Health outcomes of Anglophones after pregnancy: Differences in access compared with Francophones in Québec

In Québec, Anglophone women face higher rates of pregnancy complications (e.g., preterm birth, stillbirth, preeclampsia, gestational diabetes), which are linked to long-term risks such as mental illness and type 2 diabetes.

Using a longitudinal cohort of all pregnancies in Québec (2006–2022), this study examines whether Anglophone women have a higher risk of hospitalization for mental illness and type 2 diabetes up to 17 years postpartum, compared to Francophones. It also assesses how factors like socioeconomic status and education influence these risks.

The goal is to better understand long-term health disparities and identify groups who may benefit from improved access to care.

Outputs:

Coming soon…

Helping members of English-speaking communities in Quebec make good health decisions thanks to digital patient decision aids.

Many people in Québec lack access to a trusted health professional who can answer questions in depth and in their primary language—especially English-speaking communities outside major centres like Montreal. As a result, many turn to online health information, which can be accurate but complex, overly simplified, or misleading.

Our team has developed customizable, evidence-based digital decision support tools that provide clear, tailored health information. This project evaluates whether these tools help English-speaking communities in Québec make more informed health decisions and improve access to reliable care guidance.

Outputs:

Coming soon…

Exploring Pediatric Trainees’ Experiences Using AI-Supported Deliberate Practice to Improve Serious Illness Conversations with English-Speaking Families in Quebec

Talking with patients and families about serious illnesses is one of the most important—and hardest—parts of being a pediatric doctor. Residents (doctors in training) need to be able to guide these conversations with care and empathy. But they often do not get enough chances to practice, and sometimes their first serious illness conversation happens with a real family. This can be stressful for families and for the resident, and it can affect how well information and support are shared.

For English-speaking families in Quebec, there are extra challenges. Most medical training and many clinical discussions happen in French. This means residents have very few chances to practice these important conversations in English. When doctors are not able to practice in a family’s preferred language, it can lead to misunderstandings or less compassionate care. This is especially important for English-speaking patients and families in Quebec’s Official Language Minority Communities.

 This project will test a new way to help residents practice. An artificial intelligence (AI) training tool will let pediatric residents practice serious illness conversations in English in a safe and realistic way. The tool gives residents repeated opportunities to try difficult conversations and learn from feedback, without risking distress for real families.

Residents who use the tool will take part in interviews to share what they thought about it, how it helped them, and how it could be improved. The results will help create better training programs and improve communication and care for English-speaking children and families in Quebec

Outputs:

Coming soon…

Empowering Communication: The perspective of English-speaking patients with ALS in Quebec on voice cloning technologies

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative motor neuron disease that often leads to the loss of speech, significantly affecting communication and quality of life. As speech deteriorates, persons with ALS (pALS) increasingly rely on augmentative and alternative communication (AAC) tools (e.g. text-to-speech apps). Traditional voice preservation methods require extensive recordings and may not fully capture the emotional expressiveness or identity of the speaker. Voice cloning – a technology using artificial intelligence – can replicate a person’s voice using only a short audio sample. It offers a faster, more accessible, and potentially more natural-sounding alternative.

This project aims to evaluate the perception of voice cloning technologies among Anglophone pALS in Quebec.

Through a mixed-methods approach involving interviews, questionnaires, and hands-on use of voice cloning tools, we will explore how pALS perceive the naturalness, expressiveness, and identity preservation of their synthetic voices created with voice cloning technology. We will also assess how factors such as the severity of speech impairments, recording length, and recording tasks influence their perception.

The findings will inform the development of clinical guidelines for speech-language pathologists and support shared decision-making between clinicians and patients. Ultimately, our research seeks to empower pALS to maintain their voice, identity, and social participation throughout the progression of their disease.

Outputs:

March 2026
Invited presentation, Les 1res Rencontres RésO-MAP (Paris). Presented project and strengthened collaboration with Hôpital Fondation A. de Rothschild.

December 2025
Poster, Allied Professionals Forum (International Alliance of ALS/MND Associations), Toronto.
Kheloufi, Y., & Bouvier, L.Empowering Communication: Evaluating Voice Cloning for Anglophone ALS Patients in Quebec.

Establishing partnership with ElevenLabs and Bridging Voice.

November 2025
Oral presentation, Communauté de pratique orthophonique en SLA/MMN du Québec (Montreal).
Kheloufi, Y.AI Voice Cloning in ALS.

Collaborative Creation of Podcasts to Promote the Implementation of Virtual Reality in Children’s Health Care

Medical procedures can cause significant pain and anxiety in children, which may be exacerbated in language minority contexts. Virtual reality (VR) is an effective non-pharmacological distraction that can reduce pain and anxiety without requiring language proficiency. Although Shriners Hospitals for Children–Canada has integrated VR into its bilingual care, gaps in structure and resources remain, and broader implementation faces barriers.

