Improving Retention and Well-being of Workers in Linguistic Minority Contexts in Designated Facilities at the CIUSSS de la Capitale-Nationale

The project takes place within the healthcare setting of Jeffery Hale - Saint-Brigid’s (JH-SB), which possesses a rich and unique organizational culture due to its Anglophone heritage. The majority of patients are Anglophone, and workers are required to meet significant language requirements upon hiring. The shortage of healthcare workers in the Capitale-Nationale region is indeed a serious concern, particularly with the addition of this linguistic requirement. Its impact on access to quality services for the Anglophone community is even more concerning because the recruitment pool is narrower than in other healthcare facilities. JHSB institutions must be competitive in recruiting and retaining an adequate and competent workforce to provide safe and quality services to this minority English-speaking population. This increases the risk factors for the sustainable health and well-being of both workers and patients. Human resource management poses a real challenge in terms of strategically and sustainably valuing bilingual staff and demonstrating intercultural competencies. Thus, the study will identify the challenges and strengths of staff retention. Subsequently, the development of solutions, in collaboration with the community, will enable changes in work organization and the resources offered by the environment to allow healthcare workers to better carry out their work activities. These solutions aim to reduce psychosocial risks by increasing recognition and social support, as well as increasing retention and hiring of healthcare workers. The objectives for the English-speaking population are to reduce several negative effects that may arise, such as long waiting times for patients, service disruptions, workload overload, etc.

Learning to implement new electronic health programs: Expanding cancer care access for English-speaking Quebec patients

In Quebec, English-speaking cancer patients face language barriers in accessing healthcare services. This can cause delays and inadequate treatment leading to poorer quality of care. Electronic health platforms have the potential to improve English-speaking cancer patients’ ability to navigate the health system. E-IMPAQc is an electronic platform for cancer patients, available online or through an app that streamlines access to bilingual information, self-management tools, and coordinates patients’ appointments. My doctoral research aims to understand how e-IMPAQc can improve access to cancer care resources and delivery of services for English-speaking patients by studying the platform’s implementation process. I am conducting in-depth interviews with cancer care patients, clinicians, and e-IMPAQc implementation staff to gain insight into their experiences and how the real-world use of the platform works. The findings will directly inform e-IMPAQc’s ongoing implementation and will be published in several academic journals. The results of my study will demonstrate how electronic health platforms can be used to improve the access and delivery of care for English-speaking patients, not only in cancer, but across the Quebec healthcare system. 

Exploring Language Barriers as a Social Determinant of Mental Health among English-Speaking Post-Secondary Students in Quebec: A Scoping Review and Policy Analysis.

In recent years, there has been an increase in the prevalence of mental health related problems among post-secondary students in Canadian higher education institutions. One important factor that can negatively impact the delivery of mental health services at these institutions is the language barrier. This issue is of prominent significance in a linguistically diverse society such as Quebec, where previous research indicates that linguistic minorities encounter significant obstacles in accessing equitable healthcare services. 

While previous research has investigated the impact of language barriers on health care access and the quality of care among Quebec's linguistic minorities, there is a paucity of research regarding mental health services available to English-speaking students in Quebec’s higher education institutions and their experiences accessing such services. This scoping review seeks to fill this gap by mapping the existing academic and grey literature on language barriers and access to mental health services among English-speaking post-secondary students in Quebec’s colleges and universities. This study is guided by the following research questions: 

1. How do language barriers create inequities in access to mental health services for English- speaking post-secondary students in Quebec’s higher education institutions? 

2. What policies and resources are in place at higher education institutions in Quebec to facilitate English-speaking students' access to mental health services? 

3. What policy interventions can be implemented to enhance access to mental health services for English-speaking students attending higher education institutions in Quebec? 

This study will provide insights and policy recommendations to foster a more equitable and inclusive mental health service delivery in Quebec's higher education institutions. 

