Christopher Belanger

Objectives Language-concordant care, or healthcare in one’s preferred language, is important both for health equity and for improving health outcomes. Linguistic minorities, like Francophones in Ontario, Canada, are at risk of poorer clinical outcomes if they receive non-language-concordant primary care. However, common ratio-based access measures can provide misleading views of minorities’ actual access levels. This cross-sectional geospatial study demonstrates a new way to measure primary care access using average travel time to the nearest five English- and French-speaking family physicians. We also introduce the concept of primary care access fragility, where a region’s primary care access may depend on one or a few local family physicians. Our research question is: are there differences in travel burden and access fragility for census subdivisions (CSDs) across language (English/French), rurality (urban/rural) and region (north/south) in the province of Ontario, Canada? Design We conducted a cross-sectional geospatial analysis to estimate English-language and French-language primary care travel burdens and access fragility in Ontario, Canada. We used population and boundary data from Statistics Canada’s 2021 census, road-network data from OpenStreetMaps, and family physician practice locations and language abilities from the College of Physicians and Surgeons of Ontario. We measured travel burden using Valhalla, an open-source road-network analysis platform. Setting We conducted our analysis for Ontario, Canada’s 577 CSDs, which correspond roughly to municipalities and with populations ranging from 5 inhabitants in Rainy Lake 17B to a high of 2 794 356 in Toronto. Participants Using public data from January 2026, we identified 15 762 family physicians practising in Ontario, of whom 11.0% reported speaking French. Patient data were obtained from the most recent 2021 census. Primary and secondary outcome measures Our first primary outcome measures were CSD-level mean travel time to the nearest five English-speaking family physicians, and CSD-level mean travel time to the nearest five French-speaking family physicians, which we compared to explore regional inequities in travel burden. Our secondary outcome measures were based on a novel notion of the travel burden component of ‘primary care access fragility’. This metric indicates how dependent a region’s access is on a small number of local physicians and is defined as the difference between the CSD-level mean travel time to the nearest one physician and to the nearest five physicians. As the difference in travel times grows, so too does access fragility. Results Median differences in French-language and English-language travel burdens were strongly significant across rurality, regions and overall (median difference 13.4 min, pConclusions Compared with the general public, Ontario’s French-speakers face higher travel burdens to language-concordant family physicians and higher access fragility, especially in rural and northern regions. Our results are of interest to policymakers and health-system planners, and our methods are applicable to other populations and regions.

Background: Language barriers between Canadian patients and health care providers are associated with poorer health outcomes, including decreased patient safety and quality of care, misdiagnosis and longer treatment initiation times, and increased mortality. However, research exploring language as a social determinant of health is limited, as Canadian health data are scattered across many jurisdictions, each with its own policies and procedures. This fragmentation makes it difficult for researchers to identify, locate, and use existing data. This paper presents the results of a pilot study that attempts to address this gap by creating a metadata repository (MDR) to act as a central source of information about what data are available at which data holdings across Canada. Objective: This project aimed to (1) create a proof-of-concept MDR for Canadian health data at the variable level; (2) identify and label language-related variables existing within the MDR data; and (3) develop an interactive, public-facing web application to let users browse and search the MDR. Methods: Metadata were collected from 5 Canadian health data sources, including 4 provincial data holdings and 1 national survey, and pooled to create a data repository. Then, we performed bottom-up labeling of language-related variables within the pooled metadata by first using a search string algorithm across all variable labels, names, and definitions and then consensus screening these variables using a derived, standardized definition of language or linguistic variables. Using the Shiny web framework in R, we then developed an openly accessible web application to allow users to search the proof-of-concept MDR. Results: A total of 850,343 variables were collected and included in the repository, with most coming from Ontario (n=712,037, 83.7%) and Manitoba (n=97,051, 11.4%) provincial data holdings. Among all variables in the repository, 213,696 (25.1%) were confirmed to be language related. Conclusions: Developing a national MDR would be a transformative opportunity for Canadian researchers to leverage the full scope of Canadian health administrative data. Although a top-down approach with consistent engagement of and collaboration between provincial data holdings and federal data agencies is ideal to develop a national MDR, this study demonstrates the feasibility of a bottom-up approach in contributing to this overarching goal.

Objective Providing care in a patient’s preferred language improves health outcomes and patient satisfaction. In Ontario, access to French-speaking physicians (FSPs) is estimated using FSP-to-Francophone population ratios and compared with total physician-to-total population ratios. This approach fails to consider the fact that FSPs also serve non-Francophone patients and that Francophones must compete with the entire population to access FSPs. As a result, this approach inaccurately suggests that Francophones have better access to language-concordant care than Anglophones/Allophones. We propose a novel approach to address this issue, enabling unbiased comparisons of access to language-concordant care across linguistic groups. Design This secondary analysis of publicly available data containing linguistic variables for the Ontario population (Statistics Canada, 2021 Census) and for family physicians (FPs) (College of Physicians and Surgeons of Ontario, January 2024) calculated competition-adjusted ratios and probabilities of accessing language-concordant care. Setting Ontario, Canada. Participants Census and publicly available data on FPs (ie, those providing comprehensive family medicine care to the community) and the Ontario population were obtained. Results Province-wide, the crude ratio of FSPs per 1000 Francophones was 3.46. After adjusting for competition, the ratio of FSP per 1000 population was 0.12, compared with a general physicians-per-1000 population ratio of 1.05. Anglophones/Allophones attached to a FP have a 100% probability of receiving care in English compared with an 11.4% probability for Francophones to receive care from a FSP. Expressed otherwise, Anglophones/Allophones are 8.8 times more likely to receive language-concordant care (ie, care in English) than Francophones. Conclusions Although crude physician-to-population ratios overestimate Francophones’ access to FSPs, competition-adjusted ratios and probabilities demonstrate that they are much less likely to access language-concordant care than Anglophones/Allophones. This novel approach has equity implications for health human resources planning and can be applied to other linguistic minority groups and healthcare providers.