In Quebec, English-speaking children may experience increased communication anxiety and reduced healthcare use when care is not delivered in their preferred language, potentially leading to poorer outcomes. Addressing language barriers is therefore essential.

To support VR implementation, our team will co-develop a 5-episode English-language podcast series targeting healthcare professionals in Quebec. The series will address barriers, facilitators, and real-world use of VR in pediatric care, with a focus on improving equity for English-speaking children. It will be disseminated via the McGill website and major podcast platforms, with the goal of promoting VR adoption to reduce pediatric pain and anxiety across language contexts.

Outputs:

• A manuscript on podcasting as a knowledge translation tool has been completed and will be submitted to Digital Health Journal (April 2026).
  (Audience: research community, knowledge brokers)

• A second manuscript on integrating podcasting into academic curricula is in development (submission: Summer 2026).
  (Audience: research community, educators)

• A podcast series was produced (7 interview episodes + intro and summary) with accompanying educational materials.
  (Audience: healthcare professionals and stakeholders in pediatric VR implementation)

• Findings were disseminated at multiple national and international conferences (posters and oral presentations).
  (Audience: research community, knowledge brokers)

• Educational integration included a course assignment (Mount Allison University) and a lecture to ~150 nursing students at McGill.

• A workshop and national presentation (PICH2GO 2025) trained ~250 participants on podcast-based knowledge translation.

Gestational diabetes and preeclampsia in Anglophones of Québec: dissemination of results through open access

Previous research suggests that Anglophones in Québec may face an increasing risk of adverse birth outcomes. Earlier analyses have shown that, compared with Francophones, Anglophones have a higher risk of stillbirth and preterm birth. To better understand the factors underlying these disparities, funding was awarded by Dialogue McGill in 2023 to support two complementary studies examining the risk of gestational diabetes and preeclampsia among Anglophones versus Francophones. These conditions are significant pregnancy-related morbidities with important implications for maternal and infant health. The researchers plan to publish the findings from both studies in peer-reviewed open-access journals to ensure broad dissemination. In parallel, they are collaborating with knowledge user Marianne Bilodeau-Bertrand to translate the results into surveillance-related activities aimed at informing the Québec Ministry of Health and Social Services.

Outputs:

Two manuscripts were published in peer reviewed journals:

1) Auger, N., Ayoub, A., Bilodeau-Bertrand, M., Lafleur, N., & Wei, S. Q. (2025). Ethnocultural status and risk of preeclampsia in a Canadian setting. Pregnancy Hypertension, 39, 101202. https://doi.org/10.1016/j.preghy.2025.101202

2) Auger, N., Bilodeau-Bertrand, M., Ayoub, A., Lafleur, N., & Wei, S. Q. (2025). Increasing risk of gestational diabetes in an ethnocultural minority of Canada. Journal of Immigrant and Minority Health, 27(2), 191–199. https://doi.org/10.1007/s10903-024-01667-6.

Output recipients include members of the academic community as well as data and knowledge users at the Institut national de santé publique du Québec and Ministry of Health and Social Services of Quebec.

Catalyzing Capacity Building In Rehabilitation Post-Solid Organ Transplant - Knowledge Translation Proposal

Solid organ transplant (SOT) patients have low levels of physical activity before and after transplantation which has a negative impact on their health and survival. Despite this, in Quebec, there is limited availability of rehabilitation and physical activity programming for transplant candidates and recipients. Importantly, many healthcare professionals do not feel confident in counselling SOT recipients about physical activity that is appropriate for them due to lack of specific education about transplantation in their training.

Our objective is to develop a free online continuing education course on exercise prescription in SOT recipients for English-speaking exercise professionals in Quebec that will include interactive lectures, case studies and evaluation materials. This will ultimately improve the confidence of exercise professionals when they deal with SOT recipients and the quality of rehabilitation that they are able to offer. The development of the course will involve 4 steps.

1. A scientific committee, including both professionals and patient partners, will participate in a video conference call to define the learning objectives and the most relevant content (theory, case studies, evaluations) to be included in the course.

2. The Co-PIs, the coordinator, a trainee, patient partners, Maria Sedeno (RESPIPLUS) and Becky Zucco (Wilkin) will draft the first version of the online course including the learning objectives, content, case studies, evaluation materials as well as visual aspects and interactive components of the module.

3. Feedback from the scientific committee will be sought via email. At least two rounds of revision are planned.

4. Feedback will be integrated into the module.

Improving language awareness in mental health care by engaging clinicians of language diverse patients

Background: Despite the diverse linguistic profiles of patients at inner city hospitals, language barrier between patients and clinical staff remains neglected. Reasons may include lack of awareness of language barrier by clinicians and silencing of barriers by organizational practices and management priorities. From prior research, inpatient psychiatry nurses and medical students are least likely to seek the help of interpreters when faced with patients that don’t speak English or French. Reasons for these practice patterns are unknown.

