Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study.

BACKGROUND: Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group. METHODS: Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of 'severe' multimorbidity (defined as the presence of five or more chronic diseases). RESULTS: The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02-1.06]). CONCLUSIONS: The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.

Social Exclusion Among Official Language Minority Older Adults: A Rapid Review of the Literature in Canada, Finland and Wales.

It has been suggested that older adults from minority linguistic and ethnic communities face higher risks of being socially excluded. The aim of this review was, therefore, to explore and review social exclusion studies conducted among official language minority older adults in three countries, namely Canada, Finland and Wales. A rapid review approach was used to review scientific literature in line with six social exclusion domains. The literature searches were made in Finnish, Swedish, English, French and Welsh and were restricted to research published within the timeline of 2001 - September 2019 and yielded 42 articles. The included studies were categorized into three different domains: socioeconomic influences, social participation and societal conditions. Converging and diverging patterns of social exclusion in old age were identified between the linguistic minorities. Linguistic barriers regarding access to health care and receiving health information were common across the three linguistic contexts, whereas exclusion from social participation was noticed amongst the linguistic minorities in Canada and Wales. Some connections between belonging to a linguistic minority and being exposed to a lower socioeconomic status and higher poverty risk were made, however, these findings were not robust across all three countries. The findings indicated that experiences of exclusion could be considered fairly common among linguistic minority older adults. We conclude that the research evidence presented in the review sheds light on issues of social inequality in old age between linguistic majorities and minorities, thus identifying important aspects of social exclusion to guide future research as well as policy and practice.

Quality and Safety in Long-Term Care in Ontario: The Impact of Language Discordance.

OBJECTIVES: This study compared quality indicators across linguistic groups and sought to determine whether disparities are influenced by resident-facility language discordance in long-term care. DESIGN: Population-based retrospective cohort study using linked databases. SETTING AND PARTICIPANTS: Retrospective cohort of newly admitted residents of long-term care facilities in Ontario, Canada, between 2010 and 2016 (N=47,727). Individual residents' information was obtained from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to determine resident's primary language, clinical characteristics, and health care indicators. MEASURES: Main covariates of interest were primary language of the resident and predominant language of the long-term care facility, which was determined using the French designation status as defined in the French Language Services Act. Primary outcomes were a set of quality and safety indicators related to long-term care: worsening of depression, falls, moderate-severe pain, use of antipsychotic medication, and physical restraints. Multivariable logistic regression models were used to assess the impact of resident's primary language, facility language, and resident-facility language discordance on each quality indicator. RESULTS: Overall, there were few differences between francophones and anglophones for quality and safety indicators. Francophones were more likely to report pain (10.9% vs 9.9%; P = .001) and be physically restrained (7.3% vs 5.2%; P < .001), whereas a greater proportion of anglophones experienced worsening of depressive symptoms (24.0% vs 22.9%; P = .001). However, quality indicators were generally worse for francophones in Non-Designated facilities, except for pain, which was more commonly reported by francophones in French-Designated facilities. Anglophones were more likely to be physically restrained in French-Designated facilities (6.7% vs 5.1%; P < .001). CONCLUSIONS AND IMPLICATIONS: For francophones, quality indicators tended to be worse in the presence of resident-facility language discordance. However, these findings did not persist after adjusting for individual- and facility-level characteristics, suggesting that the disparities observed at the population level cannot be attributed to linguistic factors alone.

The fundamentals of cross-sector collaboration for social change to promote population health.

Cross-sector collaboration is increasingly relied upon to tackle society's pressing and intractable problems. Chief among societal problems are unfavorable structural and social determinants of health. The ability to positively change these health determinants rests on the collaborative processes and structures of governance across diverse sectors in society. The purpose of this article is to present a conceptual framework that sheds light on the basic requirements of cross-sector collaboration for social change to promote the health of populations. A search for theoretical articles on cross-sector collaboration in the fields of public administration and public health was conducted within the journal databases ABI/INFORM Complete and MEDLINE. This search strategy was supplemented by an internet search of the grey literature for high-profile models of cross-sector collaboration. The conceptual framework builds on previous scholarly work by placing emphasis on five essential conditions for collective impact, and on the pivotal role of collective learning. Collective learning, at the basis of planning and taking action, is at the core of effective cross-sector initiatives, specifically because of its critical role in constantly adapting strategies to changing circumstances and unanticipated situations within complex socio-ecological systems.

Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues.

