Exploring associations between social determinants of health and patient-reported outcome measures in oncology: Elucidating the disparities to be addressed

Social determinants of health, including income, education, and language, play an important role in cancer outcomes and survival. In Quebec, where nearly one in five residents speaks a first language other than French, language can be a particularly important barrier to accessing healthcare services and communicating effectively with care teams. These barriers may influence patients’ ability to advocate for themselves, ask questions, and engage in shared decision-making—factors that are linked to improved health outcomes.

Patient-reported outcome measures (PROMs) are standardized tools that allow patients to report symptoms and health status directly, and are increasingly used to improve communication, symptom monitoring, and clinical care. However, their effectiveness may vary depending on social factors such as education and language. This PhD project begins by examining how PROM data differ across key social determinants of health. Future phases will explore patients’ lived experiences completing PROMs and assess whether generative AI tools can help reduce barriers—particularly language-related barriers—to improve equitable use of PROMs in cancer care.

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Empowering Communication: An Exploratory Qualitative Study of the Perception of Voice Cloning in Persons with Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that often leads to severe speech impairment and, in most cases, the loss of functional speech within a short period after symptom onset. To maintain communication, individuals with ALS rely on augmentative and alternative communication (AAC) tools, including emerging technologies such as AI-based voice cloning. Unlike traditional voice banking methods, voice cloning can offer faster setup, greater flexibility, and potentially more natural-sounding synthetic voices, but its acceptability and perceived value among users remain poorly understood.

This study explores how English-speaking persons living with ALS in Quebec perceive voice cloning technology, particularly in terms of ethics, usability, emotional resonance, and identity preservation. It also examines whether perceptions of naturalness, expressiveness, and identity differ according to the severity of speech impairment. The goal is to better understand user perspectives to support the ethical and patient-centred integration of voice cloning technologies in ALS care.

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Advancing equitable health and primary health care access for English-speaking Black communities in Quebec

Language is increasingly recognized as a key determinant of health, particularly in contexts where linguistic and racial identities intersect. In Quebec, the English-speaking Black community (ESBC) occupies a unique position at the intersection of racialized minority status and official language minority status. Despite this, there is limited disaggregated data on how these intersecting identities shape access to primary healthcare and health outcomes. This gap reflects broader systemic challenges in Canadian health research, including a lack of representation of racialized populations in available data and a relative scarcity of Canadian studies compared to other countries.

Since the COVID-19 pandemic, our research team, in partnership with the Black Community Resource Centre (BCRC), has investigated health inequities affecting Black communities in Quebec. Our previous work has identified racial and linguistic disparities in healthcare experiences, including lower vaccination uptake, higher distrust in the healthcare system, reduced access to regular healthcare providers, and less access to COVID-19–related information among English-speaking Black communities compared to other groups. We also found that perceived discrimination is linked to poorer health outcomes and lower satisfaction with care. Building on these findings, this study uses Self-Determination Theory to examine how perceptions of restricted collective autonomy and language barriers shape healthcare access and dissatisfaction among ESBC populations in Quebec. The goal is to better understand the mechanisms driving inequities in healthcare experiences and outcomes, and to inform more equitable health system responses.

Linguistic minority status and Psychosis trajectories in Québec: A study of Pathways to care and Outcomes

Psychotic disorders are among the most severe mental health conditions and often emerge during early adulthood, a critical period for education, employment, and social development. Immigrant populations and their children are disproportionately affected, yet they frequently encounter barriers to timely and appropriate mental health care. These barriers include delayed access to services, higher rates of police involvement or compulsory treatment, and increased likelihood of disengagement from care. Emerging evidence suggests that language proficiency may play an important but understudied role in shaping both access to care and long-term outcomes in psychosis.

This project examines how linguistic minority status influences pathways to care and clinical outcomes in individuals with first-episode psychosis in Montréal, particularly in a predominantly French-language treatment context. It will assess whether prior findings on treatment disengagement can be replicated in a new cohort, and explore how language background relates to key indicators such as mode of entry into care, duration of untreated psychosis, symptom progression, and vocational recovery. The goal is to better understand how language barriers shape mental health trajectories and to inform more equitable, accessible psychosis care for linguistic minority communities.