Objectives: Developing previous work, this study aims to clarify the quality of language barriers in clinical settings, focusing especially, but not uniquely, on the work of nurses and medical students, to (1) document clinician awareness of language barriers in their patients; (2) explore how awareness of language barriers can be enhanced professionally and institutionally; (3) evaluate the discourses reinforcing language barrier in clinical practice; and (4) assess whether promoting awareness of language barrier results in a measurable increase in documentation of language dynamics in patient charts and a corresponding increase in clinician satisfaction working with language diverse patients in clinical mental health settings.

Hypotheses: We hypothesize that after focus groups on language barrier over one year on psychiatric services, measurements at Time 1 compared to Time 2 will show (1) a statistically significant increase of clinician awareness of language barriers as measured by mentions of language issues in patient charts and (2) greater clinical satisfaction working with language diverse patients.

Research Methodology and Study Population: The study is divided into two phases, each of one-year duration. Phase 1 will consist of Time 1 ratings during the first year of mentions of language issues in 250 hospital charts of patients with diverse mother languages. A baseline clinician satisfaction survey of working with language diverse patients will be administered to 50 clinicians. After these ratings have been completed, a series of focus groups will be conducted in the last six months of year 1 with clinicians and hospital managers to explore experiences, perspectives and suggestions to improve clinical communication. Phase 2 will consist of follow up focus groups during the first six months of the second year to investigate whether clinician awareness of language barriers has affected individual and team practice i.e. to determine if any change has taken place. After the focus groups are complete, Time 2 ratings of mentions of language issues in 250 patient charts will be conducted, and a follow up clinician satisfaction survey of the same 50 clinicians will be administered, both as in Phase 1.

Data Analysis: Descriptive statistics will be calculated for each study variable. Measures that are scored dimensionally (i.e., clinician satisfaction ratings) will be assessed using Analysis of Variance (ANOVA). Measures that are scored categorically (i.e., language mentioned in chart yes/no) will be assessed using standard Chi-Square tests. Where power considerations allow, analyses will control for confounders that show influence on the pattern of results. Potential confounders include clinician type, clinician experience (years), language ability of patients and clinicians, and duration of time of patients in Québec. Focus groups will be audiotaped and transcribed, then analyzed using the qualitative software MAXQDA for constant emerging themes. This will provide a comprehensive understanding of the construct of language awareness and its associated elements in clinical mental health settings.

Relevance: Linguistic diversity is a fact in clinical care settings. This study will help to bridge the gap between patients who are linguistically diverse and their clinicians’ lack of awareness of linguistic diversity and how it may compromise quality of care.

Clinical Measurement of Verbal Language Proficiency in Patients Referred to a Cultural Consultation Service (CCS)

Background: The CCS of the Jewish General Hospital has been evaluating the mental health of immigrants and refugees since 1999. As may be expected, CCS patients from linguistically diverse backgrounds need interpreter services, but how clinical decisions are made to assign interpreters to a given patient are unknown. Furthermore, there are no clinical language proficiency tools available for use in health care settings. Health care literacy tools exist, but before they can be administered to patients of diverse backgrounds, basic verbal language proficiency in English must first be evaluated.

Objectives: Using a retrospective sample of CCS referrals, this study will demonstrate that clinicians overestimate language proficiency in linguistically diverse patients. Then, a simple tool to measure verbal language proficiency, which can be administered quickly and efficiently in clinical settings, will be piloted on a prospective sample of CCS referrals to address this problem.

Hypotheses: 1) The language proficiency of patients will be overestimated by referring clinicians compared to CCS clinicians; 2) The extent to which referring clinicians differ on their estimation of patients’ language proficiency will depend on several variables, including type of referring clinician and institution, patient age (older versus younger), status in Canada (refugee versus immigrant) and level of formal education; 3) The pilot language proficiency questionnaire will, on average, take less than 10 minutes per patient (clinical utility, feasibility) and will be completed by more than 80% of the approached patients who give their consent to participate in the project (clinical acceptability).

Research Methodology and Study Population: Step 1: Retrospective language data on 150 CCS referrals (over approximately five years, 2013-2017) whose mother language is other than English will be gathered by a research assistant from patient charts. Step 2: Prospective language data on approximately 50 CCS referrals (over one year, 2018-19, with anticipated increasing referral rates due to the recent influx of refugees) whose mother language is other than English will be gathered by a research assistant as per Step 1 above. In addition to comparisons of rated language proficiency between referring clinicians and the CCS clinicians, a participant observer will note the dynamics of language use during the consultation: predominant language spoken, language preferences, and how interpreters negotiate clinical communication. Step 3: Based on input from data gathered during Steps 1&2, a pilot language proficiency questionnaire, clinician-rated, brief (less than 10 minutes), and focusing on verbal language, will be drafted by the CCS researchers and administered prior to cultural consultations by a research assistant to 25 CCS referrals (over six months in 2018-19) to estimate feasibility, clinical utility and acceptability of the instrument.

