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

Non-medical interventions, community-based care, social prescribing, older adults, ageing, scoping review ALL Metrics - Views Downloads How to cite this article Manning D, Hayes C, Galvin R et al. Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.12688/hrbopenres.14268.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Study Protocol [version 1; peer review: 1 approved, 2 approved with reservations] Danielle Manning https://orcid.org/0000-0002-1135-5849 1,2, Christina Hayes https://orcid.org/0000-0002-2218-3667 2, Rose Galvin https://orcid.org/0000-0002-8171-224X 2, Frank Houghton https://orcid.org/0000-0002-7599-5255 1, Jennifer Moran Stritch https://orcid.org/0000-0003-1523-0709 1Danielle Manning https://orcid.org/0000-0002-1135-5849 1,2, Christina Hayes https://orcid.org/0000-0002-2218-3667 2, [...] Rose Galvin https://orcid.org/0000-0002-8171-224X 2, Frank Houghton https://orcid.org/0000-0002-7599-5255 1, Jennifer Moran Stritch https://orcid.org/0000-0003-1523-0709 1 PUBLISHED 29 Oct 2025 Author details Author details 1 Technological University of the Shannon Midlands Midwest, Limerick, County Limerick, Ireland 2 University of Limerick, Limerick, County Limerick, Ireland 2 University of Limerick, Limerick, County Limerick, Ireland Danielle Manning Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Christina Hayes Roles: Formal Analysis, Supervision, Writing – Review & Editing Roles: Formal Analysis, Supervision, Writing – Review & Editing Rose Galvin Roles: Supervision Roles: Supervision Frank Houghton Roles: Supervision Roles: Supervision Jennifer Moran Stritch Roles: Supervision Roles: Supervision OPEN PEER REVIEW REVIEWER STATUS This article is included in the Ageing Populations collection. As global populations age, there is an increasing need for community-based approaches that support older adults in maintaining independence, social connectedness, and access to services. One emerging model is the Community Connector (CC), an individual who facilitates older adults’ engagement with local supports that promote well-being. Despite growing references to this role in national and international practice, there is limited comprehensive understanding of how CC’s are defined, implemented, and evaluated across diverse contexts, and how these insights may inform adaptation within varying health and social care systems. The objectives of the scoping review are to (1) identify and characterise international models of CC roles and their key interventions, including modes of delivery (2) describe key characteristics of populations they serve and (3) summarise reported outcomes. This scoping review will follow the methodological framework of Arksey and O’Malley (2005) and will be in accordance with the PRISMA-ScR guidelines. The study design was chosen due to its capacity to comprehensively map and synthesise the existing literature on international CC models, particularly given the limited nature of the evidence. A comprehensive search will be conducted from 2000 to present, across academic databases [CINAHL, Cochrane Library, EBSCO, Embase, PubMed, OVID, Scopus] and grey literature to identify CC’s models targeting older adults. Two reviewers will independently screen studies for inclusion based on the criteria of full-text, qualitative, quantitative and mixed-methods studies. Data on programme characteristics, target populations, measured outcomes and contextual factors will be extracted, charted, and synthesised using a narrative approach. The review will characterise international community connector models, including their core functions, terminology, target population and implementation strategies. It will also examine evaluation methods and assess their potential for adaptation and scale-up across healthcare settings. Non-medical interventions, community-based care, social prescribing, older adults, ageing, scoping review Corresponding Author(s) Grant information: This research was funded by the Health Service Executive Office of Clinical Design and Innovation (2025-2026) and supported by the HRB Research Leader 2020 (RL 2020-010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Manning D et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Manning D, Hayes C, Galvin R et al. Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.12688/hrbopenres.14268.1) First published: 29 Oct 2025, 8:117 (https://doi.org/10.12688/hrbopenres.14268.1) Latest published: 16 Apr 2026, 8:117 (https://doi.org/10.12688/hrbopenres.14268.2) The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There is a newer version of this article available. of this article available. 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 emphasize person-centred approaches, social prescribing, and community-based interventions (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). The community connector model, an operational model of social prescribing, is grounded in the principles of holistic and person-centred care (Polley et al., 2017). The Community Connector model 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. Typically, they 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 marginalized 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, 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). The scoping review aims to identify and characterise international models of community connector roles for older adults, including their key interventions and modes of delivery; to describe the populations they serve, and to summarise the reported outcomes associated with these interventions. This review addresses a key gap in the literature by examining community connector models across acute, primary, and community care settings to provide a comprehensive understanding of their roles in diverse healthcare contexts.

