Communication and Health

The question of how workers’ compensation systems should account for language barriers is of increasing importance given Canada’s growing linguistic diversity. This study is the first to empirically examine, based on interviews with injured workers and key informants, return-to-work policies and practices through the lens of language barriers. By comparing two jurisdictions, Quebec and Ontario, the study highlights similarities and differences in language accommodation and return-to-work policies and practices that shape the experiences of injured workers with language needs. It argues that gaps in this regard, which are more pronounced in Quebec, contribute to poor return-to-work outcomes for these workers in both provinces.

The perception of epidemic risk has been associated with the production of narratives in which figures such as villains and heroes emerge. This article critically analyzes social media users’ construction of heroic figures during the 2013–2016 Ebola epidemic. We used international Twitter and Facebook comments as our raw material, collected by key word extraction. A thematic analysis resulted in a descriptive typology of three heroic figures: the martyr, the warrior, and the saviour. Our analysis showed that heroic status (highly associated with willingness to take high risks on behalf of others) was mostly conferred on common individuals and ‘insiders’ living in the Ebola-afflicted communities – often deemed ‘unsung’ – rather than the foreigners frequently heroised in previous crises. We deconstruct this heroisation dynamic, showing that it is a socially strategic move because it is embedded in a potential instrumentalization of heroes. First, this production of ‘everyday heroes’ may encourage the involvement of lay people in the epidemic response, by conveying that anyone can become a health hero. Second, we show that this heroisation process maintains the status quo by encouraging adherence to biomedical discourses, and by individualising the narrative and neglecting the structural changes needed to address the epidemic. Finally, we caution against discourses that seem socially ‘progressive’ but may be used as a smokescreen to hide discriminatory dynamics, and we recommend changes in communication strategies.

Objective:
The objective of the study was to provide stakeholders working in the mental health sector with practical strategies to foster collaboration with public service interpreters.

Methodology:
A critical reading of the literature (narrative review) was carried out with the objective of offering a new perspective on the already existing object of study. Because it offers a critical synthesis of key information in the field, this method is particularly well suited to the needs of the reader who is not up to date with advances in the field.

Results:
This critical reading first made it possible to identify two general challenges concerning mental health practitioners called upon to collaborate with public service interpreters: the recognition of the interpreter’s role and the acknowledgement of the diversity of communicative situations likely to foster their collaboration. This paper presents seven interprofessional collaboration strategies that mental health practitioners can apply to meet these challenges: 1) using vocabulary drawn from the public service interpreter Positioning and Postures Typologies; 2) obtaining information to be transmitted in the interpreting assignment; 3) allocating time for briefings and 4) for debriefings; 5) encouraging the interpreter’s presentation; 6) framing small and big talk; and 7) promoting the continuity of care.

Discussion:
The present study offers a new perspective on some of the distinctive tensions in the PSI domain. The 7 proposed collaboration strategies are a response to these and aim to improve the quality of intercultural communication and services offered to users by promoting knowledge transfer. They are specifically addressed to knowledge users, take their practices into account and are explained using non-specific terms.

The need for the services of a healthcare interpreter to treat allophone patients is, today, indisputable. The scientific literature demonstrates such a need in all medical specialties. In mental health, the situation is particularly sensitive when a psychological assessment requires the services of an interpreter.

Objectives:
To explore the best practices highlighted in the previous literature for working with an interpreter in mental health and apply them to the specific context of psychological assessments.

Methods:
A synthesis of key research recommendations for communicating through an interpreter was conducted.

Results :
A compilation of best practices for ensuring quality psychological assessment when working in partnership with an interpreter is provided, focusing on key issues to consider when assessing linguistically and culturally diverse patients. This compilation is organized in 3 stages: before, during and after the consultation. For example, the need to prepare for the consultation with the interpreter (briefing), the impossibility of requesting “word-for-word” interpreting (except in very special cases), and the need for a debriefing with the interpreter to complete the assessment.

Discussion:
Mental health professionals can optimize their collaboration with interpreters in psychological assessment by applying this three-step model, which will improve cross-cultural communication.

