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Abstract

Background

In response to the full-scale Russian invasion of Ukraine, the Government of Canada welcomed thousands of temporary migrants under the Canada-Ukraine Authorization for Emergency Travel (CUAET) program. Ukrainian temporary migrants who are settled in Ontario experience acute, chronic, and complex health issues, creating additional demand upon the healthcare system. Despite a collective awareness of difficulty in accessing existing healthcare resources, little is known about how Ukrainian temporary migrants experience and utilise the Ontario healthcare system.

Purpose

To explore the lived experiences of Ukrainian temporary migrants navigating the Ontario healthcare system, and to report on the results of a knowledge translation (KTr) workshop intervention delivered with this population to assist in the development of knowledge and skills related to healthcare system navigation.

Methods

A KTr workshop was delivered with ten Ukrainian temporary migrants who have temporarily settled in Toronto, Canada. Inductive and deductive thematic analysis was used.

Results

Four themes emerged: 1) concerns regarding accessibility and wait times; 2) difficulties navigating the healthcare system; 3) transnational health practices; and 4) a desire for increased involvement in the care plan.

Conclusions

This project highlights barriers to services and the need for healthcare providers to explore equitable and accessible solutions to support temporary migrants.

Keywords

healthcare navigation ontario temporary migrants russia – Ukraine war knowledge translation

Introduction

There is an unquestionable concern among international humanitarian workers and health professionals about the growing global human suffering caused by the displacement of populations due to armed conflicts (United Nations High Commissioner for Refugees [UNHCR], 2023). This population settles temporarily or definitively in host countries holding different immigration statuses (e.g., immigrant, stateless, unaccompanied minor, refugee, temporary migrant, asylum seeker).

Canada is one of the top destination host societies. It welcomed a total of 298,128 Ukrainians with 962,612 approved applications for asylum between March 17, 2022, and April 1, 2024 (Government of Canada, 2024). This is in response to the full-scale Russian invasion resulting in the Government of Canada releasing the Canada-Ukraine Authorization for Emergency Travel (CUAET) program. Under the CUAET program, Ukrainian nationals can apply for temporary resident visas for up to three years, receive free open work permits, attend elementary and secondary schools and are eligible for immediate provincial health coverage. The CUAET is intended for Ukrainians and their family members to come to Canada temporarily and then return home when it is safe to do so (Government of Canada, 2022). Under this program, Ukrainians are not given refugee status, but are considered temporary migrants (Government of Canada, 2022).

Ukrainian temporary migrants who temporarily are settled in Ontario create an additional demand to the healthcare system, as they will require long-term continuous access to health services to manage both pre-existing and newly developed health conditions (Murphy et al., 2023). According to the Operation Ukrainian Safe Haven – Opération havre de paix pour les Ukrainiens [OUSH-OHPU] (2023), p. 28.5% of CUAET holders arrive in Ontario with 56.6% settling in Toronto. As per the same source, among 18,221 Ukrainians in Canada holding CUAET who took part in the survey, 5% of families have at least one family member with special needs or a disability. Chronic conditions, such as diabetes or heart disease, were identified as the most prevalent medical needs in this population (OUSH-OHPU, 2023). Healthcare access is vital for Ukrainians as this population is considered to have one of the highest global burdens of noncommunicable (i.e., ischemic heart disease, stroke, cirrhosis, lung cancer, cardiomyopathy) and chronic infectious diseases including tuberculosis, viral hepatitis, and HIV as well as the lowest vaccination coverage (for conditions such as measles, polio, and COVID-19) as documented in some European countries (Bresge, 2022). In relation to mental health, 33% of Ukrainians have experienced mental illness in their lifetime and this statistic will continue to rise as the invasion continues into an unpredictable outcome (World Health Organization, 2021). Ukrainian individuals are therefore expected to rely on their Canadian sponsors and/or communities to help them seek health information and help navigate the Canadian healthcare system (Greenaway et al., 2022).