The objectives of the scoping review are to (1) identify and characterise international models of CC roles and their key interventions, including modes of delivery (2) describe key characteristics of populations they serve and (3) summarise reported outcomes. A scoping review design has been selected due to its suitability for mapping the breadth of existing literature on international community connector models, 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 will be registered with Open Science Framework (OSF) and any changes to the proposed protocol will be amended with justifications provided. Studies will be included if they describe, evaluate or conceptualise Community Connector models (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 be considered. 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, Open Grey, Grey Literature Report (New York Academy of Medicine): www.greylit.org/, Agency for Healthcare Research and Quality (AHRQ): www.ahrq.gov/, Joanna Briggs Institute: joannabriggs.org 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): www.who.int/ictrp/en/ will be searched. The reference list of included sources of evidence in the review will be searched for additional sources. 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). They will be tailored to the indexing system of each specific database. 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: TI ('aged' OR 'elderly' OR 'elderly' OR 'older adult*' OR 'older population*' OR 'geriatric*' OR 'senior*' OR 'elder*' OR 'old aged*' OR 'older person*') OR AB ('aged' OR 'elderly' OR 'elderly' OR 'older adult*' OR 'older population*' OR 'geriatric*' OR 'senior*' OR 'elder*' OR 'old aged*' OR 'older person*') AND (social prescribing OR TI ('social prescribing*' OR 'community connector' OR 'lay person' OR 'linkworker' OR 'link-worker' OR 'link worker' OR 'community health worker' OR 'community health facilitator' OR 'patient navigator'/exp OR 'patient navigator' OR 'well-being programme') OR AB ('social prescribing*' OR 'community connector' OR 'lay person' OR 'linkworker' OR 'link-worker' OR 'link worker' OR 'community health worker' OR 'community health facilitator' OR 'patient navigator' OR 'well-being programme'). 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. A comprehensive scoping review of the existing literature will be conducted 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 grey literature published since 2000. 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) and 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 review (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). The following data items will be extracted from each included source: author(s) year of publication, and country of study study design and methodology name or description of the Community Connector model; setting in which the model was implemented (e.g., community, primary care, social services) target population characteristics (e.g., age group, health or social needs); details of implementation processes outcomes measured and indicators used and information on funding sources or declarations of interest. These items will support a comprehensive synthesis of how Community Connector models are conceptualised, applied, and evaluated across diverse contexts. 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 model 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 Connector models. 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. 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. Not relevant. This scoping review will provide a comprehensive overview of international community connector models 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. No data are associated with this protocol. Open Science Framework: Characterising the Role and Scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol. Available at: https://osf.io/6czd8/overview. 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Reference Source Author details Author details 1 Technological University of the Shannon Midlands Midwest, Limerick, County Limerick, Ireland 2 University of Limerick, Limerick, County Limerick, Ireland 2 University of Limerick, Limerick, County Limerick, Ireland Danielle Manning Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Christina Hayes Roles: Formal Analysis, Supervision, Writing – Review & Editing Roles: Formal Analysis, Supervision, Writing – Review & Editing Rose Galvin Roles: Supervision Roles: Supervision Frank Houghton Roles: Supervision Roles: Supervision Jennifer Moran Stritch Roles: Supervision Roles: Supervision Competing interests No competing interests were disclosed. Grant information This research was funded by the Health Service Executive Office of Clinical Design and Innovation (2025-2026) and supported by the HRB Research Leader 2020 (RL 2020-010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) Copyright © 2025 Manning D et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Manning D, Hayes C, Galvin R et al. Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.12688/hrbopenres.14268.1) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 29 Oct 2025 Views 0 How to cite this report: Darcy PM. Reviewer Report For: Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.21956/hrbopenres.15695.r53427) The direct URL for this report is: https://hrbopenresearch.org/articles/8-117/v1#referee-response-53427 https://hrbopenresearch.org/articles/8-117/v1#referee-response-53427 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 27 Mar 2026 Approved with Reservations VIEWS 0 Thank you for the opportunity to review this work. This review aims to synthesise the international literature on “community connectors” in older adults, and I commend the authors for addressing this important area. My comments focus on clarifying how ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close My comments focus on clarifying how ... Continue reading Thank you for the opportunity to review this work. This review aims to synthesise the international literature on “community connectors” in older adults, and I commend the authors for addressing this important area. My comments focus on clarifying how the “community connector” model aligns with or differs from the broader social prescribing model, in which a “connector” typically refers individuals to a range of local, non-clinical services. I also recommend more clearly defining the overall focus - specifically, whether the review examines the “community connector” as an operational model or as an individual role, and ensuring consistent use of this terminology to reflect the review focus throughout the manuscript. 