Pregnancy outcomes of Anglophones compared with Francophones in Québec

Research suggests that English-speaking women in Québec may face a higher risk of adverse pregnancy outcomes, including preterm birth and stillbirth. However, less is known about whether they are also at greater risk of pregnancy complications such as gestational diabetes and preeclampsia, both of which can seriously affect the health of mothers and babies.

This project will examine whether English-speaking women in Québec are more likely than French-speaking women to experience gestational diabetes or preeclampsia during pregnancy. Researchers will analyze population-based health and birth data collected in Québec between 2008 and 2020 and will also examine how factors such as age, education, country of origin, and socioeconomic status may influence these risks.

The findings will help improve understanding of pregnancy health risks among English-speaking communities in Québec and may support the development of targeted obstetric care to improve maternal and infant health outcomes.

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Outputs:

• 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.

• Presentation of the findings of work funded by Dialogue McGill (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).

• QUESCREN researcher portrait, highlighting our team’s research projects on the English-speaking community, published at: https://www.concordia.ca/artsci/ scpa/quescren/researchers/portr aits/Nathalie-Auger.html

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

This project addresses the need for culturally and linguistically sensitive mental health services, with a focus on supporting English-speaking clinical psychology trainees in Québec. Many trainees leave the province after graduation due to challenges related to French-language requirements and the difficulty of building a sustainable practice that includes Francophone clients, which contributes to a shortage of English-speaking mental health professionals.

The study examines a new initiative at Concordia University that integrates French-language training into clinical psychology education for English-speaking trainees. It aims to understand how this approach may improve training experiences and support long-term retention in the province.

The project combines a systematic review of international best practices in second-language training for mental health professionals with qualitative interviews. We will speak with 30 clinical psychology trainees, clinical supervisors, and community-based clinicians to better understand their experiences using French in clinical settings.

The findings will be used to produce a report outlining best practices for French-language training and assessment in clinical psychology, with implications for improving trainee retention and strengthening access to bilingual mental health services in Québec.

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

This project examines how language and cultural differences can affect the quality and effectiveness of psychotherapy, particularly for people experiencing anxiety or depression. When clients and therapists do not share the same linguistic or cultural background, misunderstandings can arise that may interfere with treatment.

Building on previous research supported by Dialogue McGill, the study aims to test strategies that help therapists better address these communication challenges. It will combine a review of existing research, an analysis of real therapeutic interactions, and an evaluation of interventions designed to improve communication and outcomes over time.

The study includes 12 participants from migrant or minority backgrounds who speak English as a second language and prefer another official language. Some will receive therapy in a matching language context, while others will experience a language mismatch, allowing for comparison of experiences and outcomes.

Using both qualitative and quantitative methods, the project will explore how misunderstandings arise in therapy and how they can be reduced. The results are expected to improve mental health care for linguistically diverse populations in Quebec and inform training for therapists working in multicultural settings more broadly.

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

Title: GRH durable du personnel du milieu de la santé œuvrant en contexte linguistique minoritaire – phase comparative en régions frontières

(Title in the study’s original language)

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.

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.

Catalyzing Capacity Building in Rehabilitation Post-Solid Organ Transplant

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. This initiative was made possible through a financial contribution by Health Canada. 7 By providing English-speaking exercise professionals in Quebec with the knowledge and tools to effectively prescribe exercise to SOT recipients, the availability of rehabilitation services and physical activity programming for SOT recipients in Quebec may increase.