Background

In Canada, there is collective awareness that its healthcare system is under unprecedented pressure to respond to demographic changes and diversity, emerging new health priorities, limited human resources and need for innovation to integrate care (Beland & Tombe, 2023). As of January 1, 2023, the population of Ontario has reached 15,386,407, with Ontario receiving 40.1% of all immigrants to Canada (Government of Ontario, 2023). Among them, approximately 891,000 individuals are non-permanent residents of Canada, encompassing those with temporary status such as international workers, students, and refugee claimants (Government of Ontario, 2023). The health issues faced by Ukrainians arriving to Canada under the CUAET may provoke an additional demand on the Ontario healthcare system.

The latest international Commonwealth Fund Survey reveals that the Canadian healthcare system is ranked 10th among 11 high-income countries worldwide with ranking low in measures related to access to care, equity, and healthcare outcomes (Schneider et al., 2021). The issue with healthcare accessibility in Canada has been on the rise, as two-in-five Canadians (41%) find it difficult or even impossible to access one of five key health services, which include emergency and non-emergency care services, specialist care and diagnostic testing (Angus Reid Institute, 2022).

Healthcare issues in Ontario reflect those seen widely across Canada. An online survey conducted in 2022 found that 34% of Ontarians report some challenges accessing healthcare, while only 16% claim to have a comfortable access to health services (Angus Reid Institute, 2022). Patients’ access to healthcare is largely affected by the shortages of healthcare workers in Ontario, which became increasingly evident during the COVID-19 pandemic (CIHI, 2023). Since the supply of healthcare workers is vital for the patients’ access to health services, many areas of healthcare now experience prolonged wait times. For example, as of October 2023, Ontarians spend an average of 21.8 h in the emergency department awaiting admission to the hospital with only 23% of patients being admitted within the 8-h target frame (Health Quality Ontario, 2023). Similarly, an issue with prolonged wait times is observed in the length of wait for specialty referrals, which has been found to be ranging between 34–75 days in 2022 (Naimer et al., 2022). In addition, over 2.5 years of the COVID-19 pandemic, surgery rates in Ontario went down by 15%, which created a backlog that added an additional demand on the system to return to the pre-pandemic levels (CIHI, 2023). These challenges, while faced by all Canadians and Ontarians, are especially detrimental to temporary migrants who may be experiencing compounded physical and mental health challenges with little social support. This knowledge translation (KTr) workshop intervention was vital to not only identify the gaps in knowledge of the Ontario healthcare system for Ukrainian temporary migrants, but to also identify gaps in their knowledge and what their immediate medical needs are. The Ukrainian healthcare system is a mixed public-private model. It underwent significant reform in 2017 and introduced the National Health Service of Ukraine bringing a strong shift toward a primary care-based system with funding following the patient as they navigate the requisite services based on their health needs. Under this model, primary care is now universal and free to access, but patients with financial means have the option, mostly in urban settings, to secure private services which allow for quicker access and better service quality.

The Intervention Framework

The Canadian Institute of Health Research [CIHR] (2016) defines KTr as an iterative and multifaceted processes that includes synthesizing, sharing, exchanging, and applying knowledge to improve Canadians’ health, strengthen the healthcare system, and provide health services and products that better meet the needs of the population. The KTr process is based on the needs of the knowledge users and takes place within a complex system of interactions between the session leaders and the knowledge users (CIHR, 2016). Our KTr project encompassed a workshop that focused on the dissemination of navigation-related information followed by the assembly of lived experiences of the participants with healthcare system navigation. The workshop incorporated content based on scholarly literature including evidence generated by three first co-authors’ respective scholarly work on matters of temporary migrants’ health and navigation in healthcare systems.

The guiding theoretical framework was Social Empowerment Theory (SET) (Zimmerman, 2000). SET defined empowerment as both a theoretical framework and a process that leads to increased control over the lives of individuals or communities (Zimmerman, 2000). The role of individual empowerment in healthcare has risen significantly over time since increased patient participation and involvement in the healthcare process have been linked to enhanced health outcomes and greater satisfaction with healthcare experiences (Halvorsen et al., 2020). The SET was appropriate for this KTr workshop because it aligned with the goal of addressing participants’ concerns by increasing Ukrainian newcomers’ awareness of Ontario's healthcare system, boosting their confidence, and supporting their adjustment to the local context. At the societal level, empowerment involves providing people with required resources and opportunities to take control over their lives leading to social adjustment and their active participation in social processes (Wallace & McIntyre, 2021). Health education programs employing an empowering approach have shown efficacy in enhancing healthcare accessibility for asylum seeking populations and bolstering their confidence in utilising healthcare services in Canada (Ghahari et al., 2020).

