All-Hazards Vulnerability and Adaptation Assessment of Canadian Kidney Care Systems: Protocol for a Qualitative Study

Health and health care systems are progressively challenged by more frequent natural and human-caused hazards. A hazard becomes a disaster when vulnerability and exposure interact in complex ways with system capacity to trigger major disruptions in the functioning of a community or society. Patients with kidney diseases, especially those on dialysis, are particularly vulnerable.

We will conduct a vulnerability and adaptation assessment (VAA) of Canadian provincial health systems and individual kidney care networks (KCNs) with respect to natural and human-caused disasters and emergencies. Our research aims to map existing KCNs across Canada, contextualize the current and future vulnerability of health systems and patients to disasters and emergencies, and identify and prioritize adaptation measures in partnership with key interest holders.

We are conducting a bottom-up VAA following a qualitative descriptive approach and using the framework previously developed as an operational guide. We started by conducting an environmental scan and document review and identified 75 KCNs across Canada. After collecting directives and policies on disaster management from these KCNs, we will conduct a content analysis guided by our framework in disaster management. We are now conducting semistructured interviews with kidney health care professionals across Canada recruited using purposive and snowballing techniques to better understand their perspectives, expertise, and lived experiences. We will conduct thematic analysis using an inductive-deductive approach guided by the framework. Findings from these multiple data sources will then be triangulated to generate a robust VAA.

We want to identify the existing operational and human vulnerabilities and the risks associated, as well as explore lessons learned, to develop needed adaptations. Emerging data reflect a variety of experiences across programs and provinces. The findings will explore analysis at the program, provincial, and health system levels. The environmental scan was initiated in November 2024, and the semistructured interviews started in February 2025. We have recruited 71 participants from 55 KCNs. Interviews are ongoing, and coding has been initiated simultaneously. The first VAA focusing on in-center hemodialysis services is expected to conclude in April 2026. These findings are projected to be written up by May 2026, and manuscripts are expected to be submitted for publication to peer-reviewed journals. Thereafter, similar analyses will be conducted focusing on other kidney replacement therapies and pediatric programs.

This is the first VAA of KCNs across Canada. Findings will provide a critical foundation for understanding vulnerability, supporting strategic planning, and guiding adaptation measures that can strengthen health system resilience and mitigate associated risks of disasters and emergencies to patients with kidney diseases.