Understanding the Impact of Linguistic Barriers and Stigma on English-Speaking Sinosphere Quebec Patients with First Episode Psychosis (FEP) and Their Family Members

We want to understand how negative attitudes and beliefs towards mental illness (known as stigma) affect English-speaking individuals from Sinosphere countries living in Quebec diagnosed with first episode psychosis (FEP), as well as their families. Stigma can make it harder to seek help, follow treatment, and recover. It also adds burden to their families. Therefore, it is important to recognize the challenges faced by this group. 

21.1% of Canada's visible minority population comes from East and Southeast Asian countries, including China, Hong Kong, Taiwan, Japan, Korea, and Vietnam, collectively known as the Sinosphere. Among these individuals residing in Quebec, there is a preference for English over French. Unfortunately, Sinosphere Canadians often experience poorer mental well-being and display lower rates of seeking professional help compared to others. Additionally, there is a lack of research on this specific group, which motivates us to address this knowledge gap and prioritize improving access to mental health and social services for the English-speaking Sinosphere FEP community, thereby enhancing their well-being. 

To tackle this issue, we will gather information on the experience of stigma, explore the linguistic and cultural factors that influence their experience, and find ways to reduce stigma among English-speaking Sinosphere individuals in Quebec who have FEP and their family members. We will conduct interviews with ten FEP patients and ten family members from three hospitals in Quebec. The participants must meet the following criteria: (1) they or their parents immigrated from a Sinosphere country, and (2) they prefer English as their official language. 

Traduction et validation en langue anglaise de l'EXAmen Cognitif abrégé en Traumatologie (EXACT)

Chaque année, environ 64 à 74 millions de personnes subissent un traumatisme craniocérébral (TCC) dans le monde. Lors de l’accident, des lésions cérébrales peuvent survenir et engendrer des difficultés cognitives affectant le langage, les fonctions exécutives, la mémoire, etc. L'EXAmen Cognitif abrégé en Traumatologie (EXACT) est un nouvel outil francophone, valide et fiable, spécialement conçu pour évaluer brièvement le fonctionnement cognitif global lors des 3 mois suivant l’accident (phase aiguë). Il a été initialement créé pour surmonter les limites des quelques outils d’évaluation brefs disponibles. En raison de ses qualités (validité, sensibilité, spécificité et fidélité), l’EXACT est désormais utilisé par de nombreux professionnels à travers le monde (p. ex., Canada, Suisse, États-Unis, France), incluant les centres tertiaires en traumatologie au Québec. Cependant, le fait que l’EXACT soit uniquement disponible en français et qu’il ait été validé auprès d’un échantillon presque exclusivement composé de francophones empêche son utilisation auprès d’une clientèle anglophone. L'objectif de la présente étude est donc de valider la version anglaise de l'EXACT auprès d'un échantillon de participants anglophones sans TCC. Pour ce faire, les participants complèteront la version anglaise de l’EXACT lors d’une séance d’environ 30 à 40 minutes. Ensuite, les résultats des participants anglophones seront comparés à ceux de l'échantillon original de participants francophones afin de vérifier si les performances à l'EXACT sont comparables dans les deux groupes. Une fois validé, la version anglaise de l’EXACT permettra d’optimiser la récupération cognitive des personnes anglophones au Québec et à l’international qui subissent un TCC en leur offrant un accès plus rapide aux services de réadaptation. Également, ce projet de recherche permettra d’optimiser le travail des professionnels en poste dans les milieux de soins anglophones en leur permettant d’utiliser un outil d’évaluation plus rapide et efficace qui est facile à administrer. Éventuellement, l’EXACT permettra aussi de faire avancer les connaissances sur les TCC, car il pourra facilement être utilisé comme mesure dans d’autres projets de recherche qui souhaitent évaluer les fonctions cognitives de façon brève, mais exhaustive chez les patients avec TCC. 