Data Analysis: Descriptive statistics will be calculated for each demographic and study variable. Analysis of Variance (ANOVA) will be used to determine group differences on estimation of language proficiency. Where power considerations allow, variables from Hypothesis 2 that may influence the pattern of results will be analyzed. Measures that are scored categorically (i.e., patient’s need of an interpreter, yes/no) will be assessed using Chi-Square tests. Thematic analysis of qualitative data, gathered from participant observation, will be used to inform the development of the language proficiency questionnaire and to comment on its feasibility, clinical utility and acceptability in preparation for formal empirical testing.

Relevance: Language barriers are linked to poor mental health outcomes that are preventable if clinicians recognize which patients need interpreter services and plan ahead to provide them. A clinical tool to determine basic verbal language proficiency in English, the first of its kind, would make such interventions possible.

Utilization of Psychosocial Oncology Services by Oral Cancer Patients According to their Minority Language Profile in Montreal area.

Several patients with oral cancer experience psychosocial distress during their care trajectory, and even afterwards. In recent years, psychosocial oncology services (SOP) have been implemented in many hospital centers to support cancer patients with emotional, psychological, or social support needs. The use of SOP by patients with oral cancer has not yet been documented, which hinders monitoring and continuous improvement of care. In Quebec, shortages of healthcare personnel, persistent barriers to distress screening, and stigma surrounding the use of mental health services may influence the use of SOP in oral oncology, especially among the anglophone minority where difficulties accessing healthcare and mental health services have been reported. Our objective is to generate surveillance data on the use of SOP by patients and survivors of oral cancer, according to their official linguistic status in Quebec. Therefore, we are conducting a retrospective study based on data from real patients with oral cancer who are followed in one of the major hospital centers in Montreal. In addition to sociodemographic and clinical data, francophone and anglophone patients will be compared on the rate of referral to the psychosocial oncology department, the delay and response rate to these requests, and the type of SOP received. Analyses will be conducted to explore factors related to potential differences in SOP utilization between francophone and anglophone patients. Communicating our data to healthcare providers and policymakers will help them review their policies and strategies to promote comprehensive care for patients in oral oncology while ensuring equitable access to services between linguistic minorities and majorities.

Outputs:

• March 26, 2024 – Research protocol published (Utilization of Psychosocial Oncology Services by Oral Cancer Patients: a Study Protocol), open access: http://dx.doi.org/https://doi.org/10.21203/rs.3.rs4151906/v1

• April 24, 2024 – Poster presentation at Research Day (Faculty of Dental Medicine and Oral Health Sciences); ~200 attendees: https://www.mcgill.ca/dentistry/researchand-graduate-students/events/research-day

• March 13, 2025 – Presentation at international conference (2025 AADOCR/CADR Annual Meeting & Exhibition, New York, USA): https://www.aadocr.org/2025aaam

• April–August 2025 – Results manuscript in preparation (to be published open access).

Bilingual Simulations in Nursing: Virtual Reality, Interlinguistic Pairing, and Authentic Reinforcement

In recent years, researchers in computer-assisted language learning have been exploring the potential of immersive technologies to support second language (L2) acquisition. Virtual reality (VR), defined as the computer-generated simulation of an environment in which users experience a sense of presence (Sadler et al., 2013), can immerse L2 learners in interactive scenarios where they practice communication in real-life situations. Such learning environments can reduce L2 anxiety (Gruber & Kaplan-Rakowski, 2022) while increasing willingness to communicate (Papin, 2018, 2022). However, little is known about the impact of participation in immersive interactive simulations on L2 self-efficacy (i.e., learners' belief in their ability to use the L2 to perform linguistic and non-linguistic tasks (Mills, 2014)). Given the positive impact of self-efficacy on L2 learning (Bai & Wang, 2022), the research objective of this exploratory study is to examine the impact of conducting VR simulations on L2 self-efficacy. The participants will be 48 intermediate French L2 learners enrolled in a nursing education program at two post-secondary institutions, one English-speaking and the other French-speaking. Before participating in an in-person internship at a hospital, they will be asked to individually conduct two simulations on ImmerseMe. During these simulations, which mimic daily conversations in a professional setting, learners will be individually immersed in a virtual environment. This environment will place them in a virtual hospital room using 360-degree videos, and they will have to orally interact with pre-programmed virtual agents. The simulations are based on scenarios depicting authentic interactions encountered in a hospital setting: 1) assessing a patient's level of pain; and 2) interacting with a patient as part of a postoperative protocol. Through ImmerseMe's voice recognition capabilities, the utterances of L2 learners will be compared to a pre-established script, allowing the simulations to progress if the produced sentence matches one of the possible responses.

