{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:04:52Z","timestamp":1784073892256,"version":"3.55.0"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"European Union, Horizon Europe","award":["[grant no. 101057361]"],"award-info":[{"award-number":["[grant no. 101057361]"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Navigation programs support people and families by addressing barriers to care and mitigating physical, psychosocial, and practical challenges. While navigation programs are increasingly recognized within European healthcare systems, evidence on implementation strategies for scale-up across settings such as a Train-the-Trainer program remains limited and rarely comprehensively evaluated. This study evaluates a Train-the-Trainer program developed within the EU NAVIGATE project as an implementation strategy to deliver a navigation program for older people with cancer living at home in six European countries.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The multi-method evaluation follows the four levels of the Kirkpatrick model. Levels 1 and 2 (Reaction and Learning) were assessed via questionnaires completed by trainers; Level 3 (Behavior) through weekly diaries and group interviews with (international) trainers; and Level 4 (Results) through questionnaires completed by navigators and the intervention beneficiaries (older people with cancer). Quantitative data were analyzed descriptively; qualitative data were analyzed using qualitative content or narrative analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n At Levels 1 and 2, trainers (\n n<\/jats:italic>\n \u2009=\u200911) rated the program as highly useful on a five-point Likert-scale ranging from 1 to 5 (median\u2009=\u20095, IQR\u2009=\u20090.75), reporting strong alignment with their role, clear understanding of the program, and high confidence (median scores 4\u20135). At Level 3, according to weekly diaries and group interviews, trainers applied the competencies they learned. Successes included positive navigator feedback and training adaptation. Challenges included workload and time constraints, limited team collaboration, and difficulties adapting materials. The ability to contextually adapt the training was facilitated by applying the competencies. At Level 4, reported high levels of overall understanding and confidence following the training, with median scores of 4 (IQR\u2009=\u20091) for both outcomes on a 5-point Likert scale, with highest scores reported for addressing quality of life, and lower scores for supporting technology use. Older people with cancer (\n n<\/jats:italic>\n \u2009=\u2009101) responded that navigators generally demonstrated the intended competencies with median scores ranging from 1 (IQR\u2009=\u20092) to 5 (IQR\u2009=\u20091) on a 5-point Likert scale.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Findings demonstrate the potential of training to implement a navigation program to improve long-term age-appropriate support, emphasize the importance of contextually adapting to local settings, and underline the need for further research to enhance the transferability of navigation programs across diverse health systems.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n Clinicaltrials.gov: identifier NCT06110312 (2023\/10\/31).<\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s12913-026-14717-6","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T13:45:07Z","timestamp":1779371107000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating a Train-the-Trainer program to implement a navigation program for older people with cancer across six European countries, as part of the EU NAVIGATE project: a Kirkpatrick multi-method evaluation"],"prefix":"10.1186","volume":"26","author":[{"given":"Fien","family":"Van Campe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinne","family":"Smets","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Beijer Veenman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Pivodic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barb","family":"Pesut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Else Gien","family":"Statema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Duggleby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nele","family":"Van Den Noortgate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna","family":"Szczerbi\u0144ska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Ferraris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bregje","family":"Onwuteaka-Philipsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Alfieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieve","family":"Van den Block","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of EU NAVIGATE Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Chambaere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"issue":"1","key":"14717_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-017-2046-1","volume":"17","author":"RK Valaitis","year":"2017","unstructured":"Valaitis RK, Carter N, Lam A, Nicholl J, Feather J, Cleghorn L. 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Belgium: Commissie Medische Ethiek, 09\/08\/2023, EC-2023-164; Ireland: SJH\/TUH Joint Research Ethics Committee, 14\/11\/2023, 3726; Italy: Comitato Etico Territoriale Lombardia, Istituto Nazionale dei Tumori, 31\/07\/2023, INT171\/23; the Netherlands: METC Amsterdam UMC, 22\/08\/2023, 2023.0489; Portugal: Ethics Committee of the Faculty of Medicine of the University of Coimbra and Ethics Committee of the Portuguese Institute of Oncology of Coimbra Francisco Gentil, 25\/09\/2023, EO04\/2023; Poland: Komisja Bioetyczna, Uniwersytetu Jagiello\u0144skiego, 14\/06\/2023, 1072.6120.55.2023. The trial is registered on Clinicaltrials.gov (ID: NCT06110312). All participants gave written informed consent prior to data collection. All obtained data were pseudonymized.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"N.A.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Rose Miranda\n 1\n , Chelsea Vinckier\n 1\n , Shannen De Vos\n 1\n , Chiara Verschaeren\n 1\n , Eline Naert\n 2\n , Helena Du Cheyne\n 2\n , Roeline Pasman\n 3\n , Annicka van de Plas\n 3\n , Gloria Puurveen\n 4\n , Ashford Kelly\n 4\n , Ilona Bara\u0144ska\n 6\n , Kasia Slaby\n 6\n , Agata Stodolska\n 6\n , Emilia Malmur\n 6\n , Natalia Witek\n 6\n , Maja Furlan de Brito\n 7,8\n , Vitor Rodrigues\n 7\n , Sonia Silva\n 7\n , In\u00eas Correia\n 7\n , Sandra Gervasio\n 7\n , Peter May\n 9\n ,Amanda Lavan\n 9\n , Gemma O\u2019Keeffe\n 9\n , Siofra Hearne\n 9\n , Monica Gandelli\n 10\n , Chiara Lusetti\n 10\n , Laura Gangeri\n 11\n , Bianca Scacciati\n 11\n .\n 1\n Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium.\n 2\n Department of Public Health and Primary Care, Universiteit Gent, Ghent, Belgium.\n 3\n Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Expertise Center for Palliative Care Amsterdam UMC, Amsterdam, Netherlands.\n 4\n University of British Columbia Okanagan, Kelowna, BC, Canada.\n 5\n University of Alberta, Edmonton, Alberta, Canada.\n 6\n Laboratory for Research on Aging Society, Epidemiology and Preventive Medicine, Medical Faculty, Jagiellonian University Medical College, Krak\u00f3w, Poland.\n 7\n Faculty of Medicine, University of Coimbra, Coimbra, Portugal.\n 8\n Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King\u2019s College London, London, UK.\n 9\n Trinity College Dublin, Dublin, Ireland.\n 10\n Lega Italiana per la lotta contro i tumori di Milano, LILT Milano Monza Brianza, Milano, Italy.\n 11\n Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, INT, Milano, Italy.","order":4,"name":"Ethics","label":"EU NAVIGATE Collaborative Author List and full list of consortium research members","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"987"}}