Organizational health literacy is described as an organization-wide effort to transform organization and delivery of care and services to make it easier for people to navigate, understand, and use information and services to take care of their health. Several health literacy guides have been developed to assist healthcare organizations with this effort, but their content has not been systematically reviewed to understand the scope and practical implications of this transformation. The objective of this study was to review (1) theories and frameworks that inform the concept of organizational health literacy, (2) the attributes of organizational health literacy as described in the guides, (3) the evidence for the effectiveness of the guides, and (4) the barriers and facilitators to implementing organizational health literacy. Drawing on a metanarrative review method, 48 publications were reviewed, of which 15 dealt with the theories and operational frameworks, 20 presented health literacy guides, and 13 addressed guided implementation of organizational health literacy. Seven theories and 9 operational frameworks have been identified. Six health literacy dimensions and 9 quality-improvement characteristics were reviewed for each health literacy guide. Evidence about the effectiveness of health literacy guides is limited at this time, but experiences with the guides were positive. Thirteen key barriers (conceived also as facilitators) were identified. Further development of organizational health literacy requires a strong and a clear connection between its vision and operationalization as an implementation strategy to patient-centered care. For many organizations, becoming health literate will require multiple, simultaneous, and radical changes. Organizational health literacy has to make sense from clinical and financial perspectives in order for organizations to embark on such transformative journey.

Success Strategies for Linguistically Competent Healthcare: The Magic Bullets and Cautionary Tales of the Active Offer of French-Language Health Services in Ontario.

An active offer of French-language health services (FLHS) was introduced in several Canadian provinces to help create an environment that will anticipate the needs of Francophones in their community and will stimulate the demand for services in French. For the active offer to be implemented, changes in how health services are organized and managed at both organizational and system levels must be introduced. In this perspective paper, we identify several success strategies and potential pitfalls with regards to the implementation of the active offer of FLHS primarily at the level of healthcare organization. Our recommendations are based on a recent health services research study exploring reorganization and management strategies for the delivery of the active offer of FLHS in Ontario and insights from a focus group with healthcare administrators conducted as part of this research. We propose a ";wrap-around strategy" called organizational health literacy to help reorient organizational culture and improve management and sustainability of the active offer of FLHS. These strategies have relevance for advocates and professionals working to promote an active offer of FLHS, including healthcare administrators, human resource professionals, quality-improvement specialists and others.

Primary Health Care Models Addressing Health Equity for Immigrants: A Systematic Scoping Review.

To examine two healthcare models, specifically "Primary Medical Care" (PMC) and "Primary Health Care" (PHC) in the context of immigrant populations' health needs. We conducted a systematic scoping review of studies that examined primary care provided to immigrants. We categorized studies into two models, PMC and PHC. We used subjects of access barriers and preventive interventions to analyze the potential of PMC/PHC to address healthcare inequities. From 1385 articles, 39 relevant studies were identified. In the context of immigrant populations, the PMC model was found to be more oriented to implement strategies that improve quality of care of the acute and chronically ill, while PHC models focused more on health promotion and strategies to address cultural and access barriers to care, and preventive strategies to address social determinants of health. Primary Health Care models may be better equipped to address social determinants of health, and thus have more potential to reduce immigrant populations' health inequities.

Active offer of health services in French in Ontario: Analysis of reorganization and management strategies of health care organizations.

BACKGROUND: The availability of health services in French is not only weak but also inexistent in some regions in Canada. As a result, estimated 78% of more than a million of Francophones living in a minority situation in Canada experience difficulties accessing health care in French. To promote the delivery of health services in French, publicly funded organizations are encouraged to take measures to ensure that French-language services are clearly visible, available, easily accessible, and equivalent to the quality of services offered in English. OBJECTIVE: This study examines the reorganization and management strategies taken by health care organizations in Ontario that provide health services in French. METHODS: Review and analysis of designation plans of a sample of health care organizations. RESULTS: Few health care organizations providing services in French have concrete strategies to guarantee availability, visibility, and accessibility of French-language services. CONCLUSIONS: Implementation of the active offer of French-language services is likely to be difficult and slow. The Ontario government must strengthen collaboration with health care organizations, Francophone communities, and other key actors participating in the designation process to help health care organizations build capacities for the effective offer of French-language services.

Research on health inequalities: A bibliometric analysis (1966-2014).

The objective of this study is to report on research production and publications on health inequalities through a bibliometric analysis covering publications from 1966 to 2014 and a content analysis of the 25 most-cited papers. A database of 49,294 references was compiled from the search engine Web of Science. The first article appears in 1966 and deals with equality and civil rights in the United States and the elimination of racial discrimination in access to medical care. By 2003, the term disparity has gained in prominence relative to the term inequality which was initially elected by the researchers. Marmot's 1991 article is one of the five papers with the largest number of citations and contributes to the central perspective of social determinants of health and the British influence on the international status of research on social inequalities of health.

[Health and social information systems in support of local health planning: issues and challenges]. / Les systemes d'information sociosanitaire a l'appui de la planification locale de la sante: defis et enjeux.

