Integrated primary care delivery for newcomers: a systems thinking approach

Newcomers to Canada often have diverse healthcare needs but face significant barriers, including low health literacy, limited familiarity with the healthcare system, language and communication challenges, and transportation difficulties. These barriers and limited access to primary care services make it harder to access and navigate the healthcare system, contributing to growing health inequities. This study aimed to examine, model, and analyze primary care and settlement service delivery for newcomers in Fredericton, New Brunswick (NB), and generate practical, systems-level recommendations to support a more integrated model of care. Semi-structured interviews and focus groups were conducted with newcomers and health and settlement workers involved in their care. Data were analyzed using the Functional Resonance Analysis Method (FRAM), a systems-thinking approach that models complex processes and systems and identifies performance variability. A thematic analysis was also conducted to explore perceived challenges and strengths. The FRAM model revealed a complex and fragmented care process, with 45 instances of performance variability influencing newcomer primary care delivery. Thematic analysis identified four key challenges: communication barriers, system readiness and responsiveness, uncertainty, and misaligned roles and responsibilities. Four strengths were also identified: language line services, the Multi-Cultural Association of Fredericton (MCAF), the resilience of health and settlement workers, and the involvement of the UNB Faculty of Nursing. This study highlights the need for better integration across newcomer primary care and settlement services. Guided by the Rainbow Model of Integrated Care, 16 multi-level recommendations were developed to improve access, coordination, and equity in care delivery for newcomers.