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. 2025 Jun;116(3):484-492.
doi: 10.17269/s41997-024-00962-x. Epub 2025 Jan 13.

Implementation and evaluation of a novel community-based urban mobile health clinic in Toronto, Ontario

Meghan O'Neill  1 , Robert J Redelmeier  2   3 , Camilla Michalski  1 , Raymond Macaraeg  4 , Maureen Gans  4 , Alice Schoffel  2   3 , Lori M Diemert  1 , Luwam Ogbaselassie  2   3 , Laura C Rosella  1   5   6   7 , Andrew Boozary  8   9   10
Affiliations

Implementation and evaluation of a novel community-based urban mobile health clinic in Toronto, Ontario

Meghan O'Neill et al. Can J Public Health. 2025 Jun.

Abstract
in English, French

Setting: Despite Canada's single-payer health system, marginalized populations often experience poor health outcomes and barriers to healthcare access. In response, mobile health clinics (MHCs) have been deployed in several cities across Canada. MHCs are well established in the United States; however, little is known about their role and impact in a country with universal healthcare. We describe the implementation of an urban MHC and early learnings from a mixed methods process and outcome-oriented evaluation.

Intervention: In February 2021, Parkdale Queen West Community Health Centre, TELUS Health for Good, and University Health Network's Gattuso Centre for Social Medicine partnered to launch a nurse practitioner‒led, community-based MHC in Toronto, Ontario. The MHC provides low-barrier primary healthcare, harm reduction, and mental health services at five convenient locations.

Outcomes: Through an intercept survey (n = 49) and semi-structured interviews (n = 10), we sought to understand the sociodemographic characteristics of clients, their experiences at the MHC, and barriers and facilitators to the MHC in comparison to traditional healthcare settings. Most clients surveyed reported being homeless (61%). Without the MHC, 37% of clients would have accessed care at an emergency department and 18% would not have sought care. Thematic analysis revealed two structural and two relational factors that improved care experiences and care access.

Implications: We demonstrate that in a single-payer health system, MHCs alleviate major barriers to care access for marginalized populations. Learnings provide context to the most salient factors influencing clients' decisions to seek care at MHCs and can inform how these outreach models are designed.

RéSUMé: LIEU: Bien que le Canada ait un régime de santé à payeur unique, les populations marginalisées connaissent souvent une détérioration de leur santé et des obstacles à l’accès aux soins. Face à ce problème, des cliniques de santé mobile (CSM) ont été déployées dans plusieurs villes du pays. Les CSM sont bien établies aux États-Unis, mais on en sait peu sur leur rôle et leur incidence dans un pays doté d’un régime de santé universel. Nous décrivons la mise en œuvre d’une CSM urbaine et les premiers enseignements d’un processus à méthodes mixtes et d’une évaluation axée sur les résultats. INTERVENTION: En février 2021, le centre de santé communautaire Parkdale Queen West, le programme Santé pour l’avenir TELUS et le Centre Gattuso pour la médecine sociale du Réseau universitaire de santé ont inauguré ensemble à Toronto une CSM communautaire dirigée par une infirmière praticienne. La clinique fournit des soins de santé primaires et des services de réduction des méfaits et de santé mentale «à bas seuil» dans cinq endroits faciles d’accès. RéSULTATS: En interrogeant les gens au passage (n = 49) et en organisant des entretiens semi-directifs (n = 10), nous avons cherché à définir le profil sociodémographique des usagers, leur expérience de la CSM et les éléments qui entravent ou qui favorisent l’accès à la CSM comparativement aux milieux de soins classiques. La plupart des répondants (61%) ont dit être sans abri. Sans la CSM, 37% des usagers se seraient rendus aux urgences, et 18% ne se seraient pas fait soigner. Une analyse thématique a fait ressortir deux facteurs structurels et deux facteurs relationnels ayant amélioré l’expérience de soins et l’accès aux soins. CONSéQUENCES: Nous faisons la démonstration que dans un régime de santé à payeur unique, les CSM réduisent d’importants obstacles à l’accès aux soins pour les populations marginalisées. Nos constats mettent en contexte les principaux facteurs qui influencent la décision des usagers de se faire soigner dans les CSM; ils peuvent aussi éclairer la conception des modèles d’extension des services.

Keywords: Community-based; Health equity; Intervention; Mobile health clinic; Mobile van; Social determinants of health.

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Conflict of interest statement

Declarations. Ethics approval: This evaluation was deemed a quality improvement project as described by the Tri-Council Policy Statement V.2; thus, the study received approval waiver from the University Health Network and University of Toronto Research Ethics Boards. Consent to participate: Informed consent was obtained from all subjects. Consent for publication: Not applicable. Conflict of interest: The authors declare no competing interests.

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