Health information is indispensable for monitoring the progress that has been made in improving and maintaining population health and health system functions. In the context of health reforms aiming to bring health systems closer to populations and with the objective of consistent health services planning at the community level, access to reliable social and health data has become a major issue. The need to develop specific treatment tools and the appropriation of results by the various actors involved (decision makers, planners, researchers and consumers) are central to the presentations and exchanges in this symposium.

[The architects of change: a plenary session exchange]. / Les artisans du changement: autour d'un echange plenier.

The closing plenary of the colloquium was an occasion for exchange between the four panelists and the participants. The panelists included Luc Berghmans, a doctor and director of the regional health observatory of Hainaut, Belgium; Louise Bouchard, a sociologist and professor in the Sociology and Anthropology Department, University of Ottawa, Canada; Michel O'Neill, a sociologist and professor at the Faculty of Nursing Sciences, Laval University, Quebec City, Canada; and Philippe Lorenzo, director general of IREPS, the regional bureau for health education and promotion of Picardie in Amiens, France. Louise Potvin, who moderated the plenary, provides the summary that follows. During the colloquium, three main questions were debated: 1. At what point should health be placed at the forefront of local actions, if we wish to promote the values of equity? 2. How should actions at the local, regional, national and global levels be organized and articulated? Who are the partners, and what forms of governance need to be put into place? 3. What are the parameters needed in order to define the roles, tasks and competencies of the implementers of local and regional health programs, the architects of change? Each panelist had to respond to two out of the three questions. We report on the answers that panelists gave to these questions. As it is impossible to verify the exactitude of information given by audience members in support of their viewpoints, only the content of the remarks is given, without mentioning the examples that were provided.

[Linguistic minorities in Canada and health]. / Les minorités linguistiques du Canada et la santé

Official language minorities (Francophones outside of Quebec and Anglophones in Quebec) make up about 6.4% of the Canadian population. Even though the Canadian constitution gives legal equality status to French and English, there is still room to ask if this equality is maintained in the health sector. In other words, do Francophone and Anglophone communities of Canada have the same health profiles regardless of their minority or majority status? Do they have access to the same health services and in the same conditions? The objective of this paper is to identify the health issues associated with belonging to a linguistic minority. Our research allows us to highlight the social and health disparities that can be attributed to belonging to a minority. In the Canadian context, which has two official languages, an equitable health policy will have to take into consideration language as a determinant of health.

Physical inactivity among Francophones and Anglophones in Canada.

OBJECTIVE: Leisure-time physical activity participation is influenced by various socio-demographic factors. Recent evidence suggests that being part of a minority negatively impacts an individual's health status. The objective of this study was to compare inactive leisure-time physical activity between the Francophone minority and the Anglophone majority in Canada. METHODS: Data from the fusion of cycles 2.1, 3.1, 4.1, 2008 and 2009 of the Canadian Community Health Survey (CCHS) were used. The linguistic variable was determined by languages spoken at home, first language learned and still understood, language of interview, and language of preference. Leisure-time physical activity was based on a questionnaire provided during the interview. Factors associated with inactive leisure time were examined using logistic regression models. RESULTS: Francophones were more likely than Anglophones to be physically inactive in their leisure time (49.1% vs. 47.2%). A greater percentage of Francophones had poor self-perceived health, were older, were single, had lower education, had higher rate of unemployment and lived in rural areas compared to Anglophones. When these socio-demographic factors were taken into account, there were no further differences in the likelihood of being inactive between Francophones and Anglophones. CONCLUSION: The Francophone minority in Canada is characterized by socio-demographic factors that have a negative impact on leisure-time physical activity participation.

Comparison of dietary intake between Francophones and Anglophones in Canada: data from CCHS 2.2.

OBJECTIVE: To compare the dietary intake and food choices between Francophone Canadians in a state of linguistic minority (outside of Quebec) and the English-speaking majority. METHODS: We used the 2004 Canadian Community Health Survey (CCHS) cycle 2.2 (general health and 24-hour dietary recalls) to describe dietary intake of Francophone Canadians (excluding Quebec) and compare them to the English-speaking majority. The linguistic variable was determined by languages spoken at home, first language learned and still understood, language of interview, and language of preference. The mean differences in daily nutrient and food intake were assessed by t and chi-square tests. RESULTS: Differences in total energy and daily food intakes by language groups were not observed in the sample; however, significant differences in weekly consumption were found in different age and sex categories: lower fruits and vegetables consumption, and vitamins and macronutrients intakes for older Francophone men and higher intakes of energy and saturated fat from "unhealthy" foods for Francophone men 19-30 years of age. Based on the Acceptable Macronutrients Distribution Range (AMDR), approximately 50% of the sample exceeded their acceptable energy intake from saturated fats, and 80% were below their required intake of linoleic fatty acid. CONCLUSION: We confirmed that belonging to Francophone minorities in Canada affects food choices and nutritional well-being of this population. The most vulnerable groups identified by our study were Francophone men in the youngest (19-30) and older (50 and over) age categories. The extent to which the cultural setting influences the diet and, in turn, the health of the minority population needs further examination.