In our contemporary societies where people are confronted by the requirements of performance and adaptability, and where, moreover, the democratic ideal persists, how people being the subject of racism in the workplace deal with such issues? What power of speech is giving to them and how is it being given? The organizations must show fairness toward their employees, thus supporting a democratic ideal where each worker would have the same rights and liberties. Nevertheless, relations of domination and oppression persist. Concurrently, in those organizations the subject confronts the implicit injunction to be efficient, to be autonomous and to be productive. The subject becomes responsible for his integration into the collective and he has to carry the responsibility to live “well” in the workplace. Our article will question the self-censorship of people being subjects of racism and who are not able to tell it at the risk of, seemingly being unproductive. Through a specific research methodology, we also reveal a clinic of interculturality as an approach of intercultural intervention.

To help primary care teams improve patient-centered care, we elicited health and life goals of immigrants with a chronic disease. We conducted an exploratory study of the (1) acceptability of home visits by volunteers to collect health information and (2) content of health and life goals within a primary care program for immigrants with chronic disease. Pairs of trained community volunteers visited 23 patients in their homes and asked them to identify three life goals and three health goals. We conducted content analyses of written notes. Health goals were related to disease prevention and symptom control, family well-being, own quality of life, own or family members’ work and/or financial situation. Life goals concerned family well-being, their own quality of life, work/financial situation and health. Given the limited time health professionals have with their patients, trained community volunteers could be important members of primary care teams caring for immigrants.

Cet article reprend les intentions de départ des journées d’étude qui entendaient explorer, dans une perspective comparative France-Québec, la pluralité des récits impossibles dans divers champs d’études et de pratiques (intervenants sociaux, formateurs, juristes, psychologues, traducteurs-interprètes). Elles avaient pour ambition de décloisonner les expertises et faire dialoguer les différents acteurs pour mieux comprendre et analyser les expériences et phénomènes en contexte migratoire. Ceci nous a amenés progressivement sur le terrain de l’interculturalité. Nous pensons que les perspectives théoriques et pratiques entourant le recherche et l’intervention en contexte interculturel au XXIe siècle pourraient être actualisées et enrichir ainsi les regards sur les phénomènes sociaux et migratoires. C’est à partir d’une recension des écrits et une reconnaissance des tensions interculturelles, que nous proposons de développer une dimension critique qui permet de tenir compte des rapports de pouvoir, des dimensions structurelles et systémiques qui régissent les rapports sociétaux. Ainsi, nos propos invitent l’univers du politique, de la pratique et la recherche à mieux définir leurs contours pour s’adapter aux enjeux contemporains et promouvoir une perspective interculturelle ancrée dans les réalités et expériences vécues par les premiers concernés, les acteurs eux-mêmes, les citoyens et la société civile.

What factors influence the impact of the crisis associated with COVID-19 on Montreal cultural communities?

Our study indicates that certain groups in cultural communities are made vulnerable by the intersection of multiple economic and social factors, in particular:

• Precarious financial situation;
• Employment in a position at high risk of exposure to COVID ;
• Precarious migration status or lack of status;
• Lack of medical insurance;
• Being allophone;
• Low literacy;
• Being targeted by racism.

These factors may contribute to high levels of infection and psychosocial distress in certain multiethnic, low-income neighbourhoods in Montreal.
Public health policies must take into account the combined impact of these economic, linguistic, sociocultural and migratory factors.

1. Collect data on COVID’s social determinants
2. Facilitate community collaboration and consultation
3. Improve access to health information and guidelines through a multilingual communication
4. Promote access to health and psychosocial services
5. Provide universal access to financial support measures
6. Ensure that COVID-related workplace health and safety measures are respected
7. Guarantee food security
8. Prevent evictions linked to the pandemic
9. Promote family well-being
10. Strengthen intercommunity relations and act against racism

What factors influence the impact of the crisis associated with COVID-19 on  Montreal cultural communities?

Our study indicates that certain groups in cultural communities are made  vulnerable by the intersection of multiple economic and social factors, in  particular :

• Precarious financial situation;
• Employment in a position at high risk of exposure to COVID ;
• Precarious migration status or lack of status;
• Lack of medical insurance;
• Being allophone;
• Low literacy;
• Being targeted by racism.

These factors may contribute to high levels of infection and psychosocial  distress in certain multiethnic, low-income neighbourhoods in Montreal.

Public health policies must take into account the combined impact of these  economic, linguistic, sociocultural and migratory factors.