The person-centredness (PC) perspective conceptually framed the workshop creation and execution. PC is one of the most common antecedents for an empowerment experience (Halvorsen et al., 2020). Individuals’ particular concerns, challenges, and needs should guide the choice of the appropriate approach providing individuals with resources to take control over their lives. By providing a first-hand perspective, PC considers individuals entering the shared decision-making process, where they can identify their own unique goals and priorities based on their needs that must be addressed to establish mastery. This process can also be seen as a basis for building rapport in mutual partnerships, which provides individuals with the feeling of trust, safety, and respect throughout the process (Halvorsen et al., 2020). It is also vital to highlight the societal contribution of this approach since public participation is a vital source of knowledge and expertise in the development of health policies (Conklin et al., 2015).

The second conceptual framework was the Population Health Promotion Model (PHPM) (‌Government of Canada, 2021). PHPM articulates the relationship between health promotion and population health (Government of Canada, 2021). Particularly, the PHPM allows for participants to learn how to gain personal, interpersonal, and political power to better their lives and experiences (Government of Canada, 2021). It provides an opportunity to collectively understand participant issues with navigation of the Ontario healthcare system within the context of social, political, and economic environments that may be oppressing participants due to their vulnerable state and help them to fill in any knowledge gaps on this topic.

Purpose

This paper reports on a KTr workshop with Ukrainian temporary migrants who have temporarily settled in Toronto, Canada under the CAUET program. The KTr workshop represented an intervention to assist this population as target beneficiaries to obtain skills necessary to navigate the Ontario healthcare system as well as learn from their lived experiences with such healthcare system navigation.

Ethical Considerations

Considering the known emotional vulnerability of the prospective workshop's participants, review and approval for this project was sought through the institutional Research Ethics Board. The approval was issued (REB 2023–044) for the implementation of the workshop, which also allowed the intervention team to widely disseminate the workshop's outcomes and learn lessons grounded from the discussions held with the participants. Additionally, to offer visual and auditory privacy for participants, the workshop was implemented in a classroom in an educational facility which many Ukrainians attend to drop off their children for Saturday Ukrainian language program classes. Such a familiar physical environment offered them safe conditions to share their lived experiences, thoughts, and perspectives without worry that their information would be heard by individuals outside of the project team. Participants provided written informed consent to the first author prior to the delivery of the workshop allowing for audio recording and the use of shared information during the workshops for academic and scientific purposes.

Methods and Procedures

The workshop was delivered in November 2023 in Toronto, Canada at the facilities of the Saturday Ukrainian School, the site of the community partner organisation. Three team members facilitated the workshop.

Workshop Description

The theoretical and conceptual frameworks shaped the larger group discussion in each session of the workshop. The discussions intended to allow participants to learn how to gain personal, interpersonal, and political power to better their lives and experiences. The workshop lasted approximately two hours and consisted of three sessions. Each session was conducted in Ukrainian language by the first and seventh author and included a presentation and a focus group discussion on key topic questions. The fifth author assisted with data collection during the workshop. The session descriptions follow:

The first session, entitled “Similarities and Differences Between the Ukrainian and Ontario Healthcare Systems” included a presentation on the differences between the Ukrainian and Ontario healthcare systems with an emphasis on the implications of the differences and similarities on health and health-related behaviours. A focus group discussion on the participants’ encountered information gaps and strategies to fill them in as well as the expression of participants’ feelings about new learning ensued.

The second session, entitled “Roles Ukrainian temporary migrants can enact in their healthcare in Ontario” offered participants a presentation on roles patients can enact within the Ontario healthcare system a s active participants in their care delivery. This presentation discussed how patients act as self-care managers and co-decision makers in partnership with their healthcare providers. This session also gave the opportunity to dialogue with each other and the first author through a focus group to reflect on what they learned through the presentation and what their thoughts were about potential role activations in the healthcare system to support their and their family's health and wellbeing.