Ouputs:

• July 3–5, 2024 – Presentation at IMPEC 2024 (Interactions multimodales par écran), Aix-Marseille Université, France.

• Summer 2025 – Book chapter contribution: Les jumelages interculturels pour apprendre les uns des autres, published in a collective volume with JFD.

Integrating French second-language experiences into clinical psychology training to enhance retention of English-speaking trainees

Context: Minority communities need access to linguistically/culturally sensitive mental health services. In this respect, Québec Anglophones face a retention challenge: Many English-speaking clinical psychology trainee students leave Québec upon graduation, thereby reducing the available pool of English-speaking mental health practitioners. Reasons include linguistic challenges in establishing a sustainable clinical practice in Québec, such as inability to meet French-language requirements of the Ordre des psychologues du Québec and/or inability to build a practice that includes Francophone clients. Concordia's Psychology Department is instituting a novel approach to addressing this challenge by integrating French-language experiences for English-speaking trainees into its program. This provides the project setting; we will closely study Concordia's experience and conduct a systematic review of literature on relevant best practices.

Main objective: Deliver a report on best practices for French second-language training and assessment for trainees in clinical psychology with a focus on potential implications for trainee retention.

Procedures: Procedures include (1) Examining the literature worldwide on best practices for language-training of mental health clinicians; (2) Interviewing 30 Concordia clinical psychology trainees; (3) Interviewing participating clinical supervisors; (4) Consulting community-based practicing clinicians about experiences using their secondlanguage-French with Francophone clients.

Data analyses: Systematic Reviews of the literature; Qualitative Analyses of interview data.

Outputs:

• Evidence synthesis: Following interviews with trainees and supervisors, the team conducted a global systematic review to identify best practices for second-language training of mental health clinicians, aligned with the study’s qualitative analysis.

• Final report (forthcoming): Will present theory- and evidence-based guidelines for integrating French second-language training into clinical psychology programs.

• Expected impact: Improved retention of English-speaking trainees in Québec and enhanced access to mental health services for English-speaking communities.

• Knowledge sharing: The final report will be disseminated to higher education institutions and Centres intégrés universitaires de santé et de services sociaux to support collaboration and strengthen health and social services for English-speaking populations.

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communications to Improve Outcomes

Context: Linguistic mismatch can lead to communication problems that interfere with psychological treatments for mental health problems. Cultural misunderstandings can exacerbate these problems. Past research funded by Dialogue McGill has identified ways in which psychotherapists can effectively intervene to overcome linguistic and cultural barriers. The current research proposes to directly evaluate these interventions.

Main Objectives: We will: (1) carry out a systematic review of psychotherapy effectiveness in cross-linguistic and cross-cultural settings; use (2) use qualitative inquiry to study linguistic/cultural misunderstandings between clients and their therapists; and (3) use quantitative techniques to study the impact of interventions designed to mitigate these misunderstandings.

Research Procedures: Participants will be 12 anxiety and/or depression patients from a migrant and/or minority background, all of whom speak English as a second language and prefer English as their first official language. Half will be in a situation of language match with their therapist, and half will have a mismatch, in terms of preferred official language.

Data Analysis:  Qualitative inquiry will give us a close reading on best practices when working with linguistic and cultural diversity. Quantitative modeling will allow us to study the impact of change over time through daily self-report assessments. Some models will include participants from previous Dialogue McGill-funded projects, enhancing statistical power.

Potential Contributions: We anticipate this project will improve mental health care for English-speaking patients in Quebec, as well as improving training of mental health professionals. Results will be relevant to other settings characterized by linguistic and cultural complexity.

Outputs:

• Publications in progress: A peer-reviewed article is in preparation examining how linguistic and cultural barriers affect psychotherapy, how they can be addressed, and their impact on treatment outcomes (quantitative analysis completed).

• Knowledge tools: Development of the Acculturation Toolkit, an online resource to support second-language training for clinicians, building on tools refined through this project.

• Published outputs: Four encyclopedia entries on cultural-clinical psychology published in the SAGE Encyclopedia of Depression and Anxiety, incorporating findings from the team’s systematic review.

• Knowledge mobilization:

  • Participation in an expert workshop (June 2024) featuring research funded by Dialogue McGill.

  • Keynote presentation (September 2024) highlighting this project and related funded research.

• Next steps: A training and dissemination workshop, integrating materials from this and previous funded projects, is planned for Fall 2025.

