[Validation of a questionnaire on health literacy among Francophones in situation of linguistic minority]. / Validation d'un questionnaire sur l'alphabétisme en santé des francophones en situation linguistique minoritaire.

OBJECTIVE: This study was designed to develop and test the qualitative validity of a French questionnaire. The questionnaire explored the mechanisms by which Francophone in situation of linguistic minority mobilize their social capital and cultural assets in terms of health literacy. METHODS: We used evidence derived from a previous qualitative study in which we elaborated the characteristics of social capital and cultural assets. Drawing on models of social capital and self-determination of language behaviour in Francophone in situation of linguistic minority, 21 items were developed and assessed to confirm content validity. For this purpose, cognitive interviews were conducted with 92 natural experts. These cognitive interviews tested the linguistic and content validity of the instrument. Consultations with research professionals were also conducted to increase content validity. RESULTS: Parsimony and simplicity were tested by application of the Flesch test. The results demonstrate that 19 questions (93%) corresponded to the general public, relatively simple, and everyday use categories. Natural experts confirmed the readability and simplicity of the questionnaire. CONCLUSION: This study addressed a lack of simple and readable questionnaire for collecting data among Francophone in situation of linguistic minority. The findings underscore the lack of evidence related to the familiar construction of health literacy among members of this population.

From Policy to Practice: Implementation of Treatment for Substance Misuse in Québec Primary Healthcare Clinics.

BACKGROUND AND OBJECTIVES: In 2007, the Québec Ministry of Health issued a policy document that specifically mandated the development of addiction treatment services including screening, brief interventions and referral (SBIR) to be delivered by primary healthcare clinics throughout Québec. The current study examined the level of implementation of SBIR one year following the end of the mandate (2007-2012). APPROACH: Semi-structured interviews were conducted with 45 participants from 21 primary health and social service centres throughout the province. Qualitative analysis was used to evaluate the level of success each centre had in implementing SBIR and to identify organizational measures that contributed to successful implementation. RESULTS: The results show that Québec primary health and social service centres had limited success in their efforts to integrate SBIR into their services. A comparative analysis of the centres, categorized according to their level of implementation, revealed the presence of significant organizational- and staff-level factors, including the creation of formal action plans that were conducive to the successful implementation of SBIR in primary care. CONCLUSION: The findings highlight the importance of offering support and guidance, as well as a menu of specific practices that are likely to assist primary health and social services centres to implement SBIR. At the organizational level, the adoption of local action plans and formal service trajectories offers a framework that allows for horizontal and vertical integration of new practices.

From policy to practice: implementing frontline community health services for substance dependence--study protocol.

BACKGROUND: Substance abuse is a worldwide public health concern. Extensive scientific research has shown that screening and brief interventions for substance use disorders administered in primary care provide substantial benefit at relatively low cost. Frontline health clinicians are well placed to detect and treat patients with substance use disorders. Despite effectiveness shown in research, there are many factors that impact the implementation of these practices in real-world clinical practice. Recently, the Ministry of Health and Social Services in Quebec, Canada, issued two policy documents aimed at introducing screening and early intervention for substance abuse into frontline healthcare clinics in Quebec. The current research protocol was developed in order to study the process of implementation of evidence-based addiction treatment practices at three primary care clinics in Montreal (Phase 1). In addition, the research protocol was designed to examine the efficacy of overall policy implementation, including barriers and facilitators to addictions program development throughout Quebec (Phase 2). METHODS/DESIGN: Phase 1 will provide an in-depth case study of knowledge translation and implementation. The study protocol will utilize an integrated knowledge translation strategy to build collaborative mechanisms for knowledge exchange between researchers, addiction specialists, and frontline practitioners (guided by the principles of participatory-action research), and directly examine the process of knowledge uptake and barriers to transfer using both qualitative and quantitative methodologies. Evaluation will involve multiple measures, time points and domains; program uptake and effectiveness will be determined by changes in healthcare service delivery, sustainability and outcomes. In Phase 2, qualitative methods will be utilized to examine the contextual facilitators and barriers that frontline organizations face in implementing services for substance dependence. Phase 2 will provide the first study exploring the wide-scale implementation of frontline services for substance dependence in the province of Quebec and yield needed information about how to effectively implement mandated policies into clinical practice and impact public health. DISCUSSION: Findings from this research program will contribute to the understanding of factors associated with implementation of frontline services for substance dependence and help to inform future policy and organizational support for the implementation of evidence-based practices.

Language barriers in mental health care: a survey of primary care practitioners.

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.

GPs' strategies in intercultural clinical encounters.

BACKGROUND: In North America and Europe, patients and physicians are increasingly likely to come from non-Western cultural backgrounds. The expectations of these patients may not match those of physicians. OBJECTIVE: To identify strategies used by GPs with patients from cultures other than their own. METHODS: We conducted a qualitative inductive study based on 25 semi-structured interviews with family physicians practising in Montreal, Canada. We elicited physicians' strategies when dealing with patients from a cultural background different from their own. We began by asking physicians to describe an encounter they found difficult and one they found easy. RESULTS: Physicians reported three types of strategies: (i) insistence on patient adaptation to local beliefs and behaviours; (ii) physician adaptation to what he or she assumed patients wanted; and (iii) negotiation of a mutually acceptable plan. Individual physicians did not adopt the same strategy in all situations. Their choice of strategy depended on the topic. When dealing with issues they felt deeply about, such as the autonomy of women, many physicians insisted on patient adaptation. Physicians used a patient-centred model of care, but had no framework to elicit information about patients' culture. CONCLUSIONS: A patient-centred model of care enables physicians to consult effectively despite a wide range of cultural differences between themselves and their patients. However, their lack of a conceptual framework for addressing cultural difference prevents systematic data collection and consideration of challenges to respect for individual autonomy. Physician training should include the provision of an explicit conceptual framework for approaching patients from a different culture.