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Background: Language barriers can impact health care and outcomes. Valid and reliable language data is central to studying health inequalities in linguistic minorities. In Canada, language variables are available in administrative health databases; however, the validity of these variables has not been studied. This study assessed concordance between language variables from administrative health databases and language variables from the Canadian Community Health Survey (CCHS) to identify Francophones in Ontario., Methods: An Ontario combined sample of CCHS cycles from 2000 to 2012 (from participants who consented to link their data) was individually linked to three administrative databases (home care, long-term care [LTC], and mental health admissions). In total, 27,111 respondents had at least one encounter in one of the three databases. Language spoken at home (LOSH) and first official language spoken (FOLS) from CCHS were used as reference standards to assess their concordance with the language variables in administrative health databases, using the Cohen kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV)., Results: Language variables from home care and LTC databases had the highest agreement with LOSH (kappa = 0.76 [95%CI, 0.735-0.793] and 0.75 [95%CI, 0.70-0.80], respectively) and FOLS (kappa = 0.66 for both). Sensitivity was higher with LOSH as the reference standard (75.5% [95%CI, 71.6-79.0] and 74.2% [95%CI, 67.3-80.1] for home care and LTC, respectively). With FOLS as the reference standard, the language variables in both data sources had modest sensitivity (53.1% [95%CI, 49.8-56.4] and 54.1% [95%CI, 48.3-59.7] in home care and LTC, respectively) but very high specificity (99.8% [95%CI, 99.7-99.9] and 99.6% [95%CI, 99.4-99.8]) and predictive values. The language variable from mental health admissions had poor agreement with all language variables in the CCHS., Conclusions: Language variables in home care and LTC health databases were most consistent with the language often spoken at home. Studies using language variables from administrative data can use the sensitivity and specificity reported from this study to gauge the level of mis-ascertainment error and the resulting bias., (© 2024. The Author(s).)

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., (© 2021. The Author(s).)

Background and Aims: The "Life's Simple 7" (LS7) metrics were developed by the American Heart Association (AHA) to assess and promote cardiovascular health in the American population. The purpose of this study was to assess the overall cardiovascular health of French-speaking adults from the Province of Quebec using the LS7 score., Methods and Results: A total of 777 age and sex-representative participants of five different administrative regions in the Province of Quebec (387 men and 390 women; mean age ± SEM: 41.9 ± 0.1 years) were included in these analyses. Metrics of the LS7 score (smoking, physical activity, diet, body mass index, blood pressure, fasting total cholesterol and blood glucose) were analysed to generate a final score ranging from 0 to 7. Only 0.5% of participants met all criteria for ideal cardiovascular health. The diet metric showed the lowest prevalence of "ideal" scores (4.8%) whereas not smoking was the metric with the highest prevalence (88.1%). Women had a higher LS7 score than men, while age and education level (negative and positive association, respectively; p < 0.0001) were also associated with the LS7 score., Conclusion: Consistent with studies conducted among other populations, very few French-speaking adults from the Province of Quebec achieve an ideal cardiovascular health. These data indicate that further public health efforts aimed at promoting the LS7 metrics, focusing primarily on diet, are urgently needed. Specific groups, including older adults and those with lower levels of education, should be targeted when developing cardiovascular health promotion interventions., (Copyright © 2019 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.)

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., (© 2018 Longwoods Publishing.)

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., (Copyright © 2013 Longwoods Publishing.)

Statistical analyses for small populations or small domains of interest can be challenging. To obtain reliable estimates, only very large surveys such as the Canadian Community Health Survey can be considered. However, despite its good geographical and temporal coverage, the analysis of small populations in smaller regions (e.g., health regions) and in regards to specific health issues remains challenging. We will look at the methodological issues in analysis of small populations in relation to sampling and non-sampling survey errors that affect the precision and accuracy of the estimates. Francophone minorities in Canada will be used to illustrate the issues throughout the paper.

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.