1. Abstract: “One emerging model is the Community Connector (CC), an individual who facilitates older adults’ engagement with local supports that promote well-being. Despite growing references to this role in national and international practice…..” The opening lines of the abstract refer to the community connector as both a model and an individual. Please clarify whether the ‘community connector’ in this review refers to an individual role or as an operational model, and ensure consistent terminology is used throughout the manuscript. 2. In the abstract, the authors note that “there is limited comprehensive understanding of how CCs are defined, implemented, and evaluated across diverse contexts, and how these insights may inform adaptation within varying health and social care systems.” Given the limited clarity around how a community connector is defined, should the review consider including conceptual mapping of community connectors as a key aim. It is also not clear whether ‘CC’ in this instance refers to an individual role or as an operational model, and this should be clarified. 3. Abstract: The authors note that “the objectives of the scoping review are to (1) identify and characterise international models of CC roles and their key interventions, including modes of delivery; (2) describe key characteristics of populations they serve…”. Please clarify what is meant by “international models of CC roles” - does this refer to the roles of individual community connectors, or to an operational model. The authors could include ‘older adult populations’ under objective (2). 4. Abstract: “Data on programme characteristics, target populations, measured outcomes and contextual factors will be extracted, charted, and synthesised using a narrative approach”. Should the data charting also capture how the community connector is defined (as an individual role)? This would align with the authors’ statement that “there is limited comprehensive understanding of how CCs are defined.” 5. Abstract: “The review will characterise international community connector models, including their core functions, terminology, target populations, and implementation strategies, as well as examine evaluation methods and assess their potential for adaptation and scale-up across healthcare settings”. As noted previously, it is unclear whether the review focus is on the community connector as an operational model, as an individual role, or both – please clarify and ensure consistency throughout. Additionally, please clarify what is meant by “terminology” in this context. 6. Introduction (paragraph 2): It would be helpful to more clearly define what is meant by “environmental needs” in this context, and to provide examples relevant to the population under study to enhance clarity for the reader. 7. Introduction: In the paragraph starting “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” …. This point could be strengthened by more explicitly engaging with the intersection between population ageing, increasing multimorbidity, and existing pressures on health and social care systems. Incorporating relevant evidence and references would help to situate this argument within a broader demographic and policy context, particularly in relation to the growing complexity of care needs and the implications for service demand, integration, and sustainability. 8. The manuscript may benefit from further nuance in its discussion of social prescribing. Social prescribing typically targets individuals with ‘non-medical’ needs and may not always be appropriate for, or inclusive of, those with more complex mental or physical health needs. Acknowledging this would strengthen the conceptual clarity of the paper. See for example, Cartwright et al (2022) https://socialprescribingacademy.org.uk/media/jaibqf4q/evidence-review-who-is-accessing-social-prescribing.pdf 9. Can the authors please expand on and clarify the sentence “The community connector model, an operational model of social prescribing” to help readers understand the distinctions between the community connector model and the social prescribing model, as well as the practical implications. See Muhl et al. (2023), who discuss internationally accepted conceptual and operational definitions of social prescribing (BMJ Open 2023;13:e070184, doi:10.1136/bmjopen-2022-070184). 10. Related to this comment, could the authors make explicit how the ‘community connector model’ differs from a ‘social prescribing model’ as this is not sufficiently clear. 11. The manuscript states that link workers are formally embedded within the NHS. It may be helpful to add that social prescribing link workers are also employed in VCSE organisations in the UK. See Tierney et al (2025) https://doi.org/10.3399/BJGP.2024.0279 and Hazeldine et al (2025) https://doi.org/10.1136/bmjph-2024-000941 12. The manuscript defines a community connector as “a non-medical professional who is typically based in the community setting”. Could the authors clarify if community connectors are non-clinical individuals operating both within and outside social prescribing pathways? If so, please make this explicit and provide supporting references. 13. The authors note that “This review addresses a key gap in the literature by examining community connector models across acute, primary, and community care settings to provide a comprehensive understanding of their roles in diverse healthcare contexts,” and under “Selection of Sources of Evidence,” they state that a “comprehensive scoping review of the existing literature will be conducted to map the current state of knowledge related to the international role and scope of community connectors for older adults.” Please review the manuscript to ensure consistent language, so it is clear throughout whether the focus of this review is on the community connector as an individual role or as an operational model, or both. 14. Methods: Have the authors undertaken preliminary scoping searches to support their claim of “the limited nature of the evidence”? The basis for this justification is currently unclear. 