Selon les intervenants de la Commission des normes, de l’équité, de la santé et de la sécurité du travail (CNESST), presque 50 % des travailleurs touchés par une lésion professionnelle sur l’île de Montréal seraient issus de l’immigration (ou de groupes ethnoculturels) (CNESST, 2010). Il ne s’agit que d’une estimation, puisque les indicateurs ethnoculturels tels que le pays de naissance, la langue maternelle ou autres ne sont pas des données colligées par la CNESST. Dans le cadre du projet de l’IRSST intitulé Comprendre le processus de réadaptation et de retour au travail dans le contexte des relations interculturelles (Côté et al., 2017), travailleurs, employeurs, cliniciens et intervenants de la CNESST ont été interrogés au sujet des obstacles et des facilitateurs relatifs au retour au travail. Pour le volet clinicien et intervenant de la CNESST, des stratégies ont été identifiées, ainsi que des besoins en matière de développement de compétences interculturelles (CI). Selon les intervenants, l’acquisition de compétences interculturelles peut faciliter la communication interculturelle par les habiletés relationnelles, la capacité d’écoute et de compréhension. La présente recherche a pour objectif le développement du contenu d’un outil d’aide à l’amélioration des compétences interculturelles des intervenants de la CNESST à partir d’une démarche de coconstruction. Cette étude prévoit : la coconstruction d’un outil d’aide à la communication interculturelle pour les intervenants de la CNESST (objectif 1), la documentation du processus de coconstruction de l’outil d’aide à la communication interculturelle (objectif 2) et l’évaluation du développement des compétences interculturelles d’un groupe d’intervenants de la CNESST (objectif 3).Un groupe de travail, composé de dix intervenants (conseillers en réadaptation, agents d’indemnisation) et d’un animateur, un groupe de validation composé de quatorze intervenants (conseillers en réadaptation, agents d’indemnisation) ainsi qu’un comité directeur, se sont réunis sur une base régulière pendant environ dix-huit mois dans la perspective de la recherche collaborative et suivant une approche de coconstruction. Pour atteindre l’objectif général de cette recherche, plusieurs approches méthodologiques et outils de collectes de données ont été utilisés. Tout d’abord, pour répondre à l’objectif 1, a) la recherche collaborative (Desgagné, Chené et Roy, 1997) et b) la méthode des situations en contexte interculturel (Apedaile et Schill, 2008; Mutha, Allen et Welch, 2002; Van Staalduinen, Towle, Godolphin et Laing, 2003; White et Gratton, 2017). Pour répondre à l’objectif 2, c) l’observation participante lors de chacune des rencontres avec le groupe de travail et le comité directeur. Puis, pour répondre à l’objectif 3 sur le développement de la compétence interculturelle, d) l es questionnaires : Intercultural Effectiveness Scale (IES) (Portalla et Chen, 2010) et Intercultural Sensitivity Scale (ISS) (Chen et Starosta, 2000) ont été appliqués aux intervenants et e) un groupe de discussion (avec le comité directeur

The worldwide upsurge in social polarizations generates intercommunity  tensions that challenge the social fabric of urban neighborhoods and undermine the relationships between their members. Because community arts can foster the creation of connections between people that would not have been in contact otherwise, they are often perceived as being powerful tools to foster community resilience. Through a multiple case study approach, this article describes how three community arts projects, carried out in two socioeconomically deprived neighborhoods of Montreal (Canada), influenced the social relationships between participants from diverse ethnocultural backgrounds and generations. Using participant observation and arts‐based data collection methods (photography, video, and arts productions), the authors examine how the three projects illustrate (a) the interactive processes at play, (b) the transmission and hybridization of stories and images of adversity and resiliency, and (c) the access to a collective voice.

Ce symposium fut l’occasion de poser un regard
critique sur diverses questions autour du processus de transfert de connaissances, incluant les
notions de valorisation des savoirs, d’innovation
sociale ou technologique, de “meilleures pratiques“,
de gestion ou de mode d’intervention par données
probantes. Les réflexions sur la nature du partenariat entre l’Université, les chercheurs, les établissements et les divers acteurs impliqués dans
l’intervention furent également au cœur de cette
journée