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.

Objective: From a public health perspective, the follow-up of women during pregnancy and the perinatal period requires quality communication and health services that take into account the context in which these women live. However, challenges related to access to health services in French in a minority situation have been documented in recent research. The objective of this pilot study is to better understand the perceptions, the lived experiences and the needs of pregnant Francophone women living in Canada within a linguistic minority context., Methods: Given the exploratory nature of the inquiry, a mixed method descriptive study was conducted in Alberta and New Brunswick, whose populations are 2% and 33% Francophone, respectively. Two semi-structured interviews and a series of validated questionnaires were administered to 21 pregnant women during the third trimester of pregnancy and at six weeks postnatal. Based on the questionnaires, a descriptive analysis documented participants' characteristics, and qualitative interviews were transcribed, coded and analyzed through an inductive process by four independent readers to uncover key themes related to the participants' experiences., Results: Most of the women were bilingual and language in which health services were received did not appear to be a major issue for them, except during times of stress and at critical periods of the pregnancy. In contrast, almost one third of the women reported being unsatisfied with services they had received and attributed this dissatisfaction to gaps in French language services., Conclusion: Women prefer to receive health services in their mother tongue, however services are delivered in English most of the time. Participants report that during times of stress and emergency, communication in French is essential to a quality follow-up of patients. Linguistic and cultural congruence seems to be a key factor for quality care during pregnancy. A comparative study would assist in better ascertaining the relative impact of language on Francophone women's lived experiences during pregnancy.

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.

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.

Objectives: Recent studies show a higher prevalence of being obese or overweight in Francophones living in minority settings compared to Canada's Anglophone majority. The objective of our study was to determine whether belonging to the linguistic minority constituted a social determinant of having a weight problem., Methods: Descriptive variables (n=128,986) from five cycles of the Canadian Community Health Survey were stratified by respondents' language and sex. Two logistic regression models tested the association between being overweight/obese (as defined by the measure of body mass index) and language, for men and women, while adjusting for social and behavioural determinants., Results: Prevalence of excess weight was higher among Francophones compared to Anglophones of Ontario, although the difference was not significant after adjustment for socio-economic and behavioural determinants. However, Francophones were older, less educated and more likely to live in rural areas than their Anglophone counterparts, a situation which makes them more vulnerable., Conclusion: The study confirms the role of social and behavioural determinants of being obese/overweight. Although language does not have a direct influence on having a weight problem, the socio-economic reality of the Francophone minority makes them more likely than the Anglophone majority to fall in vulnerable strata of the population with regards to being overweight/obese. This situation should be considered when planning health services.

Objective: Mental health and arthritis have been recognized as major public health issues. Francophone minority status has now been acknowledged as a health determinant. The objective of this study was to determine the prevalence of major depression among adults with arthritis in Francophone minority populations compared to the Anglophone majority., Methods: Secondary analysis of the CCHS (merger of 2003 (cycle 2.1), 2005 (Cycle 3.1), 2007 (cycle 4.1), 2008 and 2009) excluding Quebec residents. The language variable was constructed using an existing algorithm which combines maternal tongue, language of conversation, language of interview, and preferred language. Major depression was defined according to the DSM IV. Presence or absence of arthritis was a self-reported variable. The prevalence and odds ratios for depression in people with arthritis were calculated and adjusted for various factors (socio-economic, social isolation, access to health services)., Results: The study identified 159,426 Anglophones and 10,658 Francophones. Among the participants with arthritis (27%), the prevalence of depression in Francophones and Anglophones was 8.5% and 8.4%, respectively. In men, Anglophones were more at risk for depression than Francophones: OR 2.36 (95% CI: 2.07-2.70) vs. OR 1.87 (95% CI: 1.20-2.91). This trend was not observed in women., Conclusion: In our sample of people with arthritis, depression seems to affect more particularly the English-speaking men, however given the small sample size, we need to be cautious in our conclusions.