15. Eligibility Criteria: Are there any exclusion criteria or limitations applied? 16. Search Strategy: The review adopts a PCC framework; however, it is unclear how “context” has been operationalised, within the search strategy. If context is a key component of the review question, please clarify whether and how it has been incorporated into the search, or justify its omission. 17. Selection of Sources of Evidence: The authors restrict included studies to those published from 2020 onward. Please provide a clear rationale for this limitation, explaining how it aligns with the objectives of the review and whether earlier studies may have been relevant. 18. General: The terms ‘Community Connector’, ‘CC’, and ‘community connector’ are used inconsistently throughout the manuscript. Please ensure consistent terminology / formatting. Similarly, models of community connector roles and community connector models are used interchangeably. Please ensure consistency of language and terminology throughout. 19. General Context: Please consider prior reviews in the area, including the scoping review by Mulholland et al. (2025) (https://doi.org/10.1155/hsc/4394123) and provide context how the proposed review differs from or adds to the existing literature in this area. This will help to clarify the unique contribution and added value of the current review. My comments focus on clarifying how the “community connector” model aligns with or differs from the broader social prescribing model, in which a “connector” typically refers individuals to a range of local, non-clinical services. I also recommend more clearly defining the overall focus - specifically, whether the review examines the “community connector” as an operational model or as an individual role, and ensuring consistent use of this terminology to reflect the review focus throughout the manuscript. 1. Abstract: “One emerging model is the Community Connector (CC), an individual who facilitates older adults’ engagement with local supports that promote well-being. Despite growing references to this role in national and international practice…..” The opening lines of the abstract refer to the community connector as both a model and an individual. Please clarify whether the ‘community connector’ in this review refers to an individual role or as an operational model, and ensure consistent terminology is used throughout the manuscript. 2. In the abstract, the authors note that “there is limited comprehensive understanding of how CCs are defined, implemented, and evaluated across diverse contexts, and how these insights may inform adaptation within varying health and social care systems.” Given the limited clarity around how a community connector is defined, should the review consider including conceptual mapping of community connectors as a key aim. It is also not clear whether ‘CC’ in this instance refers to an individual role or as an operational model, and this should be clarified. 3. Abstract: The authors note that “the objectives of the scoping review are to (1) identify and characterise international models of CC roles and their key interventions, including modes of delivery; (2) describe key characteristics of populations they serve…”. Please clarify what is meant by “international models of CC roles” - does this refer to the roles of individual community connectors, or to an operational model. The authors could include ‘older adult populations’ under objective (2). 4. Abstract: “Data on programme characteristics, target populations, measured outcomes and contextual factors will be extracted, charted, and synthesised using a narrative approach”. Should the data charting also capture how the community connector is defined (as an individual role)? This would align with the authors’ statement that “there is limited comprehensive understanding of how CCs are defined.” 5. Abstract: “The review will characterise international community connector models, including their core functions, terminology, target populations, and implementation strategies, as well as examine evaluation methods and assess their potential for adaptation and scale-up across healthcare settings”. As noted previously, it is unclear whether the review focus is on the community connector as an operational model, as an individual role, or both – please clarify and ensure consistency throughout. Additionally, please clarify what is meant by “terminology” in this context. 6. Introduction (paragraph 2): It would be helpful to more clearly define what is meant by “environmental needs” in this context, and to provide examples relevant to the population under study to enhance clarity for the reader. 7. Introduction: In the paragraph starting “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” …. This point could be strengthened by more explicitly engaging with the intersection between population ageing, increasing multimorbidity, and existing pressures on health and social care systems. Incorporating relevant evidence and references would help to situate this argument within a broader demographic and policy context, particularly in relation to the growing complexity of care needs and the implications for service demand, integration, and sustainability. 8. The manuscript may benefit from further nuance in its discussion of social prescribing. Social prescribing typically targets individuals with ‘non-medical’ needs and may not always be appropriate for, or inclusive of, those with more complex mental or physical health needs. Acknowledging this would strengthen the conceptual clarity of the paper. See for example, Cartwright et al (2022) https://socialprescribingacademy.org.uk/media/jaibqf4q/evidence-review-who-is-accessing-social-prescribing.pdf 9. Can the authors please expand on and clarify the sentence “The community connector model, an operational model of social prescribing” to help readers understand the distinctions between the community connector model and the social prescribing model, as well as the practical implications. See Muhl et al. (2023), who discuss internationally accepted conceptual and operational definitions of social prescribing (BMJ Open 2023;13:e070184, doi:10.1136/bmjopen-2022-070184). 