Pour intervenir auprès des travailleurs immigrants, les professionnels de la santé et les intervenants en santé et en sécurité du travail ont des contacts directs avec eux, soit en personne, soit par téléphone. Ces interlocuteurs étant issus d’horizons culturels variés, leurs rencontres, dites interculturelles, peuvent mettre en relief des perspectives très différentes. Or, on ne peut traiter un travailleur ayant subi une lésion professionnelle sans tenir compte d’une multitude de facteurs qui influencent ses valeurs et la représentation qu’il se fait de lui-même (identité personnelle, organisation sociale, éducation, classe sociale, genre, religion ou idéologie, etc.). Ces variables peuvent présenter d’importants écarts de représentations culturelles entre les individus et être une source de malentendus, d’incompréhension ou de désaccords qui doivent absolument être pris en considération. Pour que ces rencontres favorisent un retour réussi au travail, il importe d’encourager le développement de la compétence interculturelle des intervenants dans les organisations. Ce document a été conçu pour servir d’instrument de réflexion visant à favoriser le développement de telles compétences.

Québec’s labour market has changed significantly in the past few years, notably with the slower growth of the labour force, an aging population, higher education levels among workers and an increasing proportion of immigrants in the workforce.
In its recent work on occupational rehabilitation, the IRSST has taken a particular interest in workers in vulnerable situations, including immigrant workers. Immigrant workers are considered a more vulnerable population due to, among other things, their proportionately higher-than-average presence in sectors characterized by less favourable working conditions and higher exposure to the risk of occupational injuries. Language and cultural barriers sometimes compound these factors.
The content of this document derives from a study titled The Notion of Ethnocultural Belonging in Rehabilitation Research and Intervention: Knowledge Summaries (published in 2012) and a study (completed in 2017) on the rehabilitation and return-to-work trajectories of immigrant workers with an occupational injury. This study highlighted the role of the health professionals and OHS practitioners involved, their intervention strategies and interactions, and the issues specific to intercultural encounters, while underscoring the impact of the organizational context on these aspects

Synthèse sur la thérapie par l’approche centrée sur la personne (ACP), développée par le psychologue humaniste américain, Carl Rogers (1902-1987). Elle propose des clés pour comprendre la relation qui se noue entre un patient et son thérapeute à partir d’exemples concrets.

À partir du cadre théorique de la niche d’activité professionnelle et d’études effectuées au Québec, un portrait des pratiques et représentations du travail avec interprètes dans les soins est dressé. Ce portrait est d’abord fait pour les contextes non sensibles aux dimensions linguistiques et culturelles des soins. Il est ensuite dépeint plus en détail avec deux études menées en contextes sensibles. Cette comparaison permet de mettre en évidence les niveaux de contexte qu’il est nécessaire de prendre en compte pour l’intégration des interprètes dans les équipes de soins et pour établir une collaboration interprète-praticien de qualité : politique, institutionnelle (qui inclut les dimensions structurelle et collaborative), de formation et déontologique. Pour chacun d’eux, les conditions idéales pour établir une collaboration interprète-praticien-usager constructive sont décrites.

This study of social representations about interpreted medical consultations examines the discourse of French language focus groups (FGs), conducted in Quebec, with 22 third year medical students (4 FGs), 29 family medicine residents (4 FGs) and 47 experienced family physicians (5 FGs). The audio-recorded FGs were transcribed. Each discussed two video vignettes of interpreted consultations. Statistical textual analysis showed that the students’ discourse patterns differed by FG. Residents prioritized access to the patient’s culture via the interpreter, though recognizing the need to respect the patient-physician relationship. Senior physicians organized their discourse differently for each vignette, associating it with a ‘standard’ response: for them, the two main issues were the quest for information, which we relate to the medical socialization process; and the interpreter’s stances, in terms of how s/he is perceived by physicians and the role(s) s/he is seen to play in the consultation. Physicians tend to represent the interpreter as a controllable ‘object’, not a full-fledged healthcare professional.

Lorsqu’on donne des soins et que la personne que l’on tente d’aider ne parle pas la même langue que nous, il est parfois difficile de comprendre l’autre et de se faire comprendre. Et si on pouvait utiliser des images pour s’aider? C’est le pari qu’a fait Juliana Alvarez, designer industrielle et cofondatrice d’IDE3S. Avec l’aide des professionnels de la santé et des services sociaux travaillant dans une ressource intermédiaire hébergeant des personnes âgées, elle a conçu une gamme d’outils visuels ayant pour but de faciliter la communication entre les intervenants et les personnes âgées allophones

