Co-Design of strategies to enhance access to Virtual Urgent Care models by equity-deserving populations

Research Overview  

This study explores how to best make digital care a bridge to better healthcare rather than a new barrier for the most vulnerable members of our community. As the Canadian health care system moves increasingly toward a digital-enabled model, inclusive design is essential. Technology has the potential to modernize, but it also carries the risk of widening existing health gaps. For health equity to be a reality, we must ensure that no one is left behind as services transition to virtual platforms.  

The core focus of this study was to improve the use of virtual approach for Urgent Care among Equity-Deserving Populations (EDPs) in the Greater Toronto Area. These populations include racialized communities, the 2SLGBTQIA+ community, persons with disabilities, and individuals experiencing homelessness or housing instability. Using a World Café co-design model, the research team gathered direct insights from those with lived experience and health care professionals to create a more accessible and effective digital health system. 

The study sought to answer critical questions about how to raise awareness and improve service delivery for these groups. World Café discussions focused on identifying unique barriers to care, as well as brainstorming outreach strategies to build trust within communities that have historically been underserved by the medical system. 

Why This Research Matters 

In 2020, Ontario rolled out virtual urgent care (VUC) to help people with minor health issues during the pandemic. People from underserved communities, which may include people with disabilities, who are from a visible minority or who are from the 2SLGBTQIA+ community, often struggle to access these services. To address this issue, an in-person World Café event was organized to brainstorm strategies to improve access to VUC for underserved communities. Discussions focused on key issues such as raising awareness of VUC, improving digital literacy, and making sure people find the service credible. They revealed the barriers people from underserved communities face as well as highlighted opportunities to promote VUC as a culturally safe option for diverse communities.  

This study advances our knowledge by examining how social support, cultural behaviours, and physical environments prevent EDPs from accessing services. Historical health inequities are often mirrored or even amplified by new technologies if they are not intentionally addressed. In the digital era, simply providing a service does not guarantee access. Without a focus on equity, virtual platforms can become exclusive tools for the privileged, leaving those with the greatest health needs even further behind. 

The strategic importance of VUC is backed by powerful data. In the 2024/25 period, VUC programs at Sunnybrook Health Sciences Centre and University Health Network managed 7,301 visits. Data shows the model is highly effective: 92% of cases were handled entirely virtually, and patients reported a 95% satisfaction rate. However, these benefits are not reaching everyone equally. Current users are typically English-speaking, middle-aged urban dwellers with higher education and stable incomes.  

The unique value of this research lies in its use of the World Café methodology. By bringing together people with lived experience alongside healthcare decision-makers, the study moved beyond academic theory. It centred on the co-creation of solutions grounded in real-world challenges faced by diverse communities. 

These collaborative sessions led to specific discoveries about the systemic gaps that currently limit the reach of virtual care. 

Key Findings 

Identifying specific barriers – from digital literacy to cultural safety – is essential for creating resilient health care interventions. When we pinpoint why a service is failing a specific group, we can move from general observations to targeted policy changes. 

The analysis identified three primary categories of findings: 

• Awareness and Accessibility Barriers: Many participants were unaware that VUC existed. Even when known, confusion remained regarding the role of staff like nurse practitioners, which is a role that does not exist in many other countries, and remains less familiar to many patients. Physical accessibility also remains a factor; for example, wheelchair users often rely on emergency departments because their family doctors’ offices are not accessible, yet they are often unaware that VUC could solve their immediate needs without travel. 

• The Digital Divide: VUC use remains hyperlocal, concentrated in specific wealthy urban postal codes. Vulnerable groups, including older adults, newcomers, and the unhoused, face significant hurdles with English-only online forms, passwords, and reliable internet access. 

• The Credibility Gap and the AI Paradox: Trust is a major barrier, both with the health care system as well as technology. Technology is seen by some as both a threat and a tool. Participants expressed fear that virtual care might be a scam, a concern fueled by the rise of online fraud and for-profit telehealth models that have faced legal charges. While trust in the health care system exists, participants noted that branding VUC as part of a trusted institution, such as Sunnybrook Health Sciences Centre, is vital to building credibility. 

