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.

Practitioner Perspectives on Linguistic Barriers in Access to Health Care for English-Speaking Minorities in Quebec

I propose to conduct a qualitative systematic review examining barriers that healthcare providers experience in providing services to linguistic minorities. In particular, the present study is designed to determine what kind of support healthcare professionals need to provide service to Anglophones in French-speaking Quebec.

Language barriers are increasingly recognized as a serious concern that creates disparities in access to health and social services (Terui, 2017). These inequalities may be reflected in access to services and healthcare delivery (Woloshin et al., 1997), as well as in low “quality of care and provider-patient relationship” (Terui, 2017, p .215). In addition, recent evidence suggests that linguistic minorities may face communication anxiety while anticipating doctor’s appointments (Zhao et al., 2021) and experience tension during appointments and low confidence in received care during (De Moissac & Bowen, 2019). 

This research project will focus on the language barriers that occur during interactions between healthcare providers and Anglophones (English speakers) in Quebec. The goal of the project is to propose feasible solutions to enhance access to health and social services in Quebec for English minority language speakers.

How Healthcare Professionals’ Communication Style Influences Black Language Minority Health Service Users’ Perceived Acceptability and Satisfaction with Healthcare Access in Quebec and Ontario

Official language minorities face language barriers when it comes to accessing health services but many of them also face racial/cultural barriers.

The healthcare system strives to ensure the health of all people equally regardless of race or language. Health-care workers communicate directly with patients and these interactions play a role in how the patients view the health care system. How the patients view the healthcare system will have implications for how they use it (Penchansky & Thomas, 1981).

The project plans to explore and highlight the importance of patient and healthcare workers communication interactions on perceptions of healthcare access from a self-determination theory perspective. The research could help protect more vulnerable groups by participating in investigations on how to reduce inequalities in healthcare access for visible and language minorities. Do health care workers’ level of language proficiency impact perceived autonomy support and perceived access to health? How do previous experiences with healthcare workers impact subsequent perceived access to health care for black linguistic minorities in Quebec and Ontario? How do race and language combine to make interactions with healthcare workers affect perceptions of autonomy support for black linguistic minorities?

The Meanings and Lived Experiences of Chronic Illness Self-Management for Culturally and Linguistically Diverse (CALD) Individuals and their Female Family Caregivers

The term culturally and linguistically diverse (CALD) refers to first-generation (foreign-born) or second-generation (having at least one immigrant parent) immigrants whose mother tongue or language spoken at home is neither English nor French. Chronic illnesses are leading causes of morbidity and mortality in Quebec, and the risk of chronic illness is increasing for CALD populations with greater time in Canada. In response to the large global burden of chronic illness, self-management has increasingly become recognized as an approach to support patients in partnering with healthcare professionals for improving their outcomes. Self-management involves the tasks (medical, behavioural and emotional), which individuals must undertake to live well with a chronic illness. However, there is limited recognition that self-management also involves family caregivers who provide most of the care to persons with a chronic illness. CALD individuals living with chronic illness face an additional burden of self-management in health care systems due to difficulties arising from culture and language. Women are more likely to be family caregivers in CALD contexts due to cultural and societal obligations, and this can result in another layer of burden for them. In view of these cumulative and intersecting burdens, there is an urgent need for meaningful definitions of chronic illness self-management that include the lived experiences of both CALD individuals and their female family caregivers.

PROJECT OBJECTIVES:

1. Explore and understand the lived experiences and meanings of chronic illness self-management for culturally and linguistically diverse individuals and their female family caregivers; and

2. Provide a critique of the assumption that self-management is not shaped by the social determinants of health, and its consequences for the study population.

Francophone Mental Health Care Practitioners’ Perceptions of Working with Anglophone Minorities: Challenges and How They Affect Practice

We are interested in investigating the perceived challenges of working with the Anglophone linguistic minorities reported by Francophone mental health practitioners in Quebec. Oftentimes, Anglophone linguistic minorities in Quebec receives mental health care services from primarily Francophone practitioners. The experiences of linguistic minority patients have been extensively documented, and it has been shown that being part of a linguistic minority decreases accessibility to health care and leads to poorer outcomes for patients (Jacobs, Chen, Karliner, Agger-Gupta, & Mutha, 2006). However, the experiences and challenges of majority linguistic mental health care providers working with linguistic minorities have rarely been explored.

We are interested in conducting a qualitative study on the experience of Francophone mental health care providers, who are part of the linguistic majority in Quebec, and are often faced with providing health care services to Anglophone linguistic minorities.

Is the Frustration of Basic Psychological Needs Interacting with Language Barriers in Worsening Health Care Access for Black Young Adults during the COVID-19 Pandemic?

The present 3-wave prospective longitudinal study will examine linguistic and motivational factors that may undermine the readiness of Black young adults to seek access to mental health care during the COVID-19 pandemic year. We will also examine whether the motivational factors interact with linguistic minority status in determining how young adults adapt to the challenges of living through the worst pandemic in a century. More precisely, the main objective is to examine whether double minorities (i.e., Black Quebec Anglophones and Black Ontarian Francophones) experiencing need frustration are less likely to seek help for mental health concerns than are Black Quebec Francophones or Black Ontarian Anglophones.

Improving Access to Fertility Care and Empowerment of Linguistic Minority Patients with Infertility Through a Mobile App

The current project involves the evaluation of a mobile app developed by a multidisciplinary team of researchers and health professionals to provide targeted bilingual informational and social support resources to patients undergoing fertility treatments in Montreal. The app content will be available in both French and English and using language that aims to be accessible to everyone with fertility concerns. The educational component will include evidence-based information on a variety of fertility-related topics and presented in a way that is easy to understand and accessible to people with differing eHealth literacy levels. Specific sections will be devoted to information about infertility diagnoses, treatment options, risks to fertility, reproductive health promotion as well as how to navigate through treatments and tips on how to cope with infertility. The social support component will consist of discussion boards and a peer support network to help connect patients with others who can understand the difficulty of their situation. The app is hypothesized to have a beneficial impact on patients’ well-being (stress, anxiety and depression), perceived empowerment, quality of life, and eHealth literacy.

The principal objective of my research project is to investigate the effectiveness of a patient-centered mobile health (mHealth) intervention that delivers informational and emotional support in improving patient empowerment in infertile patients facing language barriers in Montreal.