This article describes the development of a dynamic culturally constructed clinical practice model for HIV/STI prevention, the Narrative Intervention Model (NIM), and illustrates its application in practice, within the context of a 6-year transdisciplinary research program in Mumbai, India. Theory and research from anthropology, psychology, and public health, and mixed-method ethnographic research with practitioners, patients, and community members, contributed to the articulation of the NIM for HIV/STI risk reduction and prevention among married men living in low-income communities. The NIM involves a process of negotiation of patient narratives regarding their sexual health problems and related risk factors to facilitate risk reduction. The goal of the NIM is to facilitate cognitive-behavioral change through a three-stage process of co-construction (eliciting patient narrative), deconstruction (articulating discrepancies between current and desired narrative), and reconstruction (proposing alternative narratives that facilitate risk reduction). The NIM process extends the traditional clinical approach through the integration of biological, psychological, interpersonal, and cultural factors as depicted in the patient narrative. Our work demonstrates the use of a recursive integration of research and practice to address limitations of current evidence-based intervention approaches that fail to address the diversity of cultural constructions across populations and contexts.

Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners’ experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40 % of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.

Bien que le travail avec interprète professionnel soit fortement recommandé dans les consultations médicales plurilingues, de nombreuses consultations sont réalisées en présence dinterprètes familiaux (membres de la famille). Cette étude compare la situation médicale avec interprètes professionnels et celle avec interprètes familiaux selon deux perspectives : 1) les conceptions que médecins et interprètes ont des rôles des interprètes dans la consultation médicale, 2) les implications des postures de linterprète par rapport à la voix du monde vécu (lifeworld) lorsque celle-ci apparaît dans la consultation. Les principaux rôles de linterprète rapportés par les participants à notre enquête sont celui de linterprète professionnel comme « traducteur effacé » et celui de linterprète familial comme « interlocuteur à part entière ». Lun et lautre ont une vision différente du message et du contexte du patient. Dans certains cas, leur apport favorise une négociation de sens, dans dautres cas, il bloque la communication entre le médecin et le patient. Une meilleure connaissance des implications des postures de linterprète sur la communication permet de faire des choix éclairés quant à ces postures.

With the increase in international mobility, healthcare systems should no longer be ignoring language barriers. In addition to the benefit of reducing long-term costs, immigrant-friendly organizations should be concerned with mitigating the way language barriers increase individuals social vulnerabilities and inequities in health care and health status. This paper reports the findings of a qualitative, exploratory study of the health literacy of 28 Francophone families living in a linguistic-minority situation in Canada. Analysis of interviews revealed that participants social vulnerability, mainly due to their limited social and informational networks, influenced the construction of family health literacy. Disparities in access to healthcare services could be decreased by having health professionals work in alliance with Francophone community groups and by hiring bilingual health professionals. Linguistic isolation and lack of knowledge about local cultural organizations among Francophone immigrants were two important findings of this study.

Nyra, une jeune immigrante, a des idées suicidaires. Dans quelques jours, elle doit rejoindre sa famille et épouser son fiancé dans son pays d’origine, le Nyrabec (pays fictif). Elle est tiraillée entre sa peur qu’on lui fasse du mal si on apprend qu’elle a perdu sa virginité et, d’autre part, son désir de revoir les gens qu’elle aime.

Une intervenante de Relais Côte-des-Neiges nous raconte un événement durant l’un des ateliers de francisation que l’organisme propose. Un homme et une bénévole ont une altercation autour d’un sujet d’ordre religieux. Il faut alors rapidement intervenir pour ne pas laisser s’envenimer le conflit.

Dans ce récit, Danielle nous parle de la participation citoyenne à l’école publique, thème qui est au cœur des activités de l’organisme La Troisième Avenue

Une intervenante de Multi-Écoute se rappelle d’un de ses premiers suivis d’intervention psychosociale, à ses débuts, avec une jeune mère monoparentale immigrante.

Un animateur sportif raconte comment un jeune est sorti de l’équipe de basket avant même d’y entrer. Il revisite ses certitudes et grâce à une formation en animation, il va découvrir ses erreurs passées et cherche désormais à devenir un meilleur animateur pour aider les jeunes.

Drawing on knowledge of the historical evolution of health and social services in Quebec and Canadian studies on accessibility to healthcare for immigrants, this paper provides some reflections for initiating dialogue on this subject in relation to English-speaking ethnocultural and immigrant communities. A training tool designed to sensitize health and social service practitioners to barriers of access within a multiethnic context is also outlined as means of improving accessibility as well as the quality of care.