The third session, entitled “Pressing healthcare needs and action plans to address them” focused on a presentation of active and productive collaborations patients can engage in with healthcare professionals for their own and their family's health and well-being. The session's focus group promoted a discussion on the identification and means to address the participants’ most pressing health concerns through outlining plans for action-oriented solutions for their needs.

The facilitators’ engagement in discussions with participants guided their understanding of participant's accounts of previous experiences with the Ontario healthcare system navigation. Information provided by the participants during all sessions was digitally audio-recorded. The seventh author transcribed the interviews verbatim and then translated the transcripts from Ukrainian to English. The audio recordings and transcriptions were stored in the Principal Investigator's institutional Google Drive account. The audio-recordings were deleted immediately upon completion of transcript generation; the translated transcripts will be kept for a total of 5 years. After 5 years, this data will be deleted.

Participants and Recruitment

The invited workshop participants were parents of children who attended a Ukrainian Heritage Language Saturday School Program. Participants represented recent Ukrainian temporary migrants who arrived in Canada on or after Winter 2022 and possessed an OHIP (Ontario Health Insurance Plan) card, which allows them to access and navigate healthcare services free of charge in Ontario. Information about the workshop was personally shared by the first author with parents at drop off time of their children at the Ukrainian school two Saturdays prior to the scheduled workshop. In addition, the school Principal emailed parents the workshop information through a project poster in case some parents were not in attendance for the in-person poster distribution. Finally, the first author and the school Principal also provided the school parents with a suggestion to use the word-of-mouth approach to invite qualifying participants beyond the school community to contact the first author expressing interest in participation.

Data Analysis

A hybrid technique of inductive and deductive thematic analysis was used (Fereday & Muir-Cochrane, 2006). Thematic analysis is defined as a search for emerging themes in the data that are raised to categories used for analysis to describe the phenomenon of interest (Fereday & Muir-Cochrane, 2006). The hybrid technique provided a means for the tenets of the study's selected theoretical and conceptual frameworks to be integral to the deductive thematic analysis process while providing a means for themes to be generated directly from participants’ data using inductive coding. The method's seven steps (Fereday & Muir-Cochrane, 2006) (modified) applied to the translated transcripts included: (1) the identification of a framework based on the review of the literature. This was done during the phase of workshop design resulting in the use of SET, PHPM and PC frameworks to also guide the subsequent analysis of the data collected; (2) development of a code manual through labelling, defining, and describing the themes of interest. For these initial steps the preliminary themes were similar to the session titles; (3) discussion for the testing of the appropriateness of the codes; (4) data summary and identification of initial themes which started to take shape to stand on their own diverging from the initial session title labels for the themes; (5) application of the template of codes and additional coding. While the coding process was done collaboratively, the first and fifth author conducted the coding of the transcripts separately first, using NVIVO software, to determine relevance and connection to the study preliminary themes (the session titles). Upon this, the two coders met to compare their coding, resolve any discrepancies together and through team consensus, and refine the coding framework. The coding process generated 18 codes; (6) connection among codes and final identification of themes; and (7) corroborating the final themes: (a) concerns regarding accessibility and wait times; (b) difficulties navigating the Ontario healthcare system; (c) transnational health practices; and (d) a desire for increased involvement in the care plan.

Results

The key themes voiced by the participants were: 1) concerns regarding accessibility and wait times; 2) difficulties navigating the Ontario healthcare system; 3) transnational health practices; and 4) a desire for increased involvement in the care plan . It is necessary to mention that participants’ self-identification of their own immigration status and other acquaintances was called “refugees” and not temporary migrants. Thus, the term refugees will appear in the presentation of some of the participants’ quotes selected to support the themes presented below.

Theme #1: Concerns Regarding Accessibility and Wait Times

Participants of the KTr workshops agreed that it is helpful to learn more about the Ontario healthcare system but stated that this information was not useful to them if they cannot access the services. For example, one participant was only able to successfully access a walk-in clinic because her son already understood how to apply for an OHIP card for her. He also attended each appointment with her to translate, as there were no Ukrainian-speaking healthcare providers or translation services offered near their home. However, several participants acknowledged that they had better experiences in walk-in clinics than hospitals.

