Anika Maraj1, Manuela Ferrari2, Jai Shah1,2, Srividya N Iyer1,2; 1McGill University, 2Douglas Mental Health University Institute
Background: Although specialized early intervention (EI) programs for psychosis invest in keeping clients engaged in treatment, (dis)engagement remains a concern. Service- and system-related factors, particularly language, used in the provision of care, are currently understudied. Given that language is known to broadly impact health care accessibility and perceived suitability, investigating the role of language in EI service disengagement is imperative. Methods: A mixed-methods sequential explanatory study was conducted at an EI program in the bilingual city of Montreal, Canada. 378 clients were included in a time-to-event analysis with Cox Proportional Hazards regression models. Preferred language (English or French), immigrant status, visible minority status, age, gender, education, substance abuse, family contact, social and material deprivation and medication non-adherence were investigated as predictors of 24-month service disengagement. Subsequently, two focus groups (1 English, n=7; 1 French, n=5) were conducted to explore quantitative findings and generate more knowledge. Results: Overall, about 28.6% (n = 108) of persons disengaged from the service. Those whose preferred language was English were more likely to disengage from services (n=57, 34.5%) than those whose preferred language was French (n= 51, 23.9%; p=0.017). In contrast, focus group participants did not identify language as a barrier in accessing or receiving care. Participants discussed the overall impact that client-provider communication and language, as the expression of culture, have in service (dis)engagement. Conclusion: Findings from this study highlight how language and culture impact service user engagement in EI programs; emphasizing that language is the mediator of social interactions –including therapeutic ones.