Remotely-Delivered CBT for English-Speaking Psychiatric Outpatients across Quebec: An Evaluation of Treatment Effectiveness, Treatment Acceptability and Barriers to Accessing Care

Cognitive behavioural therapy (CBT) is the ‘gold standard’ psychological intervention for most mental health problems, however, access to CBT is often challenging due to long clinic waitlists and limited availability of trained professionals in all communities. In Quebec, English-speaking Quebecers are faced with additional challenges in accessing care due to their status as a linguistic minority. One method of increasing access to CBT is using a model of remote service delivery whereby clinics that specialize in CBT can provide services in English to patients located anywhere in the province. Using a non-randomized design, we aim to examine whether providing remotely-delivered CBT to English-speaking Quebecers from across the province will lead to similar improvements in symptoms and functioning compared to patients receiving in-person treatment. We will also examine questionnaire results and identify themes in patients’ written feedback to assess their treatment satisfaction and to better understand their experiences of receiving remotely-delivered CBT. This study will be conducted in the Centre for CBT Research, Training and Intervention (Centre for CBT-RTI), a clinic located in the McGill University Health Centre. The Centre for CBT-RTI is a non-sectorized clinic staffed by bilingual mental health professionals with expertise in CBT who provide in person and remotely-delivered CBT for patients from across Quebec. The findings from this research are anticipated to increase awareness among mental health professionals and key stakeholders in government and hospital administration about the benefits of remote-delivered CBT and patient preferences for service-delivery.

Outputs:

• Project completion: Data collection and analysis finalized. Results shared with mental health professionals locally at McGill University and the McGill University Health Centre, and nationally through the Canadian Association of Cognitive and Behavioural Therapies. An additional submission was made to the Douglas Research Centre / McGill Psychiatry Research Day.

• Conference presentations:

  • April 2025 – Poster at the 3rd Annual MUHC Mental Health Mission Research Day (Montréal).

  • May 2025 – Poster at the Canadian Association of Cognitive and Behavioural Therapies 15th Annual Conference (Banff).

  • Submitted – Poster to the Annual Research Day of the Douglas Research Centre and McGill Department of Psychiatry.

• Student training and outputs: MSc student is preparing a master’s thesis (submission planned August 2025), including a manuscript to be submitted to a peer-reviewed journal in Fall 2025.

Sustainable Human Resource Management of Healthcare Personnel Working in a Minority Linguistic context – Comparative Phase in Border Regions

This project aims to address strategic human resources management (HRM) issues faced by the part of the healthcare system serving the English-speaking population and other cultural minorities in regions of Quebec outside the Montreal metropolitan area. Its initial phase took place in the Quebec City region at Jeffery Hale - Saint Brigid's Hospital (JHSB), grouped as part of CIUSSS de la Capitale-Nationale, and then has proceeded to a comparative analysis of recruitment processes between CIUSSS de la Capitale-Nationale and CISSS des Laurentides. The present project aims to conduct further comparative analysis between these two establishments and regions of Quebec bordering the English-speaking provinces: Outaouais, Montérégie-Ouest and Côte-Nord. The first objective of the project is to report on the current bilingual staffing process (recruitment, selection, on-boarding and integration) for four job categories in high demand in the Quebec healthcare system, in designated English-speaking facilities. Its aim is to establish the degree of adequacy between published language requirements, initial assessment of candidates and upgrading measures offered to newcomers. Secondly, the project aims to identify HRM practices that can help retain staff working in a bilingual healthcare context. The entire non-agreement-based HRM process will be covered (staff appraisal, skills development, non-monetary recognition), while investigating the potential strategic contribution of the surrounding English-speaking community in this respect.

Outputs:

• 3 scientific presentations delivered: one at an international conference in Europe (late 2024) on workplace diversity; one at ACFAS 2024 (the largest Francophone scientific conference in Canada), within a symposium on health and social service delivery in official language minority communities (OLMCs), co-organized by Consortium national de formation en santé and Groupe de recherche sur la formation et les pratiques en santé et service social en contexte francophone minoritaire; and one at a national conference hosted by a pan-Canadian association focused, among other topics, on current human resource management issues.

• 1 conference proceeding and 1 scientific book chapter (in press) resulting from the international conference; the book is expected to be widely distributed across the Francophonie.

• 2 posters: one presented at a 2024 symposium organized by Health Canada, and another for a research event organized by CISSS de l’Outaouais (abstract accepted, event scheduled for June).

• 3 research reports submitted to CISSS de l’Outaouais, CISSS de la Côte-Nord, and CISSS de la Gaspésie (the latter currently undergoing local validation). Along with a fourth report from CISSS des Laurentides, these outputs stem from a study funded by Dialogue McGill and will be disseminated via the Centre d’expertise ACESS website to support improved access and adaptation of health and social services for English-speaking communities in Eastern Québec.

• 4 presentations of comparative results delivered to the Jeffery Hale–Saint Brigid’s steering committee; selected materials may be published on the Centre d’expertise ACESS website following approval.

• 1 invited presentation at the ACESS Symposium Improving Access Through Knowledge, held in Québec City in 2025 and funded by the Secrétariat aux relations avec les Québécois d’expression anglaise.