When asked to share about recent experiences seeking care for themselves or a family member at a Toronto-area hospital, one participant expressed surprise when they had to wait five hours to see a doctor for their broken arm. Another participant noted that their child was crying from pain while waiting to be seen. “My husband was angry. He wondered, ‘Is this a hospital or what?’.

The topic of mental health was discussed at length during the KTr workshop. Participants conversed candidly about the idea that conditions such as anxiety, depression, or eating disorders are not widely acknowledged or discussed within Ukrainian culture, despite their existence. They went on to share that it is so difficult for them to seek out mental health care because of this cultural taboo and stigma, and that it is a significant cry for help if such care is accessed. However, participants were disheartened by the wait for an OHIP-covered mental health practitioner. Considering that they are temporary migrants from a war-torn country, when arriving in Canada, most of the participants shared how disheartened they were that there were no accessible options planned for them to access mental health services.

Theme #2: Difficulties Navigating the Ontario Healthcare System

Participants also experienced difficulties in navigating the landscape of Ontario healthcare system as temporary migrants, citing several barriers including: lack of knowledge, language barriers, and expenses not covered under OHIP, like dental care. They shared:

“It is complicated to reach different doctors [in Canada]… in Ukraine, you can just book an appointment with the doctor you want without a referral; you can decide not only the specialist you need, but you can book an appointment with a specific person”.

“Poor healthcare customer service is a barrier for refugees to understand and access the healthcare system…it would be helpful if [healthcare workers] knew that refugees have limited knowledge of the system and would benefit from more time with healthcare providers to ask questions. The healthcare system is overwhelming and confusing”.

Participants also noted that there is no direct Canadian equivalent to the Helsi.me online system used in Ukraine (a medical portal for patients). Without this, participants stated that the process of finding a doctor, getting a prescription, and accessing personal medical records was significantly more time-consuming and complex for them to undertake and this is not even considering the challenges with language barriers and lack of navigation experience.

When discussing out-of-pocket expenses, participants were eager to share their stories and ask questions about accessing dental services in Ontario. Unfortunately, this was a prominent source of concern for Ukrainian temporary migrants. One participant mentioned that they had a negative experience at a clinic when their retainer was glued incorrectly after multiple attempts by a dental assistant or student. Eventually, the dentist was called to correct this, but they still owed $475 for a less-than-satisfactory service. As they arrived in Canada, participants expressed a delay until they were able to secure employment or gain employment that offered a supplemental insurance option. Additionally, if they had an option to choose a portion of their salary to go to insurance or towards their salary, they chose the latter to make ends meet in the moment. This posed an affordability issue when non-OHIP insured health concerns arose in them or their family members.

Theme #3: Transnational Health Practices

Due to the high cost of services not covered under OHIP, participants noted that they planned to travel back to Ukraine for vision and dental care. Specifically, they mentioned forgoing eye check-ups, eyewear and vision prescriptions, and dental work in favour of more affordable, or insured services back home. The participants favoured travelling back to their war-torn country to receive such care rather than figure out the logistics on how to access such services in Canada as participants shared their worries about the “hidden” costs involved. Despite the cost of the plane ticket, the safety concerns and time involved, the ability to access “known” and “proven” services and providers brought a sense of familiarity and comfort to the participants. As one participant shared,

“I know exactly who to see, when and how much it will cost me. Here, I have no idea what the final number will look like as there are always added costs at the end.”

The worry in Canada that the services provided would not be of a similar quality, the lengthy wait times, the lack of ability to communicate properly with the service provider propelled participants to engage in such travel for health purposes. Other participants also discussed engaging in virtual care with providers back home, having family members in Ukraine send them over the counter medications that they cannot get in Canada through mail, and receiving second opinions after they have consulted a healthcare provider here. As one participant shared, “I am lucky and unlucky to have my mother back home, who sends me all the medications and tablets my family, and I need to continue to stay healthy here. If she was not back home, I do not know what I would do as I cannot get the same medications here.”

Theme #4: Desire for Increased Involvement in the Care Plan

Notably, multiple participants expressed disappointment when recounting visits with their medical practitioners. Some examples given were not being informed about the results of medical testing or diagnostic imaging directly and not being consulted about the results immediately or in real-time. As one participant shared, “In Ukraine, usually right when you do your ultrasound for example, the person who is doing it can comment on what they see and give you the photo of it”.

