Principles to Practice: An Evaluation of Healthcare Providers’ Perspectives on Delivering Equity-Focused Care at a Refugee Health Centre

Background/Objectives: In response to growing global displacement, specialized refugee clinics have emerged to support new arrivals, yet little is known about how different models operate. Principles-based approaches, which use explicit values to guide services, are increasingly relevant to equity-oriented healthcare. However, limited research has examined these approaches in clinical settings. This study addresses this gap by exploring how guiding organizational principles at a refugee health centre in Western Canada are applied in daily healthcare practices. Methods: Principles supporting social justice, equity, and inclusion guide healthcare at the Western Canadian centre. Using a principles-focused process evaluation approach, nine healthcare providers were engaged in in-depth interviews to gather their perspectives on the principles. Combined deductive and inductive qualitative content analysis, grounded in implementation science concepts, generated three categories of exploration: providers’ understandings of principles, their application in practices, and related tensions and challenges. Results: Refugee healthcare providers’ firsthand accounts suggest that all the health centre’s guiding principles were reflected in practice, although providers’ understandings and the extent of operationalization varied across principles. Principles were enacted through provider attitudes, patient engagement strategies, clinical practices, and organizational structures. Their role in practice was shaped by capacity-related, relational, and structural challenges. Conclusions: The findings highlight both coherence and variation in how guiding organizational principles appear in practice, impacted by providers’ individual understandings of them, along with practical demands and constraints. Effective strategies for refugee healthcare are identified. Implications are discussed related to model implementation, refugee healthcare practices, and evaluation research.