Despite living in a country with one of the world’s most developed healthcare systems, a significant portion of Canadians struggle to access the care they need, and when they do, they often leave appointments without clearly understanding their diagnosis, treatment plan, or next steps.
In Canada, nearly one in five adults lacks a designated primary care provider [1], resulting in pervasive gaps in consistent and timely access to care. Furthermore, when access is ultimately achieved, patients can encounter numerous barriers to a comprehensive understanding of their care. A study from the SRDC found that while most participants valued the convenient online access to medical results, 1 in 4 reported difficulty understanding said results, with challenges most prevalent among older adults and those facing limited linguistic or digital proficiency [2]. This gap in comprehension disproportionately impacts groups facing systemic barriers such as newcomers learning to navigate an unfamiliar health system, seniors who may struggle to process complex information during brief appointments and patients facing linguistic barriers all who may rely on family members or third-party tools to further explain after the appointment.
This article examines these challenges of limitation, in access to healthcare and effective comprehension of care, and explores how digital tools can bridge these gaps. By supporting facilitated education, multi-language delivery and continuity of information beyond the clinic visit, such technologies can help bridge gaps in access and understanding, empowering meaningful and informed patient participation in their own care.
Across Canada, patients continue to encounter substantial barriers to obtaining consistent and timely primary care. Although among the highest spenders on healthcare globally, Canada’s proportion of adults with a designated primary care provider has steadily declined over the past decade, leaving roughly one in six Canadians without stable first-point access [3]. Furthermore, for those with a provider, timely access can often be limited, with only 35% of patients being able to secure an appointment within three days and one in four patients waiting for more than a week [3], leading many to seek care through emergency departments instead for timely support. Consequently, emergency departments continue to face record-high wait times and overcrowding [4]. This challenge continues into the healthcare system, with the median wait time between family physician referral to specialist visit now exceeding 27 weeks, the longest reported in three decades [5].
The impact of these gaps extends beyond the logistics with clinical, emotional and public health consequences. Delayed access can allow disease to progress, discomfort & anxiety to increase for patients with unresolved symptoms and further contribute to disparities in outcomes between populations facing systemic barriers. Rural communities, indigenous groups, immigrants, seniors and those with limited mobility or transportation are disproportionately affected, reinforcing long standing systemic inequalities in access to healthcare. Furthermore, prolonged wait times and increased pressure on emergency and primary care services continue to contribute to rising burnout and attrition among healthcare professionals [6], further straining the system’s capacity to meet patient needs. However, access alone is not enough, patients must also be able to understand and meaningfully engage with the care they receive.
Once patients have gained access to the healthcare system, a second barrier emerges: the ability to comprehend and action the care provided. Data suggests that misunderstandings of clinical information are both common and consequential. A multicentre Canadian study found that between one-fourth and two-thirds of patients misunderstood key elements of their discharge instructions, with lower income and education levels being associated with poorer comprehension [7]. Further contributing to reduced comprehension are broader communication challenges, ranging from sensory impairment to the use of technical terminology during care. Patients that encountered such communication challenges were observed to have nearly three times the odds of experiencing preventable adverse events in hospital care [8]. Linguistic factors further compound impact on patient comprehension, a factor particularly relevant in Canada’s diverse multicultural population. Among Canada’s official-language minority populations, language barriers have been shown to compromise understanding of medical information, continuity of care and patient confidence in the care received [9]. These findings highlight that comprehension barriers stem not only from patient characteristics but also from the existing communication practices and structure within the healthcare system.
The consequences of these gaps are considerable. Patients who struggle to understand clinical guidance are at greater risk of missing following-ups, medication errors and avoidable complications. Systematic reviews have shown that patients with limited understanding of medical information are two to three times more likely to experience hospital readmission due to adverse outcomes [10]. This suggests that comprehension barriers in healthcare signify more than mere communication failures, but rather determinants of safety and outcomes. These barriers take on the shape of a second, quieter barrier that diminishes from the efficacy of care even when access has been achieved.
One way to address these dual barriers of access and comprehension is to redefine how care is delivered and the channels through which it is communicated to patients. In the modern digital era, technology facilitates a compelling pathway to both extend reach and enhance understanding. Studies show that well designed digital health interventions, ranging from patient portals to telemedicine platforms, can significantly improve health literacy and empower patients to better understand and act on care provided [11]. In recent years, virtual and hybrid models of care in Canada have continued to demonstrate strong promise; teleconsultations, remote monitoring and secure messaging have reduced the need for travel and improved continuity of care for many patients, particularly for underserved and rural populations [12]. These tools can improve comprehension by providing patients with continued access to plain-language medical guidance, historical clinician notes and other educational resources to promote clarity and confidence for patients well beyond the clinical encounter.
The impact of these technologies lies not only in their availability but also in the thoughtful design and features that shape how patients access these tools and interact with them. Features such as multilanguage support, low bandwidth/offline accessibility, visual aids and asynchronous communication are no longer technical luxuries but serve as equity requirements. Multilingual content and culturally tailored formats have facilitated an increase in understanding and engagement among immigrant and minority populations [13]. Offline or asynchronous access allows users to revisit medical explanations, review materials with family or record questions for later follow up. Patient-facing platforms, such as onehealthreport.com, which translate medical results and data into plain-language explanations and provide user-friendly interfaces, exemplify how digital health can bridge comprehension gaps while reinforcing patient autonomy. When integrated effectively within our healthcare system, these solutions can extend care beyond a patient’s appointment, supporting patients in the language, medium and pace that best serves them.
Addressing these gaps of access and understanding is not only a means to improve the system’s efficiency but also a matter of equity. Canada’s healthcare system ranks amongst the top in the world, yet continues to exhibit gaps in reach, with delayed access and impacted comprehension of care provided continuing to influence health outcomes. Digital advancements offer a path forward to narrowing these gaps, not by replacing human care, but by extending it; bringing information closer to patients and patients closer to understanding. To accomplish this goal, these technological solutions must be developed around clarity, inclusion and trust, and must be implemented with the same care and intention applied to medicine itself. Digital literacy, accessibility and inclusivity should be considered among the modern determinants of health, essential for the delivery of equitable and compassionate care. When built and deployed with these principles in mind, digital solutions can help deliver the promise of healthcare to every patient, not only those able to navigate the existing barriers within our healthcare system.