The role of adolescent peer navigators in health service delivery: perspectives from Kenyan adolescents and young adults, caregivers and other knowledge users

Adolescents and young adults (AYA) in Kenya face numerous structural and sociocultural barriers to accessing health services, including stigma, low health literacy, and lack of adolescent-friendly services. Peer navigation-where trained individuals with shared experiences provide education, psychosocial support, and system navigation-has emerged as a promising strategy to address these challenges. While widely implemented in adult HIV and maternal care programs across sub-Saharan Africa, the role of adolescent peer navigators remains under defined. This qualitative study aimed to explore perspectives on the role of adolescent peer navigators in health service delivery in Uasin Gishu County, Kenya, and to develop a conceptual framework grounded in the Information-Motivation-Behavioral Skills (IMB) model. Through convenience sampling, data were collected in 16 focus group discussions with 127 AYA aged 10-24 years and 40 in-depth interviews with healthcare providers, caregivers, community leaders, policymakers, and peer navigators. Mixed deductive and inductive thematic analysis, theme organization, and framework development was guided by the IMB model, which revealed strong support for the integration of peers into AYA health services. Participants identified three key functions for adolescent peer navigators aligned with the IMB model: (1) delivering accurate and relatable health information; (2) fostering motivation through shared identity and emotional support; and (3) facilitating behavioral skills and system navigation through accompaniment, referral, and logistical guidance. Trust, confidentiality, age appropriateness, and adequate training were highlighted as essential to program acceptability and effectiveness. Findings demonstrate the acceptability of peer navigators in health education, counseling, and service navigation and reinforce the need for clearly defined roles supported by comprehensive training and supervision. The resulting Adolescent Peer Navigator-Based Health Services Framework provides a novel model for integrating peer support into adolescent health service delivery. Grounded in the IMB model, this framework can guide the design and implementation of peer navigation programs to improve AYA engagement in care in low-income settings.'