10. Related to this comment, could the authors make explicit how the ‘community connector model’ differs from a ‘social prescribing model’ as this is not sufficiently clear. 11. The manuscript states that link workers are formally embedded within the NHS. It may be helpful to add that social prescribing link workers are also employed in VCSE organisations in the UK. See Tierney et al (2025) https://doi.org/10.3399/BJGP.2024.0279 and Hazeldine et al (2025) https://doi.org/10.1136/bmjph-2024-000941 12. The manuscript defines a community connector as “a non-medical professional who is typically based in the community setting”. Could the authors clarify if community connectors are non-clinical individuals operating both within and outside social prescribing pathways? If so, please make this explicit and provide supporting references. 13. The authors note that “This review addresses a key gap in the literature by examining community connector models across acute, primary, and community care settings to provide a comprehensive understanding of their roles in diverse healthcare contexts,” and under “Selection of Sources of Evidence,” they state that a “comprehensive scoping review of the existing literature will be conducted to map the current state of knowledge related to the international role and scope of community connectors for older adults.” Please review the manuscript to ensure consistent language, so it is clear throughout whether the focus of this review is on the community connector as an individual role or as an operational model, or both. 14. Methods: Have the authors undertaken preliminary scoping searches to support their claim of “the limited nature of the evidence”? The basis for this justification is currently unclear. 15. Eligibility Criteria: Are there any exclusion criteria or limitations applied? 16. Search Strategy: The review adopts a PCC framework; however, it is unclear how “context” has been operationalised, within the search strategy. If context is a key component of the review question, please clarify whether and how it has been incorporated into the search, or justify its omission. 17. Selection of Sources of Evidence: The authors restrict included studies to those published from 2020 onward. Please provide a clear rationale for this limitation, explaining how it aligns with the objectives of the review and whether earlier studies may have been relevant. 18. General: The terms ‘Community Connector’, ‘CC’, and ‘community connector’ are used inconsistently throughout the manuscript. Please ensure consistent terminology / formatting. Similarly, models of community connector roles and community connector models are used interchangeably. Please ensure consistency of language and terminology throughout. 19. General Context: Please consider prior reviews in the area, including the scoping review by Mulholland et al. (2025) (https://doi.org/10.1155/hsc/4394123) and provide context how the proposed review differs from or adds to the existing literature in this area. This will help to clarify the unique contribution and added value of the current review. - Is the rationale for, and objectives of, the study clearly described? Partly - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Partly - Are the datasets clearly presented in a useable and accessible format? Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: social prescribing, community-based assets, applied health research, mental health and multi-morbidity CITE HOW TO CITE THIS REPORT Darcy PM. Reviewer Report For: Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.21956/hrbopenres.15695.r53427) The direct URL for this report is: https://hrbopenresearch.org/articles/8-117/v1#referee-response-53427 https://hrbopenresearch.org/articles/8-117/v1#referee-response-53427 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Views 0 How to cite this report: O'Grady M. Reviewer Report For: Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.21956/hrbopenres.15695.r53424) The direct URL for this report is: https://hrbopenresearch.org/articles/8-117/v1#referee-response-53424 https://hrbopenresearch.org/articles/8-117/v1#referee-response-53424 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 24 Feb 2026 Approved with Reservations VIEWS 0 Thank you for the opportunity to review this work. This scoping review will provide a synthesis of evidence regarding 'community connector' interventions for older adults and will provide an important overview of these approaches. This review is timely given the ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close Thank you for the opportunity to review this work. This scoping review will provide a synthesis of evidence regarding 'community connector' interventions for older adults and will provide an important overview of these approaches. This review is timely given the importance of community-based approaches to health, and the need to address social isolation and social health in older adults. There were some details missing in relation to the methods, but I am confident that these can be addressed by the authors. General comments: 1. You mention the Population-Concept-Context framework, and state that this will guide selection of search terms and synthesis of results. However, you do not define what these are in the context of your review. Please provide a definition of PCC. 2. You state throughout the methods that you will examine implementation processes and strategies of the different CC models but your objectives state that you only plan to characterise these models. Perhaps this objective could be expanded to demonstrate that you plan to describe how these models are implemented also? Specific comments: Title: 1. Consider capitalising 'role and scope' in the title for consistency.

