Newcomers to Canada often arrive with diverse healthcare needs but face significant barriers to receiving care, including low health literacy, limited familiarity with the healthcare system, language and communication challenges, and transportation difficulties. These obstacles, combined with limited access to primary care services, make it harder to access and navigate the healthcare system and contribute to growing health inequities.
A new study published in BMC Health Services Research examined, modelled, and analysed primary care and settlement service delivery for newcomers in Fredericton, New Brunswick, with the aim of generating practical, systems-level recommendations to support a more integrated model of care.
The researchers conducted semi-structured interviews and focus groups with newcomers and with the health and settlement workers involved in their care. The study is open access and was published on 27 October 2026.
To analyse the data, the team used the Functional Resonance Analysis Method, known as 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 within the local service network.
The FRAM model revealed a complex and fragmented care process, with 45 instances of performance variability influencing newcomer primary care delivery in the city. This systems-level picture showed how variability in one part of the network could resonate across the wider process of care and settlement support.
The thematic analysis identified four key challenges: communication barriers, system readiness and responsiveness, uncertainty, and misaligned roles and responsibilities. These themes reflect how both newcomers and the workers supporting them experienced gaps and friction points in the delivery of primary care and settlement services.
Alongside the challenges, the analysis identified four strengths in the local system: language line services, the Multi-Cultural Association of Fredericton, the resilience of health and settlement workers, and the involvement of the University of New Brunswick Faculty of Nursing. These existing assets formed part of the foundation for the study’s recommendations.
Guided by the Rainbow Model of Integrated Care, the researchers developed 16 multi-level recommendations intended to improve access, coordination, and equity in care delivery for newcomers. The recommendations span multiple levels of the system, consistent with the study’s conclusion that better integration across newcomer primary care and settlement services is needed.
The study was conducted in a single city, Fredericton, New Brunswick, and its findings reflect that local context. As a qualitative study based on interviews and focus groups with newcomers and health and settlement workers, it describes the experiences and perceptions of participants rather than measuring clinical outcomes. The authors note that the work highlights the need for better integration across newcomer primary care and settlement services, and the resulting model and recommendations are intended as practical guidance for building a more coordinated system of care.
By mapping how care actually functions as a system, the research offers a detailed picture of where variability enters newcomer primary care delivery and where existing strengths, such as settlement organisations and nursing education partnerships, could be leveraged to improve access and equity for people newly arrived in Canada.
Subject of Research: Systems modelling of primary care and settlement service delivery for newcomers in Fredericton, Canada
Article Title: Integrated primary care delivery for newcomers: a systems thinking approach
Article References: McGill, A., Salehi, V., Bishop, S., & Okoroji, C. (2026). Integrated primary care delivery for newcomers: a systems thinking approach. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15980-3
Image Credits: AI Generated
DOI: 10.1186/s12913-026-15980-3
Keywords: primary care, newcomers, Canada, systems thinking, FRAM, integrated care, health inequities, settlement services, qualitative research, New Brunswick, Integrated, primary
News Source: Ophelia Keating. (October 28, 2026). Systems model maps fragmented primary care for newcomers in Canada. Scienmag.