The intersecting impacts of racism and language barriers on the wellbeing and sense of belonging of English-speaking Black young adults in Quebec

Full title: Whether I belong, depends on whether my group belongs: The intersecting impacts of racism and language barriers on the wellbeing and sense of belonging of English-speaking Black young adults in Quebec 

The proposed three-wave longitudinal research will examine the perception of multiple forms of discrimination (i.e., racism, language barriers) experienced by English-speaking Black individuals in Quebec, a racialized and official language minority population. Following a Self-Determination Theory framework, the primary objective is to examine perception of barriers to healthcare and the basic psychological needs of collective autonomy for English-speaking Black individuals in response to racism and language barriers in every-day life. Furthermore, we will also examine whether greater barriers to healthcare and deprivation of collective autonomy will decrease psychological well-being and increase intentions to leave Quebec for English-speaking Black Quebecers, respectively. With a focus on intersecting and context-dependent forms of discrimination within the healthcare system, the current study will further our understanding on how well-being and intention to migrate are affected among racialized and official language minority populations, in the hope of informing health and social policies and developing interventions collaboratively with community partners.

Culturally Adapted Psychosis Interventions: A scoping review

First episode psychosis (FEP) typically occurs in late adolescence and early adulthood when identity is in formation and parents play a key role in care. As a result, the experience of psychosis is exceptionally distressing for youth and family who often endure this crisis without support. In FEP services Family Psychoeducation has been widely recommended as one of the key evidence-based psychosocial interventions. Family Psychoeducation consists of seminars in which the FEP caregiving team meet the families of their newly referred patients to provide education about psychosis, to listen to their concerns and to explore strategies to improve family problem-solving skills, communication skills and positive coping mechanisms. There are no FEP studies considering an adapted program specifically for linguistic and cultural minorities to make interventions better suited to the needs of patients and families. This is a glaring gap in clinical knowledge that requires urgent attention. Furthermore, recently arrived immigrant groups have the greatest need for family and community support.

Common experiences of stress, isolation, and burden experienced by families dealing with mental illness are likely to be further intensified for newly settled migrant families because of language and communication difficulties, reduced access to extended family supports, and lack of knowledge of mental health services as well as cultural differences regarding the etiology of mental illness and issues of social stigma. Through the current proposed scoping review, we aim to gather the extant literature on culturally adapted psychoeducation for families; document what gaps currently exist regarding culturally adapted psychoeducation for the families of patients with first episode psychosis (FEP) from English-speaking minority communities; and describe additional positive ingredients in psychoeducation for the families of patients with first-episode psychosis (FEP) from English-speaking minority communities. The findings of the current project will redress the knowledge gap that exists in psychoeducation in Quebec, especially for English-speaking minorities, and will clarify future directions for healthcare professionals within Quebec.

The network of health: How autonomy-supportive relationships influence linguistic barriers and vaccine hesitancy among English-speaking minorities in Québec

Objectives: The proposed three-wave prospective, retrospective, longitudinal research will examine linguistic and motivational factors that may influence vaccine hesitancy in English- and French-speaking visible and non-visible minorities living in Québec. Following a Self-determination theory framework, the main aim will be to examine whether autonomy support from social networks (comparing family and peers) interacts with motivational and linguistic barriers, and how this, in turn, interacts with vaccine hesitancy. Exploratory aims will examine and compare the variables of interest among the different groups.

The Role of Language and Cultural Background on Young Adults’ Covid-19 Vaccination Plans in Quebec

*Lay abstract currently unavailable.

The first vaccination effort against Covid-19 started in December 2020, and as of June 2021 over 2 billion doses of the Covid-19 vaccine have been administered worldwide. However, posing a problem to vaccination efforts is the concept of vaccine hesitancy which refers to a delay or refusal of vaccine services. Data prior to Covid-19 demonstrates that vaccine hesitancy was an issue in Quebec, Canada where 32.2% of respondents in a study revealed being vaccine-hesitant in general. Currently, as of June 2021, 30% of the Quebec population have not yet received their first dose of the vaccine against Covid-19. Elsewhere, a large study conducted in the UK reveals that ethnic minorities may be more reluctant to vaccinate with 72% of Blacks reporting being unlikely to get vaccinated for Covid-19. Barriers such as culture, religion, and language influence immunization decisions.