Methods 1. More appropriate to say will be "reported" in accordance with PRISMA guidelines.

2. I'm not sure what you mean by 'terminology' - is this to determine naming conventions for the role, or terminology in relation to community connector models?

1. 'Community connector' is sometimes capitalized, sometimes not - choose one for consistency. 2. In Paragraph 3/4, you discuss that there is "inconsistencies in their effectiveness" for community connectors. I think it is more appropriate to say that there is inconsistent evidence for effectiveness - as the literature is limited it is difficult to conclude whether one model is more effective over the other. 3. Missing word in Paragraph 4: "outcome measures across studies"

1. You state that there is limited evidence for the community connector role. How did you determine this? JBI recommend doing a preliminary search for existing reviews and stating this was performed in the introduction - was this how you determined a lack of evidence? 2. Typos: Scoping review is registered, and changes will be reported not amended. 3. You need to state how you will define community connector models in eligibility criteria - perhaps you mean to use the definition of community connector models in the introduction but this needs to be made clear. Are there any specific exclusion criteria? You may consider a table outlining specific inclusion/exclusion criteria which would be helpful for the reader. Information Sources 1. The URL for JBI is incorrect, and you have included URLs for some sources but not others. Also the Joanna Briggs Institute goes by JBI now, please correct throughout the manuscript. 2. How will you systematically search and screen grey literature? Godin et al. have published useful guidance: Refer to reference no. 1 Selection of sources of evidence 1. You do not describe how articles will be screened or by whom which is important for replicability. You need to describe how titles and abstracts, full texts etc. will be screened. Data charting process 1. Typo - third reviewer Synthesis of results 1. The sentence "quantitative data..." paragraph 2 seems to be repeating the sentence "a descriptive numerical..." paragraph 1? General comments: 1. You mention the Population-Concept-Context framework, and state that this will guide selection of search terms and synthesis of results. However, you do not define what these are in the context of your review. Please provide a definition of PCC. 2. You state throughout the methods that you will examine implementation processes and strategies of the different CC models but your objectives state that you only plan to characterise these models. Perhaps this objective could be expanded to demonstrate that you plan to describe how these models are implemented also? Specific comments: Title: 1. Consider capitalising 'role and scope' in the title for consistency.

Methods 1. More appropriate to say will be "reported" in accordance with PRISMA guidelines.

2. I'm not sure what you mean by 'terminology' - is this to determine naming conventions for the role, or terminology in relation to community connector models?