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Exploring Healthcare Equity: How to Increase Satisfaction for Non-Francophone Immigrants Using Telemedicine Services

The COVID-19 pandemic accelerated the rapid adoption of digital health tools, particularly telemedicine, which has transformed how healthcare is delivered in Canada. Telemedicine improves access to care and supports national goals of health equity, especially for populations facing geographic or systemic barriers. However, Canada’s linguistic diversity also raises important questions about whether digital health services are equally accessible across language groups.

In Quebec, where French-first policies shape many aspects of healthcare delivery, telemedicine services may not consistently address the linguistic and cultural needs of non-francophone patients. This can create barriers for immigrant and minority-language communities seeking care through virtual platforms. This study explores how telemedicine experiences can be improved for non-francophone immigrant patients in Quebec by identifying and addressing linguistic and cultural barriers that impact user satisfaction and access to care.

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Evaluation of the use and impact of English on access to mental health care among the Spanish-speaking Latinx minority group in Montreal

This study is about illness stories from Spanish-speaking Latinos/Latin Americans in Montreal with schizophrenia. These participants speak English, French, or Spanish. This study suggests mental health services should be provided in English and other languages. We want to show how English was used by Spanish-speaking Latinos/Latin Americans in Montreal with schizophrenia. Most people in our study used English and Spanish services. This shows there is a need for mental health services for minorities. Many of these services could reach to wider cultural populations if they were provided in English. For our participants experiencing problems, mental health services for language minorities were important. In our study, we used a questionnaire and an interview to find out more about this group. We learned that English was important for using mental health care for several participants. This study will help us understand the need for English services for this language minority group. This research supports more specific mental health care for language minorities in Montreal, including English mental health services.

Access and Equity: Evaluating Linguistic Disproportionality in Child Protection Services

In Quebec, access to social services can vary significantly for linguistic minority communities, with evidence suggesting that public policy and system organization can shape service equity. Following the 2016 merger of health and social services into the Centres intégrés universitaires de santé et de services sociaux (CIUSSS), and ongoing reforms toward Santé Québec, these large-scale restructuring efforts have been criticized for potential unintended impacts on service accessibility, particularly for minority populations. Concerns have been raised that such system changes may have contributed to disparities between communities, including those based on language.

This project investigates whether differences exist between English- and French-speaking child welfare services in Quebec. Using provincial administrative data (AS480), we will compare key indicators such as child protection signalments, time to investigation, placement availability, clinical decision-making outcomes, and adoption rates across Montreal-based agencies and other regions over the past five years, including both pre- and post-pandemic periods. The goal is to identify potential service gaps linked to linguistic context and regional variation. Ultimately, this research aims to support more equitable, timely, and consistent child welfare service delivery across Quebec’s English- and French-speaking communities.

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

Title: L’amélioration de la fidélisation et le bien-être des travailleurs en contexte de minorité linguistique dans les installations désignées au CIUSSS de la Capitale-Nationale

(Title in original language)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

English Validation of the EXACT Cognitive Assessment

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

(title in original language)

This project aims to validate the English version of the EXAmen Cognitif abrégé en Traumatologie (EXACT), a brief cognitive assessment tool developed for individuals who have experienced a traumatic brain injury (TBI). Although the EXACT is already recognized as a valid and reliable French-language tool used in trauma centres internationally, its use with English-speaking populations remains limited. This study will evaluate the English adaptation of the EXACT in anglophone participants and compare results with the original francophone validation sample to ensure equivalent performance across languages. Validating the English version of the EXACT will improve access to rapid cognitive assessment and rehabilitation services for English-speaking individuals with TBI, while also supporting clinicians and future research in traumatology.

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

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

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

Culturally Adapted Psychosis Interventions: A scoping review

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

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

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

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

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

*Lay abstract currently unavailable.

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

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

Objectives:

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

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

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

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

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

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

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

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

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

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

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Outputs:

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

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

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

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

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