Age-based discrimination or ageism is often propagated through media platforms. Focusing on the 2023 reality television show “The Golden Bachelor”, which features older adult contestants seeking romance, this study explored ageism spread via social media posts related to the program. Using social astronomy software and qualitative content analysis of user posts, four forms of ageism (1) personal, (2) explicit, (3) implicit, and (4) benevolent, were explored in a sample of 4000 posts shared between November 2023 and June 2024 in Reddit’s English-language corpus. The analysis of Reddit posts related to “The Golden Bachelor” revealed four key themes: (1) Dimensions of Ageism—discussions highlighted overt and subtle forms of ageism, including personal, explicit, and benevolent biases; (2) Aesthetic and Gendered Expectations in Aging—Reddit users critiqued societal pressures for older women to maintain youthful appearances; (3) Sexuality and Romance in Older Adults—while some users expressed skepticism about older adults’ romantic pursuits, others celebrated the cast members’ desires for love and intimacy; (4) The Convergence of Ageism and Sexism—comments reflected a gendered lens, where older women faced harsher scrutiny compared to their male counterparts. While “The Golden Bachelor” may help some understand the capabilities of older adults and counter the misperception of them as asexual, existing ageist stereotypes emerge and are shared on social media platforms. These findings underscore the pervasive nature of ageism in social media and highlight the importance of addressing age-related biases in media representation.

BACKGROUND Language barriers between Canadian patients and providers are associated with poorer health outcomes, including decreased patient safety and quality of care, misdiagnosis and longer treatment initiation times, and increased mortality. However, research exploring language as a social determinant of health is limited, as Canada’s health data is scattered across many jurisdictions, each with its own policies and procedures, making it difficult for researchers to identify, locate, and use existing data. This paper presents the results of a pilot study that attempts to address this gap by creating a metadata repository (MDR) to act as a central source of information about which data is available at which data holdings across Canada. OBJECTIVE This project had several objectives: 1) To create a proof-of-concept metadata repository for Canadian health data at the variable level. 2) To identify and label language-related variables existing within our MDR of Canadian health data. 3) To develop an interactive public-facing web application to let users browse and search the MDR. METHODS Metadata were collected from five Canadian health data sources, including four provincial data holdings and one national survey, and pooled to create a data repository. We then performed bottom-up labelling of language-related variables within the pooled metadata by first employing a search string algorithm across all variable labels, names and definitions, and then consensus screening of these variables using a derived, standardized definition of language/linguistic variables. Using the Shiny web framework in R, we then developed an openly accessible web application (healthdatadictionary.ca) to allow users to search the proof-of-concept MDR. RESULTS A total of n=850,343 variables were collected and included in the repository, with most coming from the ICES (n=717,032; 83.7%) and MCHP (n=97,051; 11.4%) provincial data holdings. Among all variables in the repository, n=219,198 (25.8%) were confirmed to be language-related variables. CONCLUSIONS Developing a national metadata repository would be a transformative opportunity for Canadian researchers to leverage the full scope of Canadian health administrative data. While a top-down approach with consistent engagement of and collaboration between provincial data holdings and federal data agencies is ideal to develop a national MDR, the present study demonstrates the feasibility of a bottom-up approach in contributing to this overarching goal.

This research introduces cultural cartography as an innovative methodological approach integrating ontological foundations with reflective praxis to deepen digital discourse analysis. Using the 2022 Rogers Communications internet outage in Canada as a case study, we demonstrate the process of effective map-making and apply Narrative Mosaic Analysis (NMA) to examine how social media users expressed their frustrations, humour, and calls for accountability during the crisis. By mapping and analyzing textual and symbolic elements like emojis, memes, and hashtags, this approach uncovers how communities construct and communicate their shared experiences online. Cultural cartography advances netnographic research by offering a robust framework for integrating the nuanced dynamics of digital discourse, enabling a more comprehensive interpretation of how cultural realities are articulated and shared within digital environments. This methodological innovation provides a new lens for exploring the symbolic richness of online interactions and the narratives they create.

Background: Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients.

BACKGROUND Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. OBJECTIVE This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. METHODS This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. RESULTS A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. CONCLUSIONS While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients.

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic led to many hospital service disruptions and strict visitor restrictions that affected care of older adult populations. This study investigates perceptions of hospital care for persons with dementia during the COVID-19 pandemic as shared on Reddit’s social media platform. Research Design and Methods: This study combined an Opinion Mining Framework with linguistic processing to conduct a sentiment analysis of word clusters and care-based content in a sample of 1,205 posts shared between February 2020 and March 2023 in Reddit’s English-language corpus. Data were classified based on reoccurring contiguous sequences of 2 words from our text sample. Results: Hospital dementia care discourse on Reddit advanced 4 negative sentiment themes: (1) fear of poor medication management, hydration, and hygiene, (2) loss of patient advocacy, (3) precipitation of advance directive discussions, and (4) delayed discharge and loss of nursing home bed. One positive sentiment theme also emerged: gratitude toward hospital staff. Discussion and Implications: Negative sentiment Reddit posts constituted a larger share of the posts than positive posts regarding hospital care for persons with dementia. People who posted about their experiences shared their concerns about hospital care deficiencies and the importance of including informal caregivers in hospital settings, particularly in the context of a pandemic. Implications exist for dementia training, improved quality of care, advance care planning, and transitions in care policies.