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Transnational Health Care Practices Among Afghan, Syrian and Ukrainian Refugee Older Adults in the Greater Toronto Area

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Project Leads

Sepali Guruge, Lu Wang, Kateryna Metersky

Team Members

Areej Al-Hamad, Hasina Amanzai, Yasin Yasin, Lixia Yang, Jordana Salma, Cristina Catallo, Zhixi Zhuang

Refugees are forced to migrate often due to war and other civil, political, social environmental and economic unrest. While this population exhibits high levels of resilience, they often face considerable physical and mental health consequences as well as major barriers to (re)settling in a new country.

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Objective

Transnational health care practices (THP) are part of a response to lack of access to care and unmet health needs related to language, geographic access, cost, wait times and perceived service quality, particularly later in life. A considerable research gap exists in Canada and elsewhere on THP among refugees, and refugee older adults, in particular.

The overall study purpose is to generate a comprehensive understanding of the role THPs play in the lives of Afghan, Syrian, and Ukrainian refugee older adults in the Greater Toronto Area (GTA), and the factors, processes, and stakeholders that shape these refugee older adults’ perceptions of, access to, and engagement with THPs.

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Research question(s)

  1. How are refugee older adults perceiving and experiencing THP in terms of quality, effectiveness, and related contextual factors?
  2. What is the role of THP in terms of stress perception, coping, and resilience in the context of health promotion, illness diagnosis, and disease management among refugee older adults?
  3. What health-related information, care, supports, technology use and services need to be in place in the GTA for Afghan, Syrian, and Ukrainian refugee older adults to manage their health and wellbeing locally?
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Methodology

This study will adopt a constructivist grounded theory approach, a qualitative inductive method that helps explore the presence of social processes associated with complexities of worldviews and multiple realities. Constructivist grounded theory will be used to combine interpretivism, critical theory, and social constructivism. Activities carried out in the study include scoping reviews, individual interviews with a purposeful sample of Afghan, Syrian, and Ukrainian refugee older adults living in the GTA, and a set of focus groups.

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Status

The project is currently ongoing.

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Outcomes

Publications

Al-Hamad, A., Yasin, Y.M., Guruge, S., et al. (2025) Equitable Aging Among Migrants: A Concept Analysis and Model Development for Transcultural Nursing Care (external link) . Journal of Transcultural Nursing.

Metersky, K., Guruge, S., Wang, L., Al-Hamad, A., Yasin, Y. M., Catallo, C., Yang, L., Salma, J., Zhuang, Z. C., Chahine, M., Kirkwood, M., & Al-Anani, A. (2025). Transnational Healthcare Practices Among Migrants: A Concept Analysis (external link) . Journal of advanced nursing, 81(7), 3647–3673.

Yasin, Y. M., Al-Hamad, A., Guruge, S., Metersky, K., Catallo, C., Wang, L., Yang, L., Zhuang, Z., & Salma, J. (2024). Healthcare practices among refugee older adults: A scoping review protocol. (external link)  Open Science Framework. 

Yasin, Y. M., Al-Hamad, A., Guruge, S., Metersky, K., Catallo, C., Wang, L., Yang, L. Zhuang, Z., Salma, J., MacKenzie-Ede, F., Charbonneau, K., & Ravichandran, A. (2024). Healthcare practices among refugee older adults: A scoping review protocol. International Health Trends and Perspectives, 4(2), 310–316.

Yasin, Y. M., Al-Hamad, A., Guruge, S., Metersky, K., Catallo, C., Wang, L., Yang, L., Zhuang, Z. C., Salma, J., MacKenzie-Ede, F., Charbonneau, K., & Ravichandran, A. (2025). Healthcare needs, barriers, and practices among refugee older adults: A scoping review. (external link)  Ageing International, 50(4).  

Past events and conferences:

  • A conceptual exploration of transnational healthcare, presented by K. Metersky, International Council of Nurses (ICN) Congress 2025 – Nursing Power to Change the World, Helsinki, Finland, June 9-13 2025
  • Transnational healthcare: Conceptual understanding for international and interprofessional collaborative practice, presented by K. Metersky, Collaborating Across Borders IX Conference, Omaha, United States, May 27-30
  • Transnational health: A concept analysis among migrant populations, presented by K. Metersky, 16th Annual Canadian Association for Refugee and Forced Migration Studies (CARFMS / ACERMF) Conference 2025 – Canadian, Regional, and International Responses to Forced Migration, Toronto, Canada, May 26-29, 2025
  • Transnational healthcare among (im)migrants: A concept analysis, presented by K. Metersky, Sigma Theta Tau International (STTI) North America Region 10 Biennial Conference, Ann Arbor, United States, April 4-5, 2025
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Key words

Greater Toronto Area; older adults; refugees; refugee older adults; transnational healthcare practices