Key causes of vaccine hesitancy include misinformation through platforms such as social media and lack of health literacy in regards to knowledge about vaccines. Social media outlets such as Facebook allow individuals to connect in healthy ways. However, it also allows misinformation to spread rapidly across social networks leading to over-exposure of health-related misinformation such as anti-vaccine campaigns. A possible solution is to create policies that target the promotion of critical thinking skills in health and internet literacy especially among youth because they are heavy consumers of social media. Health literacy is defined as a set of competencies that allow individuals to make decisions concerning their quality of life and influences various health behaviours such as vaccine uptake. Health literacy has been linked to hepatitis B vaccination in men, and contributes to vaccine safety confidence as well. Thus, understanding the role of social media misinformation and health and vaccine literacy among vulnerable groups is a priority to control the spread of Covid-19.

Objectives:

1. To elucidate the language needs of at-risk vulnerable groups for vaccination services in Quebec.

2. To understand risk factors for under immunization in Quebec and promote more inclusion.

3. To gain insights on communication strategies for vaccination campaigns in a technological era

The Impact of Experience of Discrimination on Social and Health Care Service Use and Satisfaction among Racial and Ethnic Minority Family Caregivers of Older Adult Relatives in Canada

Relatively little is known about the relationships between satisfaction with services, utilizations of social and health care services and caregivers’ experiences of discrimination in Canada. Hence, this study is guided by the following research questions:

1) how do experiences of discrimination in daily life impact social and health care service use among racial and ethnic minority family caregivers of older adults? 

2) how do the experiences of discrimination in social and health care settings impact overall satisfaction with social and health care services among minority family caregivers of older adult relatives? 

3) how do caregivers and care recipients’ social locations, needs, and enabling factors impact family caregivers’ unmet needs?

Respite Care Accessibility in Montréal’s English-Speaking Disability Community: A Needs-Based Assessment

This research project will critically examine the accessibility of respite care through community integration social services for Anglophone persons with profound intellectual and/or developmental disability in Montréal. The research is guided by the hypothesis that a rationed care model, which prioritizes access to respite services for Francophone Montréal residents, creates systemic inequities that disadvantage Anglophone residents; these systemic inequities are exacerbated by the rationing of English-language services, and the subsequent prioritization of higher functioning and more youthful participants, deemed to possess “the potential to learn new skills.” As such, I will investigate the social and economic impacts of the new rationing policy on English-speaking adults for whom families are seeking respite care. Section fifteen (15) of the Act Respecting Health Services and Social Services (chapter S-4.2) states that “English-speaking persons are entitled to receive health services and social services in the English language” (1991). Nevertheless, the Anglophone families’ ability to locate and assess the acceptability of potential programs is made difficult by the fact that many important documents are available by Santé Montréal, Montréal’s health and social service network, in French only (personal communication, March 10, 2018). The exploratory research will attend to a range of variables, including access barriers for Anglophone residents and for care-seekers who are deemed to be of a lesser priority, and the felt impacts of the prioritization of disability respite services.

As such, the research will address the following inter-related questions:

(1) How does access to respite care services influence the felt impacts of the prioritization of disability respite services?

(2) In regard to linguistic barriers, what availability, accessibility, and acceptability needs are and are not being met by Anglophone disability services for the English-speaking disability community in Montréal?

