealand (Boulton et al., 2009), they are called community navigators, focusing on culturally appropriate care for Indigenous populations. In Canada (CPHA, 2022) and the U.S., they are referred to as community health workers, primarily supporting marginalised groups (Larson et al., 2024). In Ireland, Community Connectors function within integrated care programs, assisting older adults with complex social and health needs (Hannan & Sieger-Jamison, 2024). Thus, without clear guidelines or a unified framework, there is considerable variation in how these services are delivered, leading to inconsistencies in their effectiveness. This was emphasised in a recent systematic review conducted by Kiely et al. (Kiely et al., 2022), which examined evidence from randomised controlled trials and controlled before-after studies to determine the effectiveness of social prescribing link workers. Findings from this review demonstrated significant heterogeneity in intervention design, populations served, and outcome measures across studies, leading to inconsistent evidence regarding the impact of social prescribing on health outcomes and healthcare utilisation (Kiely et al., 2022). Furthermore, authors of this review called for future research to better understand the components of social prescribing and outcomes considered for older adults (Kiely et al., 2022).

Methods

A scoping review design has been selected due to its suitability for mapping the breadth of existing literature on international Community Connector roles, interventions, and outcomes, particularly given the limited nature of the evidence and the emerging status of the field. The proposed scoping review will be conducted in accordance with the Arksey and O’Malley (Arksey & O’Malley, 2005) scoping review framework and later refined by Levac et al. (Levac et al., 2010) and the Joanna Briggs Institute. The review will also adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to ensure transparency and rigour in reporting. The scoping review is registered with Open Science Framework (OSF) and any changes to the proposed protocol will be reported with justifications provided.

Eligibility criteria

Given the absence of a universally accepted definition of Community Connector roles in the literature, a working definition was developed for this study which can broadly be defined as non-clinical providers, such as community health workers, link workers, patient navigators or social prescribing facilitators, who support older adults to navigate and access community-based resources (Moffatt et al., 2017; Hannan and Sieger-Jamison, 2024).

Studies will be included if they describe, evaluate or conceptualise the role of Community Connectors (including equivalent roles) that aim to support older adults (aged 60 years and older) in accessing community-based health or social care services. Eligible sources may include both empirical and theoretical work, with no restrictions on study design; qualitative, quantitative and mixed-methods studies will all be considered. No restrictions will be placed on the countries in which studies are conducted, however only studies published in English will be eligible for inclusion.

Information sources

A comprehensive search will be conducted across multiple electronic databases including CINAHL, Cochrane Library, EBSCO, Embase, PubMed, OVID and Scopus to identify relevant peer-reviewed literature.

In addition to academic databases, a grey literature search will be conducted in the following databases: grey literature sources (DART-Europe E-theses portal, https://libereurope.eu/article/dart-europe/, Open Grey, Grey Literature Report (New York Academy of Medicine): www.greylit.org/, Agency for Healthcare Research and Quality (AHRQ): www.ahrq.gov/, JBI: https://jbi.global/ and National Institute for Health and Care Excellence (NICE): www.nice.org.uk/, and Trip Medical database) and Trial registries including the WHO International Clinical Trials Registry Platform (ICTRP): https://www.who.int/tools/clinical-trials-registry-platform will be searched. The reference list of included sources of evidence in the review will be searched for additional sources.

Search strategy

Search terms will be adapted to the indexing of each database using Boolean operators (AND, OR) to combine concepts. Search terms will incorporate both keywords and controlled vocabulary (subject headings) relevant to the PCC framework (Population, Concept, Context). Keywords will be derived from the titles and abstracts of pertinent articles and will contribute to the development of the final search strategy, alongside database-specific subject headings aligned with the PCC elements.

An example search strategy for EBSCO is as follows:

These will be adapted according to the indexing of each database and logged in a master search strategy form using Microsoft Word. In accordance with replicability, a descriptive account of each search strategy of the databases will be provided in the appendix.

Selection of sources of evidence

A comprehensive scoping review of the existing literature will be undertaken to map the current state of knowledge related to the international role and scope of Community Connectors for older adults. The review will include peer-reviewed articles, systematic reviews and relevant grey literature published since 2000. Grey literature will be systematically identified using relevant organisational websites, grey literature databases, and search engines using predefined search terms (Godin et al., 2015). All retrieved records will undergo an initial screening of titles and abstracts conducted by DM to assess eligibility against the predefined inclusion criteria. Articles deemed potentially relevant will subsequently undergo full-text review. The screening and study selection process will be independently verified by CH to ensure methodological rigour and consistency in the inclusion of studies.

Data charting process

A standardised data charting form will be developed using Microsoft Excel, based on the Joanna Briggs Institute (JBI) data extraction tool for scoping reviews (Peters et al., 2020). The form will be piloted by two independent reviewers (DM and CH) on a sample of studies to ensure clarity and relevance and will be refined as needed. Following piloting, data will be charted by one reviewer (DM) using Rayann software. This will be cross-checked by a second reviewer (CH) to ensure accuracy and consistency. Any discrepancies identified during this process will be resolved through discussion, and if consensus cannot be reached, a third reviewer (RG) will be consulted to adjudicate.

Assessment of the risk of bias or methodological quality of included studies is not relevant as the aim of this scoping review is to characterise international models of Community Connector roles for older adults (Peters et al., 2020).

Data items

The following data items will be extracted from each included source:

These items will support a comprehensive synthesis of how Community Connectors are conceptualised, applied, and evaluated across diverse contexts.

Synthesis of results

The synthesis of results will be guided by the Population-Concept-Context (PCC) framework, as recommended by Joanna Briggs Institute for scoping reviews (Peters et al., 2020). Extracted data will be organised to capture key characteristics across included studies, including the target population, Community Connector components, implementation strategies, outcomes measured, and contextual factors. A descriptive numerical summary will be used to map the distribution of studies by variables such as publication year, country, setting, study design, and population characteristics.

Qualitative data will be analysed narratively (i.e., narrative descriptions of roles, implementation processes, and experiences) to identify common patterns, functions and challenges associated with Community Connectors. A basic coding framework will be developed to categorise emerging themes. Quantitative data will undergo basic descriptive analysis to summarise variables such as publication year, country of study, and population characteristics. Findings will be presented in narrative form and supported by tables and visual mappings where appropriate to enable interpretation and knowledge dissemination.

Dissemination plans

Findings will be disseminated through publication in a peer-reviewed open-access journal, conference presentations and target summaries for practitioners. Where possible, public-facing materials will be developed to enhance accessibility and knowledge distribution.

Ethics and dissemination

Not relevant.

Discussion

This scoping review will provide a comprehensive overview of international Community Connectors supporting older adults, highlighting variations in strategies, outcomes and contextual influences. It will provide critical insights into how these models can be adapted to other health and social care landscapes.