Circuits of Care in Displacement: Hybrid Transnational Health Care Pathways among Older Syrian Refugees in the Greater Toronto Area

BACKGROUND: Older refugees often navigate complex health care needs while aging in resettlement contexts. For Syrian refugees in the Greater Toronto Area and surrounding regions, barriers within the Canadian health care system may shape how care is accessed, coordinated, and supplemented through transnational practices. OBJECTIVE: This study examines how older Syrian refugees aging in the Greater Toronto Area and surrounding regions navigate health care and construct hybrid health care pathways across local and transnational contexts. METHODS: A qualitative interpretive descriptive design was used. In-depth interviews were conducted with 20 Syrian refugees aged 55-63. Data were analyzed using reflexive thematic analysis to identify patterns in participants' experiences of accessing, coordinating, and supplementing health care. FINDINGS: Participants described persistent linguistic barriers, long wait times, and limited access to culturally aligned services within the Canadian health care system. In response, they developed hybrid health care pathways that combined Canadian health care with transnational practices, including consultations with clinicians abroad, cross-border medication use, family support, traditional remedies, and digital technologies. Digital tools played a central role in bridging language and geographic gaps and supporting care coordination. While these hybrid pathways enhanced autonomy, continuity of care, and perceived control, they also introduced risks related to medication safety, fragmented care, informal decision-making, and digital inequities. DISCUSSION: The findings show that older Syrian refugees' health care navigation extends beyond formal Canadian health services and is shaped by transnational relationships, cultural knowledge, digital access, and prior health system experiences. Hybrid health care pathways can support continuity and culturally meaningful care, but they also require careful attention to safety, communication, and equity. Health systems should develop culturally responsive and digitally inclusive models that recognize transnational care practices while supporting safer integration with local care.