Japanese immigrants in Québec: Experience of health information access during the COVID-19 pandemic

Our study seeks to understand the effect of language on the dissemination of critical pandemic public health information in the Japanese immigrant community in Québec. As this group is not the only small community struggling with linguistic barriers on information access, the current study can serve as a model for investigating similar kinds of questions in other small linguistic minority communities. We first explore information access patterns of first generation, Québec-dwelling Japanese immigrants during the pandemic. We will document the community’s perceived limitations in their access and whether they experienced inconsistences and conflicting information between news sources in different languages. Secondly, we test if and how language proficiency prevented Japanese immigrants from accessing local COVID-related information (Canada and Québec), in English and in French. Finally, we will investigate the mental health and behavioural impacts of having limited Canadian COVID-19 information on this community.

A Qualitative Study on Narratives of South Asian Women with First Episode Psychosis

Research Objectives. This study will seek to explore the cultural and linguistic factors that should be considered when providing services to South Asian (SA) women with First Episode Psychosis (FEP). As we consider this question, we will focus on the real-life needs associated with SA women, as well as the challenges and barriers they face when seeking care for FEP. Careful linguistic records will be kept for the SA women identified as eligible for the study: What is their mother tongue? How well do they speak English? How does their level of English impact their lived FEP experience and the treatment that they receive? Do they express an interest to learn English? Are they given opportunities to attend school by their families to improve their linguistic skills?

Research Methodology. This qualitative study will be conducted within an ethnographic framework to identify the cultural patterns and meanings that patients ascribe to their experience with FEP, thereby enriching the data by gathering first-person accounts and experiences (Green & Thorogood, 2004).

Examining and Providing Access to Health Care Services to Official Language Minority Anglophone Caregivers and Their Minimally Verbal Children with Autism

For this proposal, I aim to; (1a) Examine access to English health services, in particular autism intervention and support services in Québec, as experienced by English-speaking (ES) caregivers and their minimally-verbal (MV) child with autism and (1b) Compare access to English autism health services between ES families residing in Québec versus the rest of Canada and (2) provide a free parent-coaching intervention aimed at increasing the child’s ability to communicate using non-spoken methods to ES caregivers and their MV child with autism. This proposal’s objectives 1 and 2 above will be completed within scope of my larger dissertation project that seeks to develop, test, and compare the effectiveness of a novel non spoken communication intervention for MV children with autism, delivered via telehealth, with that of a control intervention from the community. If effective, this model could broaden the options for service provision to this underserved group.

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Outputs:

• MacDonald. A. (February 2021). Potential Healthcare Access Barriers for English Speaking People with Autism in Québec [Virtual presentation]. Institute for Health and Social Policy’s Graduate Award Program

Acceptability of Multimedia Animations as Preoperative Multi-language Guides for Surgical Patients in Montreal

Main objective: Assess acceptability of creation and application of multimedia animation as preoperative multi-language guides for surgical patients in Montreal.

Secondary objective: Analyze patient satisfaction with pre-operative animation guides for surgeries in Montreal.

This project will be a qualitative descriptive prospective study to assess the acceptability of creation and preoperative application of disease-specific multimedia animations as multi-language guides for patients in Montreal.

Bilingual Language Development in Children with ASD

Children with autism spectrum disorder (ASD) can become bilingual however, when  children receive the diagnosis of ASD, professionals in the fields of healthcare and  education often recommend that minority language parents refrain from using their  minority language and instead speak only the majority language with their child. Such recommendations are based on the belief that deficits often reported in children with ASD, such as attending to others and difficulty with phonology, will make the acquisition of two languages difficult. However, such recommendations are not supported by current evidence. 

We aim to better understand how the bilingual experience impacts language acquisition in these children and examine whether there are differences in language learning between monolingual children with ASD and their bilingual peers. We predict that bilingual and monolingual children with ASD will have formal language abilities similar to those of their bilingual and monolingual neurotypical peers. We also predict that while neurotypical children will have better performances on the narrative tasks than their peers with ASD, bilingual children with ASD will outperform their monolingual peers with ASD given their improved socio-pragmatic skills.

