Mapping Refugee Primary Care Access in Newfoundland and Labrador: A Retrospective Functional Resonance Analysis of the Initial Medical Intake Process

Introduction: Newcomer refugees often face significant barriers to accessing healthcare in Canada, including linguistic, logistical, and systemic. While dedicated refugee clinics have emerged to address these gaps, there remains limited understanding of how care processes unfold within these settings. This study applies the Functional Resonance Analysis Method (FRAM) to examine how the initial medical intake process for government-assisted refugees (GARs) is operationalized at a refugee health clinic in St John’s, Newfoundland and Labrador. Method: Using FRAM, we mapped the intake journey of adult GARs for their first medical intake between January 2023 and March 2024. Data collection involved stakeholder workshops with clinicians, researchers, and settlement staff, supplemented by document review. A combination of thematic analysis and network mapping was used to identify functional interdependencies and sources of variability. Findings: Thirteen core functions were identified and analyzed using FRAM’s six-aspect schema (Input, Output, Preconditions, Resources, Control, and Time). The intake process followed a structured but flexible sequence, beginning with receipt of arrival lists and proceeding through appointment booking, triage, clinical assessment, and follow-up actions including lab work, prescriptions, and referrals. Findings revealed a tightly coupled administrative tasks, a central clinical hub anchored by the intake assessment, and a cross-cutting reliance on interpretation services. Key variability hotspots included interpreter availability, appointment wait times, and transport logistics. Conclusion: FRAM enabled a detailed, systems-level view of refugee healthcare access in a regional setting, highlighting both vulnerabilities and adaptive strengths. The method is valuable in visualizing how interdependent tasks align to support care delivery.