Engaging with Care in an Early Intervention for Psychosis Program: The Role of Language, Communication, and Culture

The author notes that engagement with treatment in early intervention for psychosis programs has been conceptualized as key to facilitating better symptomatic and functional outcomes, thereby making it a focus of early intervention programs. Despite this focus, service disengagement remains a concern and numerous predictors have been identified as increasing risk for disengagement before completing the recommended two-to-five-year course of early intervention. She points out that despite language being an important aspect of communication and language status being known to impact health care accessibility, its perceived suitability, and outcomes, its influence on treatment engagement and/or disengagement is unknown, a gap the author sought to address. Specifically, her study sought to investigate the impact of language on service disengagement in an early intervention psychosis program in Montreal (in a province with French as the official language). The author aimed to compare service disengagement between a linguistic minority group (i.e. English) vis-à-vis those whose preferred language was French and to explore the role of language in service engagement. Using a mixed methods sequential design, the author tested preferred language and several sociodemographic characteristics known to be associated with service disengagement in early psychosis based on prior literature in a time-to-event analysis with Cox Proportional Hazards regression models (N=338). She then conducted two language-cohesive focus groups with English (seven patients) and French-speakers (five patients) to further explore differences between the two linguistic groups. The author's quantitative sample included 338 patients; 189 (55.9%) preferred receiving services in French, and 149 (44.1%) in English. French speakers demonstrated greater material [French: M=65.8, SD=27.9, English: M=56.7, SD=31.6; t(336) = 2.78, p<0.01] and social deprivation [French: M=76.9, SD=17.7, English: M=72.2, SD=23.5; t(336) = 2.12, p<0.05. Overall, 24% (n = 82) of persons disengaged from the service before the two-year mark. The author found that those whose preferred language was English were likelier to disengage (n=47, 31.5%) than those whose preferred language was French (n= 35, 18.5%; χ2=9.11, p<0.01). Time-to-disengagement was 14.1 months (SD=5.4) for French-speakers and 10.5 months (SD=5.8) for English speakers [t(80) = 2.84, p<0.01]. In the multivariate Cox proportional hazards regression, preferred language remained significant (HR = 2.07, 95% CI 1.31-3.28) and there was a significant association between family involvement (HR = 1.97, 95% CI 1.20-3.21) and service disengagement. The author conducted two post hoc time-to-disengagement analyses, demonstrating 1) no difference in disengagement rates between non-immigrants and immigrants and 2) that English-speakers are more likely to disengage than Allophones or French-speakers (n=325, χ2=7.79, p<0.05). In both focus groups there was an overarching picture of the importance of communication as an essential mediator of the clinician-patient relationship. Two main themes related to communication were identified by the author – technical communication/syntax and semantic communication/meaning-making. Participants identified language as one aspect of a complex communication process between patients and clinicians and highlighted the importance of culture in the clinical encounter. The author concluded that quantitative findings demonstrated that persons whose preferred language was English were likelier to disengage from our early intervention program for psychosis than those whose preferred language was French. Qualitative results helped to unpack the complexity of the relationship between language and service engagement by suggesting that language is just one component of a much broader communication process that impacts clinical/therapeutic relationships. The author found that her findings underscore the value of establishing communication and cultural understanding in creating clinical/therapeutic alliance.

Master's Thesis

McGill University

Montreal

2021

70p.

en