• 1 lunchtime discussion session planned for Fall 2025 with Équipe de recherche en partenariat sur la Diversité culturelle et l’Immigration dans les régions du Québec, a funded research network involving regional partners including Jeffery Hale–Saint Brigid’s.

A review of migration patterns of English — speaking healthcare workers in Québec and existing French-language supports

In 2022, PERT published a report titled “French-language support for Québec’s English-speaking professionals.” This report examined the role of French language policies in professional orders and the language supports available to English-speaking prospective and current members of professional orders. We concluded that there is no comprehensive framework for supporting individuals who need to improve their French. Additionally, we found that most institutional stakeholders were not mandated nor had adequate capacity to provide French-language support to English-speaking health professionals. Since the publication of this report, the situation for English speakers within Québec’s healthcare system has become more complex. There are acute shortages of healthcare professionals, concerns about reduced access for English speakers, outmigration of healthcare workers, and the implementation of new French-language policies that may impact the hiring and retention of English-speaking healthcare workers.

In this project, we will expand on the findings of the report. The objectives are to:

• Understand the immigration and out-migration of English-speaking healthcare professionals in order to identify the impacts of outmigration and immigration and analyze the existing capacity of English-speaking workers to fill existing labour shortages and healthcare needs

• Identify the government-funded French-language training programs targeted at healthcare professionals in Québec

• Formulate policy recommendations to support English speakers’ entry into and retention in Québec’s healthcare industry

This will be accomplished in two ways: an inventory of existing government-funded French-language training for healthcare workers, and analysis of education and migration patterns of English-speaking healthcare professionals through 2016 and 2021 census data.

Outputs:

• March 14, 2025 – Webinar: Building Healthy Systems: Mobilizing the Potential of English Speakers to Enhance Québec’s Healthcare Sector. Organized and hosted by PERT (online); 64 participants. Delivered in partnership with the Community Health and Social Services Network (CHSSN), disseminating knowledge and laying the groundwork for future collaborations to address healthcare employment among English-speaking Quebecers.

Pregnancy outcomes of Anglophones compared with Francophones in Québec

A growing number of studies suggest that Anglophones may be at risk of preterm birth and stillbirth in Québec. However, pregnancy outcomes such as gestational diabetes and preeclampsia have not been studied. These two pregnancy complications are major causes of morbidity in pregnant women and have potential to explain why some Anglophones have a greater risk of preterm birth and stillbirth. Gestational diabetes is a type of hyperglycemia that develops specifically during pregnancy, and can lead to complications in infants and mothers. Preeclampsia is a life-threatening pregnancy complication that can lead to severe hypertension, seizures, and maternal death. The objective of this research proposal is to investigate if Anglophones have a higher risk of gestational diabetes and preeclampsia, compared with Francophones. We will perform population-based studies using linked data that include birth characteristics and medico-administrative information in Québec from 2008 to 2020. The main exposure will be English or French maternal mother tongue. The main outcomes will be gestational diabetes and preeclampsia. We will measure the association between maternal mother tongue and the risk of gestational diabetes and preeclampsia using regression models. We will also determine if maternal characteristics such as age, country of origin, education, and socioeconomic status influence the relationships of interest. Our findings will help assess the extent to which Anglophones have high risk pregnancies that may benefit from enhanced obstetric care to prevent adverse outcomes.

Outcomes:

• Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. (2024; submitted). Increasing risk of gestational diabetes in the Anglophone minority of Quebec. Canadian Journal of Diabetes.

• Auger, N., Bilodeau-Bertrand, M., Lafleur, N., & Lewin, A. (2024). Underlying Causes of Ethnocultural Inequality in Pregnancy Outcomes: Role of Hospital Proximity. Journal of immigrant and minority health, 26(1), 54–62. https://doi.org/10.1007/s10903-023-01545-7

• Auger N, Bilodeau-Bertrand M, Lafleur N. (2023). Access to perinatal healthcare: Risk of adverse birth outcomes among minority Anglophones in Montreal, Canada [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N, Bilodeau-Bertrand M, Lafleur N, Lewin, A. (2023). Ethnocultural inequality in pregnancy outcomes: Comparison of Francophones and Anglophones in Montreal [Poster presentation]. Colloquium 2023 on the Health of OLMCs, Health Canada, Ottawa, Ontario, Canada.

• Auger N. Pregnancy outcomes of Quebec Anglophones: recent research results. (unknown). QUESCREN Concordia Lunch and Learn. Montreal, Québec, Canada.

• Auger N, Ayoub A, Bilodeau-Bertrand M, Lafleur N, Wei SQ. Ethnocultural status and risk of preeclampsia in a Canadian setting. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health. 2025;7;39:101202. doi:10.1016/j.preghy.2025.101202. PMID: 39922025.

• Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. Increasing risk of gestational diabetes in an ethnocultural minority of Canada. Journal of Immigrant and Minority Health. 2025;27(2):191-199. doi:10.1007/s10903-024-01667-6, PMID: 39824967. 