1. 'Community connector' is sometimes capitalized, sometimes not - choose one for consistency. 2. In Paragraph 3/4, you discuss that there is "inconsistencies in their effectiveness" for community connectors. I think it is more appropriate to say that there is inconsistent evidence for effectiveness - as the literature is limited it is difficult to conclude whether one model is more effective over the other. 3. Missing word in Paragraph 4: "outcome measures across studies"

1. You state that there is limited evidence for the community connector role. How did you determine this? JBI recommend doing a preliminary search for existing reviews and stating this was performed in the introduction - was this how you determined a lack of evidence? 2. Typos: Scoping review is registered, and changes will be reported not amended. 3. You need to state how you will define community connector models in eligibility criteria - perhaps you mean to use the definition of community connector models in the introduction but this needs to be made clear. Are there any specific exclusion criteria? You may consider a table outlining specific inclusion/exclusion criteria which would be helpful for the reader. Information Sources 1. The URL for JBI is incorrect, and you have included URLs for some sources but not others. Also the Joanna Briggs Institute goes by JBI now, please correct throughout the manuscript. 2. How will you systematically search and screen grey literature? Godin et al. have published useful guidance: Refer to reference no. 1 Selection of sources of evidence 1. You do not describe how articles will be screened or by whom which is important for replicability. You need to describe how titles and abstracts, full texts etc. will be screened. Data charting process 1. Typo - third reviewer Synthesis of results 1. The sentence "quantitative data..." paragraph 2 seems to be repeating the sentence "a descriptive numerical..." paragraph 1? - Is the rationale for, and objectives of, the study clearly described? Yes - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Partly - Are the datasets clearly presented in a useable and accessible format? Not applicable

1. Godin K, Stapleton J, Kirkpatrick S, Hanning R, et al.: Applying systematic review search methods to the grey literature: a case study examining guidelines for school-based breakfast programs in Canada. Systematic Reviews. 2015; 4 (1). Publisher Full TextCompeting Interests: No competing interests were disclosed. Reviewer Expertise: Social prescribing, scoping reviews, health promotion, physical activity CITE HOW TO CITE THIS REPORT O'Grady M. Reviewer Report For: Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.21956/hrbopenres.15695.r53424) The direct URL for this report is: https://hrbopenresearch.org/articles/8-117/v1#referee-response-53424 https://hrbopenresearch.org/articles/8-117/v1#referee-response-53424 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Views 0 How to cite this report: Welch V and Manirambona L. Reviewer Report For: Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.21956/hrbopenres.15695.r51142) The direct URL for this report is: https://hrbopenresearch.org/articles/8-117/v1#referee-response-51142 https://hrbopenresearch.org/articles/8-117/v1#referee-response-51142 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 17 Nov 2025 Approved VIEWS 0 Thank you for the opportunity to review this great work ; it represents an important contribution to the field of health care, community services and healthy ageing. The protocol is well written and clear. Please consider the comments below ... Continue reading 2. Idriss-Wheeler D, Ormel I, Assefa M, Rab F, et al.: Engaging Community Health Workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs. PLOS Global Public Health. 2024; 4 (1). Publisher Full Text 3. Glenton C, Javadi D, Perry H: Community health workers at the dawn of a new era: 5. Roles and tasks. Health Research Policy and Systems. 2021; 19 (S3). Publisher Full Text We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close The protocol is well written and clear. Please consider the comments below ... Continue reading Thank you for the opportunity to review this great work ; it represents an important contribution to the field of health care, community services and healthy ageing. The protocol is well written and clear. Please consider the comments below for improvements: Terminology and Consistency Ensure consistency in the use of terms: Community Connector model, CC, or community connector. You may choose one and apply it throughout the document.

Second paragraph: It appears that addressing social determinants of health or community-based interventions is focused only on older adults. You may wish to clarify that these approaches apply to the general population but that this study specifically focuses on older adults. Third paragraph: Clarify how you plan or anticipate categorizing the types of outcomes (health, social, …) Eligibility Criteria Indicate whether there are any restrictions regarding countries or languages. Data Charting Specify whether you will use any software (e.g. Covidence) for screening studies and data extraction. Search Strategy The second sentence appears to be cut in 2, please revise for clarity and completeness. Data item Since the definition of community connector is unclear (as noted in the introduction), you may consider adding it as an item to collect data if included studies have attempted to provide the definition You may also consider collecting data (if possible) about instruments/tools used to measure the outcomes Synthesis of Results Consider providing a chart (e.g: Prisma Chart?) summarizing included and excluded studies, along with reasons for exclusion. The protocol is well written and clear. Please consider the comments below for improvements: Terminology and Consistency Ensure consistency in the use of terms: Community Connector model, CC, or community connector. You may choose one and apply it throughout the document.