Furthermore, participants were saddened by a lack of personal connection with their healthcare providers. One participant noted that their appointment with a family doctor lasted four minutes, but they waited over one week to attend that appointment. As one participant shared, “In Ukraine, I can usually get an appointment with a primary-care provider the same day if not the following day.” They shared that their perception of Canadian doctors was that they paid less attention to patient concerns and health histories, being quick to prescribe medication like antibiotics without looking in-depth at the issue. A lot of the doctors they saw also had a policy of one problem per visit, which was difficult for participants to comprehend especially since they presented with mental, social, and health challenges that they needed assistance with being temporary migrants who arrived from a war-torn country. With minimal time spent on assessment and physical examination, the participants were also surprised that a diagnosis could be given without substantiating medical testing.

Discussion

Temporary migrants experience complex and time-sensitive healthcare needs which require the integrated support of a community-based healthcare network and dedicated health system navigators (Riza et al., 2020). It is recommended that all resettled temporary migrants be seen by a primary care provider soon after arrival (Riza et al., 2020). To provide adequate services for Ukrainian temporary migrants, healthcare providers must consider the effects of language, financial, and cultural barriers that can affect patient safety, treatment adherence, and long-term management of chronic health conditions (Aljadeeah et al., 2022). Wanigaratne et al. (2023) undertook a population-based study of 59,348 resettled temporary migrants arriving in Ontario between April 1, 2008, and March 31, 2017, studying their navigation of primary healthcare resources during the large-scale Syrian resettlement initiative. Results from this study suggest that resettlement models and their related processes are a more consistent predictor of these populations’ timely access to primary healthcare use than specific country contexts, with government-assisted temporary migrants typically accessing primary healthcare in a timelier fashion than privately sponsored temporary migrants (Wanigaratne et al., 2023). When considering the varying levels of support received upon arrival in Canada, the process of knowledge assessment and education becomes even more important to support Ukrainian temporary migrants in navigating the healthcare system.

Participants in this KTr workshop reflected upon their challenging experiences utilising hospital services as recent Ukrainian temporary migrants. While Emergency Departments (EDs) in many countries are primarily used for immediate or critical care, in Canada, they also function as a key point of entry into the healthcare system, particularly for individuals who experience barriers accessing primary care (McDonald et al., 2020). Some evidence suggests that poor access to primary care physicians may contribute to increased ED use (Harris et al., 2011, as cited in McDonald et al., 2020); however, Canadian studies have found that individual and community-level factors such as low educational attainment and income may contribute to more frequent ED utilization than poor access to physicians (Ohle et al., 2017, as cited in McDonald et al., 2020). While the Emergency Department (ED) is a crucial point of entry for individuals requiring medical treatment, prolonged wait times reflect an inability for healthcare systems to meet the demands of the populations they serve (McDonald et al., 2020). McDonald et al.'s (2020) study of 118 Ontario hospitals suggested that communities with higher levels of total marginalisation have longer ED wait times across both high- and low-acuity visits. These findings complement current health research, which frequently reports correlations between high levels of marginalisation and lower access to healthcare. Conversely, a Canadian study by McMurray et al. (2014) demonstrated the impact of establishing a partnership between a primary health clinic for refugees, a local reception centre, and community healthcare providers in improving wait times and referrals: wait times decreased by 30% with the introduction of a dedicated newcomer health clinic, and the likelihood of these individuals being referred to a specialist decreased by 45%. These results suggest that community-based health services and programming have the potential to ease some of the challenges faced by service users. Efforts to introduce more accessible, local health resources could allow for recent Canadian temporary migrants to dedicate more time towards making a living and taking care of their families.