• Auger N, Bilodeau-Bertrand M, Ayoub A, Lafleur N, Wei SQ. Risk of gestational diabetes in Anglophones and Francophones of Quebec) at the 91st Annual Acfas Congress (May 14th 2024).   

Digital cognitive assessments for Quebec English-speaking older adults and patients on the Alzheimer’s disease spectrum

About 1 in 9 people above 65 years old has Alzheimer’s disease (AD). Timely and precise diagnosis, along with comprehensive cognitive assessment, play crucial roles in managing this disease effectively. A precise evaluation of cognition is essential for making accurate diagnoses, including the identification of the prodromal phase of AD known as mild cognitive impairment (MCI). However, conventional cognitive tests come with significant limitations, especially for the English-speaking population in Quebec. These issues encompass the absence of tests tailored to English speakers in Canada or Quebec, outdated norms exceeding 20 years, a lack of contemporary digital assessment tools, and the failure to consider social determinants of health (SDOH) in normative data. Our project has two primary goals:

1. to validate and standardize a cognitive battery incorporating digital adaptive tests for English-speaking older adults in Quebec, while accounting for SDOH;

2. to compare the diagnostic accuracy of a traditional paper-pencil cognitive battery with a digital counterpart for MCI. Our study will involve 150 cognitively unimpaired older adults and 20 MCI patients, who will undergo both traditional and novel digital cognitive assessments.

This project holds immense significance for clinical practice and Quebec's English-speaking communities, as it will provide novel open-access digital tools for researchers and clinicians. These tools will offer a more accurate, efficient and engaging experience for patients and clinicians.

Virtual Reality Exposure Therapy for Severe Anxiety Disorders: Effectiveness and Acceptability in English-Speaking Quebeckers

Exposure therapy consists in approaching one’s fears without avoidance. It is known to be the best psychological intervention for anxiety disorders, which are some of the most common, debilitating mental health problems in Quebec. Recently, virtual reality exposure therapy (VRET) has been developed to address some of the accessibility and acceptability concerns of traditional exposure therapy conducted in “real life”—one of these being the need for consistently clear communication between therapists and patients. Through computer-generated, language-free environments, VRET helps individuals confront the virtual counterparts of their fears, without extensive therapeutic discussions. VRET’s potential to increase access to a first-line anxiety treatment for English-speaking Quebec residents is thus promising. Although the efficacy of VRET has been shown to be comparable to traditional exposure therapy, most of this research has been conducted in well-controlled laboratories focusing on subclinical anxiety. This project aims to examine the effectiveness and acceptability of VRET for severe symptoms of anxiety disorders in a non-sectorized mental health clinic, accessible to all Quebec residents. English-speaking Quebeckers with an anxiety disorder will receive twelve sessions of VRET and will complete symptom measures pre- and post-intervention. Results will be compared to symptoms of individuals who have already undergone traditional exposure therapy at the clinic. Demonstrating that VRET is as effective as traditional exposure therapy in a real-life and language minority context will help increase access to a gold standard intervention, using approachable, language-free technology. Lastly, themes will be extracted from participants’ feedback to compare the treatments’ perceived accessibility and acceptability

Outputs

• Pilot and early results dissemination: Pilot data (2 participants) and preliminary analyses (8 participants) were presented at the McGill University Health Centre Research Days (2023 and 2025) as part of research dissemination and recruitment efforts.

• Conference presentations: The project was presented at the First Annual Conference in Digital Mental Health (Québec), showcasing the technology and its clinical applications to researchers and healthcare professionals.

• Future outputs planned: In line with the original proposal, the project is expected to produce two peer-reviewed publications, two out-of-province conference presentations, and one clinical workshop on integrating virtual reality into exposure therapy practice.

• Knowledge mobilization and media coverage: The project has been featured in multiple media outlets, including La Presse, 98.5 FM Radio Textos, CBC Radio Noon Quebec, CBC Daybreak Montreal, and Y’a du monde à messe (Télé-Québec) (broadcast scheduled June 6, 2025).

Increasing access to pediatric sleep care for youths in the English-speaking community in Quebec.

Abundant evidence indicates that the negative impacts of sleep disorders can be significantly reduced by effective treatment. However, interventional opportunities that would improve the sleep and overall health of children and adolescents in the English-speaking community in Quebec are currently being missed because healthcare providers serving this community are either unaware of the tools available or do not know how to use the tools effectively. Significant progress towards increasing access to pediatric sleep services could be made if healthcare professionals serving the English-speaking community in Quebec be provided with knowledge and skills in pediatric sleep medicine. Thus, the objective of the proposed activities is to disseminate pediatric sleep training to healthcare professionals who treat youths in the English-speaking community. This is important as it is expected to facilitate increased access to pediatric sleep care for youths with sleep problems and disorders in the English-speaking community in Quebec.