Second paragraph: It appears that addressing social determinants of health or community-based interventions is focused only on older adults. You may wish to clarify that these approaches apply to the general population but that this study specifically focuses on older adults. Third paragraph: - In some programs or countries, community connectors can also be based in primary care settings,see Tierney et al., 2025: Experiences of integrating social prescribing link workers into primary care in England:Bolting on,fitting in, or belonging? A realist evaluation. - Considering the ‘’internationally’’ use of terminology for ‘’community connectors’’, in some low and middle-income countries (LMICs), community health workers (CHWs) may also deliver early treatment as part of their mandate.You may wish to clarify and redefine the terms and scope accordingly (see: https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-021-00748-4)You may also find relevant insights with this article Engaging Community Health Workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs and clarify who might meet the criteria for being considered a community connector in this present study. Clarify how you plan or anticipate categorizing the types of outcomes (health, social, …) Eligibility Criteria Indicate whether there are any restrictions regarding countries or languages. Data Charting Specify whether you will use any software (e.g. Covidence) for screening studies and data extraction. Search Strategy The second sentence appears to be cut in 2, please revise for clarity and completeness. Data item Since the definition of community connector is unclear (as noted in the introduction), you may consider adding it as an item to collect data if included studies have attempted to provide the definition You may also consider collecting data (if possible) about instruments/tools used to measure the outcomes Synthesis of Results Consider providing a chart (e.g: Prisma Chart?) summarizing included and excluded studies, along with reasons for exclusion. - Is the rationale for, and objectives of, the study clearly described? Yes - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Yes - Are the datasets clearly presented in a useable and accessible format? Yes

1. Tierney S, Westlake D, Wong G, Turk A, et al.: Experiences of integrating social prescribing link workers into primary care in England — bolting on, fitting in, or belonging: a realist evaluation. British Journal of General Practice. 2025; 75 (752): e195-e202 Publisher Full Text2. Idriss-Wheeler D, Ormel I, Assefa M, Rab F, et al.: Engaging Community Health Workers (CHWs) in Africa: Lessons from the Canadian Red Cross supported programs. PLOS Global Public Health. 2024; 4 (1). Publisher Full Text 3. Glenton C, Javadi D, Perry H: Community health workers at the dawn of a new era: 5. Roles and tasks. Health Research Policy and Systems. 2021; 19 (S3). Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Evidence synthesis,global health,health equity and healthy ageing. CITE HOW TO CITE THIS REPORT Welch V and Manirambona L. Reviewer Report For: Characterising the role and scope of Community Connectors for Older Adults Internationally: A Scoping Review Protocol [version 1; peer review: 1 approved, 2 approved with reservations]. HRB Open Res 2025, 8:117 (https://doi.org/10.21956/hrbopenres.15695.r51142) The direct URL for this report is: https://hrbopenresearch.org/articles/8-117/v1#referee-response-51142 https://hrbopenresearch.org/articles/8-117/v1#referee-response-51142 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 26 Nov 2025Danielle Manning, Technological University of the Shannon Midlands Midwest, Limerick, Ireland26 Nov 2025Author ResponseDear Vivian, I wish to thank you for your constructive and insightful feedback. I have taken your comments on board and will adjust the protocol accordingly. Thank you again ... Continue reading Dear Vivian, I wish to thank you for your constructive and insightful feedback. I have taken your comments on board and will adjust the protocol accordingly. Thank you again for taking the time to peer review this article. Kind Regards, Danielle ManningDear Vivian,Competing Interests: No competing interests Close I wish to thank you for your constructive and insightful feedback. I have taken your comments on board and will adjust the protocol accordingly. Thank you again for taking the time to peer review this article. Kind Regards, Danielle Manning COMMENTS ON THIS REPORT - Author Response 26 Nov 2025Danielle Manning, Technological University of the Shannon Midlands Midwest, Limerick, Ireland26 Nov 2025Author ResponseDear Vivian, I wish to thank you for your constructive and insightful feedback. I have taken your comments on board and will adjust the protocol accordingly. Thank you again ... Continue reading Dear Vivian, I wish to thank you for your constructive and insightful feedback. I have taken your comments on board and will adjust the protocol accordingly. Thank you again for taking the time to peer review this article. Kind Regards, Danielle ManningDear Vivian,Competing Interests: No competing interests Close I wish to thank you for your constructive and insightful feedback. I have taken your comments on board and will adjust the protocol accordingly. Thank you again for taking the time to peer review this article. Kind Regards, Danielle Manning Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | ||| |---|---|---|---| | 1 | 2 | 3 | | | Version 2 (revision) 16 Apr 26 | read | || | Version 1 29 Oct 25 | read | read | read | Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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