Further, participants in the KTr workshops voiced concerns regarding the affordability of services not covered by OHIP. Their hardships echo the existing criticisms of Canadian healthcare benefits; namely, the “deep but narrow” coverage of physician and hospital-based services juxtaposed with inconsistent coverage of drugs and dental services (Urbach, 2018). At a community level, more robust information on accessing low-cost clinics or financial support for temporary migrants may be helpful to individuals, but a more in-depth examination of provincial health insurance policies is warranted. Participants also voiced an explicit desire for increased involvement in their healthcare planning and treatment. Specifically, participants discussed their disappointment at not being able to convey an adequate personal health history to their healthcare provider, resulting in rushed diagnoses and unsatisfactory care outcomes. Iqbal et al. (2022) identified continuity of care as a significant challenge in providing healthcare to temporary migrants, especially when compounded with existing healthcare issues like time constraints and lack of cultural competency from the providers’ perspectives. Many displaced Ukrainians will require specialised, trauma-informed mental health care for Post Traumatic Stress Disorder, anxiety, and depression because of war trauma, but these health problems are largely overlooked by health screenings in asylum seeker host countries (Javanbakht, 2022). Services should be accessible, inclusive, and empowering to patients (Magwood et al., 2022); however, it is evident that the physical and mental health needs of Ukrainian temporary migrants are not being adequately addressed.

Rigour

To enhance the trustworthiness of our results, rigour was achieved through multiple strategies. As mentioned, coding and generation of final, resultant themes was conducted by two independent research team members who then engaged in a collaborative discussion on code refinement and any necessary consolidation. During the coding process, each coder engaged in memo and reflective journal writing to minimize the impact of any of their biases on the results contributing to maintaining reflexivity and enhancing study rigour. A clear audit trail of the coding process was developed to ensure transparency and confirmability, while credibility occurs through the coders’ integrative analysis process and prolonged engagement with the data. Finally, transferability of the findings was enhanced through the presentation of themes that were supported by participant quotes and lived experiences providing readers the ability to assess the relevance of our findings to their context.

Implications

The findings from this KTr workshop can be of interest to health policymakers, administrations, and researchers to inform strategic initiatives to design a friendly interaction between health systems and their temporary users dealing with other concomitant multidimensional barriers and obstacles. This project holds several potential implications that could enhance healthcare accessibility for Ukrainian temporary migrants and communities with similar experiences in other Canadian provinces or countries with similar healthcare system structures. For instance, healthcare providers can learn from the firsthand perspectives of Ukrainian temporary migrants, shedding light on their unique experiences with healthcare system navigation in Ontario. Understanding their distinct circumstances may encourage healthcare practitioners to deliver culturally competent care, taking additional time to foster therapeutic relationships and promoting trust in the healthcare system, especially considering the explicit differences between the two healthcare systems. Furthermore, this has the potential to raise awareness among the general population about the specific challenges faced by Ukrainian temporary migrants, promoting the inclusive culture that aids their integration into the new host society. Moreover, health education and outreach programs can draw on these findings to effectively target the needs of temporary migrants and promote social empowerment. Additionally, this project can propel the exploration of experiences of other asylum-seeking groups to deem any similarities and/or differences in their experiences. This project holds importance for collaborative efforts on individual, community, organisational and systemic levels to enhance healthcare accessibility of Ukrainian temporary migrants in Ontario (and globally).

Conclusion

With the influx of Ukrainian temporary migrants arriving in Canada, ensuring their access to healthcare services continues to be a priority. In this KTr project, a workshop was delivered to increase Ukrainian temporary migrants’ knowledge for navigating the Ontario healthcare system. Participants shared their experiences, including successes and challenges they faced while navigating healthcare. They expressed difficulty accessing services due to various barriers such as language, lack of knowledge, prolonged wait times, and costly services not covered by OHIP. Additionally, participants indicated a desire for increased involvement in their individual care plans and more time to develop a personal connection with their healthcare providers. Overall, this project highlights the many barriers to services and the need for healthcare providers to continue to explore equitable and accessible solutions to support asylum seeker populations.

Footnotes

ORCID iDs

Kateryna Metersky

Margareth S. Zanchetta

Areej Al-Hamad

Yasin M. Yasin

Caitlin Cosgrove

Ethical Considerations

Approval for this study was granted by the institutional Research Ethics Board (REB 2023–044).

Consent to Participate

Written informed consent (for inclusion and collection/use of data, as applicable) was obtained from participants prior to engaging in this study.

Consent for Publication

Written informed consent for publication was provided by participants prior to engaging in this study.