Discussions also highlighted the needs of those in multi-generational households, where a lack of private space can make sensitive medical calls impossible. Similarly, those experiencing intimate partner violence may face surveillance at home, making it dangerous to seek virtual care without safe community access points. As one participant noted, poor translation services often lead to stressful and suboptimal care, proving that language access is about more than just words, it is about safety. 

These discoveries provide a roadmap for moving from research to meaningful, system-wide action. 

Turning Research into Action 

Research provides true value when it is translated into specific, actionable changes in practice and policy. For VUC to be a sustainable tool for equity, it must be integrated into the broader healthcare system with clear, authoritative mandates. 

The following directives are recommended for key stakeholders: 

• Healthcare Practitioners: Mandate the use of teach-back protocols, where patients repeat instructions to ensure they are understood across language or literacy barriers. Institutionalize warm handovers between virtual and in-person care so that medical records follow the patient, preventing them from having to repeat their story during a crisis. 

• Community Partners and Advocates: Where trust already exists with community partners, participants discussed that it would be useful to establish VUC kiosks in trusted community hubs like libraries, shelters, and community centres. These kiosks would provide soundproof, private spaces and technical support to bridge the digital divide for those without personal devices. 

• Policymakers and Hospital Leaders: Standardize VUC branding to link it explicitly to well-known authorities like Sunnybrook to combat any gaps in trust or credibility. Invest in AI-driven solutions for positive utility, such as automated symptom checkers and high-quality, real-time translation tools to support a multilingual population. 

Future research mandates must focus on the most excluded groups, such as refugees and the unhoused. Crucially, future studies must include measures of cost-effectiveness. To sustain these resources over the long term, we must prove that inclusive virtual care is not only more equitable but also a fiscally responsible way to manage health system resources. 

This actionable roadmap is supported by the rigorous methodology used to engage the community. 

Methodology  

The study used a modified World Café process to ensure all voices were heard. In a traditional World Café, participants move between tables; however, to accommodate those with mobility issues, this study had facilitators rotate while participants stayed in place. This allowed for a continuous exchange of ideas in a safe and accessible environment. 

The engagement involved a total of 36 participants, including: 

• 22 invited attendees: This group featured hospital providers, community advocates, and decision-makers. 

• 14 study team members: These included experts in emergency medicine and academic researchers. 

• Diverse Identifiers: Participants represented 2SLGBTQIA+ individuals, racialized communities (including Black, South Asian, and East Asian), and persons with disabilities. 

However, a critical review of the demographics reveals important gaps for future study. The participant group was heavily skewed by gender, with 18 women and only 4 men. There was a significant age gap, with only one participant aged 65 or older. While the World Café was a success, future engagement must work harder to include older adults and a more balanced gender representation to fully understand the digital divide. 

Ultimately, these findings reinforce that Virtual Urgent Care can serve as a culturally safe and highly accessible modality. If we implement these co-designed strategies, we can move toward a system where technology actively reduces health inequities for everyone in Ontario. 

Study authors and journal/book name 

Authors: Sander L Hitzig, Yomna HE Ahmed, Akm Alamgir, Courtney F Kupka, Cliff Ledwos, Rozhannaa Sothilingam, Rhea Alitawi, Marina Motsenok, Johnathon Orr, Logan Reis, Izabelle Siqueira, Sarmitha Sivakumaran, Talitha Brush, Kimberly Devotta, Maarib Kirmani Haseeb, Emily Huynh, Ezza Jalil, Triti Khorasheh, Kosal Ky, Shelley L McLeod, Wendy MacLellan, Sandra Mills, Katrine Pilested, David Rosenstein, Christine L Sheppard, Simone Stothers, Jiayu Zhang, Rosanra Yoon, Cynthia Zhang, Shaun Mehta, Umberin Najeeb, Justin N Hall.

Publication: PLOS Digit Health. 2026 Apr 17;5(4):e0001368. doi: 10.1371/journal.pdig.0001368 (original link) 

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