Do Language and Motivational Barriers Influence COVID-19 Vaccine Beliefs, Intention, and Behavior? A Longitudinal Study among English-speaking Minorities Living in Quebec

Objectives: The proposed 3-wave retrospective and prospective longitudinal study will examine linguistic and motivational factors that may attenuate intention and uptake of the COVID-19 vaccine among young adults belonging to different language (English vs. French) and visible minority status groups living in Quebec. Based on the Self-Determination Theory (SDT; Deci & Ryan, 1985), the primary objective will identify antecedent factors that predict both vaccine intention and vaccine uptake. Exploratory aims will examine potential group differences and will test whether vaccine intention mediates the relation between motivation and vaccine uptake.

Facilitators and Barriers to Equitable Healthcare Delivery for Linguistic Minorities: A Qualitative Pilot Study of Healthcare Professionals in Montreal, Quebec, Canada

Objectives/Research Questions: 1) What do healthcare professionals perceive as barriers to healthcare access/delivery for linguistic minorities? 2) What resources do healthcare professionals in public and private settings utilize to facilitate healthcare access/delivery for linguistic minority patients?

Methods: This study will be conducted over a period of 6 months using participant snowball sampling. Data gathering will begin with interviews (conversational and guided) with a sample of 10-12 healthcare professionals from different healthcare fields (nursing, speech language pathology, physiotherapy, occupational therapy, and medicine) working in both public and private healthcare settings. With consent, audio recordings and written memos will be taken during the interviews. Data to foster reflexivity will include a detailed record of my own experiences as an upcoming healthcare professional who also identifies as part of the linguistic minority population. Data collection will be recursive, whereby observations will refine interview questions. Healthcare professionals may be invited to participate in a second interview following the initial interview to clarify any emergent questions/observations and ensure accuracy of data interpretations. Data analysis will be ongoing, critical and iterative and will occur in dialogue with relevant critical theories, published evidence, and my supervisory committee.

Interpreters Working in Mental Health Settings with Refugees: A Scoping Review

The objectives of the first phase of the project is: (1) to consolidate and map current knowledge on interpreters working in mental health settings with refugees; (2) to identify the unique issues and dilemmas that arise when interpreters are used in metal health interventions with refugees; (3) to inform the second phase of the project which seeks to explore the experiences and needs of interpreters working in mental healthcare for refugees in Quebec; (4) To contribute to the design and implementation of culturally and linguistically appropriate mental health services and policies for refugees residing in Quebec.

Given that the intention of my study is to produce an overall map of what evidence has been produced in the field of mental health interpretation with refugees, a scoping review is the most suitable review method to deploy in this case. While the review will be international in its scope, concentrating on the relatively few studies in Canada and elsewhere that examine this understudied topic, it aims to analyze the research evidence from a Quebecois perspective.

Examining Barriers to Mental Health Access for Canadian-born Anglophones and Chinese-born English-favouring Allophones in the Montreal Area

We are interested in examining and comparing two linguistic minority groups: Canadian-born Anglophones (whose first language is English) and Chinese-born English-favouring Allophones (whose first language is Chinese, and whose preferred official language is English). Canadian born Anglophone (AN) communities face substantial linguistic challenges when using mental health services in French, and these challenges have largely been neglected in the literature, perhaps due to their majority status in other provinces. Chinese-born English-favouring allophones (AL) are at a double-disadvantage for healthcare in Quebec, being a linguistic minority (Chinese first language) within a linguistic minority (Anglophone community) in the larger Quebec context. We hope to profile the perceived mental health communication challenges in AN and AL communities when accessing mental health services in French.

We hypothesize that both Canadian-born Anglophones (AN) and Chinese-born English favouring Allophones (AL) will perceive language barriers when accessing mental health services in French, and the extent to which language barriers are perceived will negatively correlate with the individual’s proficiency in French. Additionally, we hypothesize that ALs will perceive significantly more cultural barriers when using mental health services in Quebec compared with ANs.