Author Contributions

Kateryna Metersky: Conceptualization, Methodology, Validation, Formal Analysis, Investigation, Resources, Data Curation, Writing – Original Draft, Writing-Review & Editing, Visualization, Supervision, Project Administration, Funding Acquisition.

Margareth Zanchetta: Methodology, Validation, Formal Analysis, Investigation, Resources, Data Curation, Writing – Original Draft, Writing-Review & Editing, Visualization.

Areej Al-Hamad: Methodology, Validation, Formal Analysis, Investigation, Resources, Data Curation, Writing – Original Draft, Writing-Review & Editing, Visualization.

Yasin M. Yasin: Conceptualization, Methodology, Writing – Original Draft, Writing-Review & Editing, Visualization.

Valerie Tan: Conceptualization, Methodology, Writing – Original Draft, Writing-Review & Editing, Visualization.

Kristina Tsvygun: Conceptualization, Methodology, Writing – Original Draft, Writing-Review & Editing, Visualization.

Tetiana Podobailo: Conceptualization, Methodology, Writing – Original Draft, Writing-Review & Editing, Visualization.

Caitlin Casgrove: Conceptualization, Methodology, Writing – Original Draft, Writing-Review & Editing, Visualization.

Bohdan Onushko: Conceptualization, Methodology, Writing – Original Draft, Writing-Review & Editing, Visualization.

Olesya Falenchuk: Conceptualization, Methodology, Writing – Original Draft, Writing-Review & Editing, Visualization.

Tatiana Sunak: Conceptualization, Writing – Original Draft, Writing-Review & Editing, Visualization.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Faculty of Community Services KT grant (Toronto Metropolitan University, Toronto, Canada).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author Biographies

Kateryna Metersky is an Assistant Professor and Associate Director of the Collaborative Nursing Degree Program at Daphne Cockwell School of Nursing, Toronto Metropolitan University. Her area of research is focused on vulnerable populations.

Dr. Margareth S. Zanchetta is a Full Professor at Daphne Cockwell School of Nursing, Toronto Metropolitan University. Her area of research is focused on vulnerable populations.

Dr. Areej Al-Hamad is an Assistant Professor at Daphne Cockwell School of Nursing, Toronto Metropolitan University. Her area of research is focused on vulnerable populations.

Dr. Yasin M. Yasin is an Assistant Professor at the Faculty of Nursing, University of New Brunswick.His area of research is in vulnerable populations and nursing education.

Valerie Tan is a Research Assistant at the Daphne Cockwell School of Nursing, Toronto Metropolitan University.

Kristina Tsvygun is a Research Assistant at the Daphne Cockwell School of Nursing, Toronto Metropolitan University.

Tetiana Podobailo was a Research Assistant at the Daphne Cockwell School of Nursing, Toronto Metropolitan University.

Caitlin Cosgrove is a Research Assistant at the Daphne Cockwell School of Nursing, Toronto Metropolitan University.

Bohdan Onushko was a Research Assistant at the Daphne Cockwell School of Nursing, Toronto Metropolitan University.

Olesya Falenchuk is a Research Systems Analyst, Office of the Associate Dean, International & Innovation, Ontario Institute for Studies in Education, University of Toronto.

Tatiana Sunak is the President of the Ukrainian Canadian School Board, Toronto Branch.

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Unpacking the Mystery of the Ontario Healthcare System in Canada: Ukrainian Temporary Migrants and Healthcare System Navigation

Abstract

Background

Purpose

Methods

Results

Conclusions

Keywords

Introduction

Background

The Intervention Framework

Purpose

Ethical Considerations

Methods and Procedures

Workshop Description

Participants and Recruitment

Data Analysis

Results

Theme #1: Concerns Regarding Accessibility and Wait Times

Theme #2: Difficulties Navigating the Ontario Healthcare System

Theme #3: Transnational Health Practices

Theme #4: Desire for Increased Involvement in the Care Plan

Discussion

Rigour

Implications

Conclusion

Footnotes

ORCID iDs

Ethical Considerations

Consent to Participate

Consent for Publication

Author Contributions

Funding

Declaration of Conflicting Interests

Author Biographies

References