[Validation of the equity of access of the OLMCS to health professionals in health regions of Canada]. / Validation de l'équité d'accès des CLOSM aux professionnels de la santé dans les régions sociosanitaires du Canada.

OBJECTIVE: Our research uses a regional summary indicator (IHPOLM) to measure the capacity of the health system to provide equitable access to health professionals for 2 million Official Language Minority Community (OLMC) members dispersed across 104 health regions in Canada. METHOD: The summary indicator IHPOLM compares the official language minority and the official language majority potential access to health professionals. The IHPOLM indicator uses 22 professional health care occupations, representing 79% of the health care workforce in Canada, who communicate directly with their clientele for therapeutic or diagnostic purposes (Statistics Canada, 2006). RESULTS: The IHPOLM indicator revealed that the OLMC population is at a disadvantage in potential access to health professionals capable of providing services in the minority language when compared to the majority language population in 10 of the 13 Canadian provinces/territories. OLMC members are disadvantaged in 13 out of 14 health regions in Ontario, in 16 out of 18 in Québec and in 3 out of 7 in New Brunswick. CONCLUSION: The summary regional indicator IHPOLM identified OLMC health care access inequalities between the official language minority population and the majority language population in the health care system across the health regions in Canada. The more detailed analysis of IHPOLM for individual health occupations will further improve our knowledge of Official Language Minority Community health access inequalities.

[The concept mapping of representations of the future of health services in French in linguistic minority]. / La cartographie conceptuelle des représentations de l'avenir des services de santé en français en situation linguistique minoritaire.

OBJECTIVE: In the context of institutional incompleteness affecting the official minority language communities, we examine how the Francophones in a minority context see the future of health services offered in French. METHOD: The study is based on a participatory methodology: the concept mapping will serve to identify the conceptual universe of a given problem. From a master statement such as: "When I think about the future of health services in French, I think of ...", participants are invited to make as many statements as come to mind. These statements are then categorized individually and treated collectively through a multivariate analysis. OUTCOME: The main themes emerging from the mapping exercise indicate the issues and challenges raised by the participants, namely the geographical context, specific needs, language rights, education and training, human resources, bilingualism and translation, the minority experience, active offer, the role of governmental bodies, community mobilization, collaboration and networking. CONCLUSION: The participatory approach that concept mapping allows is interesting in more than one way: its flexibility provides a space for both individual and collective reflection; it allows identification and structuring of the crucial dimensions of an issue; and the research outcomes are useful both to researchers and participants in guiding action and achieving goals. Social actors can therefore benefit from a collective dynamic to reflect on the foundations for the development and organization of health services in French.

[The movement to represent Francophone minority groups: the future of health services in French]. / Le mouvement de santé en français en contexte linguistique minoritaire: les représentations des acteurs sur l'avenir des services.

The Action Plan for Official Languages launched in 2003 intends to revitalize the country's linguistic duality. Among the priority areas, health is the focus in order to ensure the training of health professionals to serve official language minority communities and to network the main actors concerned about the organization of services in the minority language. The aim of this paper is to report representations of Francophones in minority with respect to the future of health services in French. The study is based on a participatory methodology: concept mapping to identify the conceptual universe of a given problem.

Perceived health status of Francophones and Anglophones in an officially bilingual Canadian province.

OBJECTIVE: It has been reported that being part of a minority group may be negatively associated with self-perceived health. The objective of this analysis was to determine whether there are differences in perceived health between the Francophone minority and Anglophone majority in New Brunswick, the only officially bilingual province in Canada. METHODS: Data from the first four primary cycles of the Canadian Community Health Survey (2001 to 2007) were obtained for 17,729 New Brunswick residents. Odds of reporting good health among Francophones and Anglophones were compared using multivariate logistic regressions accounting for age, health-related behaviours, socio-demographic variables, and medical conditions. RESULTS: In the final models, Francophone men and women were less likely than Anglophones to report their health as being good, although these differences were not statistically significant (Odds ratio, 95% confidence interval: 0.88, 0.61-1.26; 0.71, 0.49-1.04, in men and women, respectively). CONCLUSION: This study suggests that being part of the linguistic minority in New Brunswick is not associated with statistically significant differences in self-perceived health.