Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide cul... more Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide culturally safe and remotely delivered emotion regulation interventions. We conducted a co-design process of a CBT treatment manual and complementary VR environments for the Inuit populations from Nunavik. Here, we describe the knowledge gained during the adaptation process on the approach to mental well-being and psychotherapy. We followed qualitative, participatory, and research co-design methods. After an initial concept of VR-CBT, an advisory group made up of 7 adults identifying as or working with Inuit participated in 4 focus group meetings. A thematic analysis of the discussions was carried out. A nonsymptom-focused approach with the therapist guiding the individual in empowerment and emotion management was accepted in the advisory group, replacing a symptom-focus. Several CBT in-and between-session techniques were seen critically or rejected, and time for working on a certain theme was increased. Some elements in the proposed landscape were rejected as unsafe, other elements added as culture-specific to increase safety. Future work should confirm broader acceptance and utility. Culturally specific factors play an essential role in acceptance of concepts and approaches used in psychotherapy. Accordingly, they can have an impact on acceptance and attendance in therapy. Access to Mental Health Services Among Inuit in Quebec 1077-7229/20/Ó 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. This is an open access 1 First authorship shared. 2 First authorship shared.
Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance,... more Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures' cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community's needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.
Background: Implementing culturally sensitive psychometric measures of depression may be an effec... more Background: Implementing culturally sensitive psychometric measures of depression may be an effective strategy to improve acceptance, response rate, and reliability of psychological assessment among Indigenous populations. However, the psychometric properties of depression scales after cultural adaptation remain unclear. Methods: We screened the Ovid Medline, PubMed, Embase, Global Health, PsycInfo, and CINAHL databases through three levels of search terms: Depression, Psychometrics, and Indigenous, following the PRISMA guidelines. We assessed metrics for reliability (including Cronbach's alpha), validity (including fit indices), and clinical utility (including predictive value). Results: Across 31 studies included the review, 13 different depression scales were adapted through language or content modification. Sample populations included Indigenous from the Americas, Asia, Africa, and Oceania. Most cultural adaptations had strong psychometric properties; however, few and inconsistent properties were reported. Where available, alphas, inter-rater and test-retest reliability, construct validity, and incremental validity often indicated increased cultural sensitivity of adapted scales. There were mixed results for clinical utility, criterion validity, cross-cultural validity, sensitivity, specificity, area under the receiver operating characteristic curve, predictive value, and likelihood ratio. Conclusions: Modifications to increase cultural relevance have the potential to improve fit and acceptance of a scale by the Indigenous population, however, these changes may decrease specificity and negative predictive value. There is an urgent need for suitable tools that are useful and reliable for identifying Indigenous individuals for clinical treatment of depression. This awaits future work for optimal specificity and validated cutoff points that take into account the high prevalence of depression in these populations. Impact statement The present study suggests that modifying depression scales to fit the Indigenous context through changes to language or question structure is a culturally sensitive strategy that increases acceptance of psychological evaluation and treatment in communities. However, increasing acceptability must be balanced with maintaining clinical utility of instruments. The high prevalence of depression in these populations must be taken into account when developing culturally sensitive but specific tools.
Background: Emotion regulation is an ability related to psychological well-being; when dysregulat... more Background: Emotion regulation is an ability related to psychological well-being; when dysregulated, individuals may have psychiatric symptoms and maladapted physiological responses. Virtual reality-assisted cognitive behavioral therapy (VR-CBT) is an effective psychotherapy to target and strengthen emotion regulation; however, it currently lacks cultural sensitivity and can be improved by adapting it to the cultural context of service users. During previous participatory research, we co-designed a culturally adapted cognitive behavioral therapy (CBT) manual and 2 virtual reality (VR) environments to function as a complement to therapy (VR-CBT) for Inuit who would like to access psychotherapy. Emotion regulation skill building will occur in virtual environments that have interactive components such as heart rate biofeedback. Objective: We describe a protocol for a proof-of-concept 2-arm randomized controlled trial (RCT) with Inuit (n=40) in Québec. The primary aims of this research are to investigate the feasibility, benefits, and challenges of the culturally adapted VR-CBT intervention versus an established VR self-management that is available commercially. We will also investigate self-rated mental well-being and objective psychophysiological measures. Finally, we will use proof-of-concept data to identify suitable primary outcome measures, conduct power calculations in a larger trial for efficacy, and collect information about preferences for on-site or at-home treatment. Methods: Trial participants will be randomly assigned to an active condition or active control condition in a 1:1 ratio. Inuit aged 14 to 60 years will receive a culturally adapted and therapist-guided VR-CBT with biofeedback or a VR relaxation program with nonpersonalized guided components over a 10-week period. We will collect pre-and posttreatment measures of emotion regulation and biweekly assessments over the treatment and at 3-month follow-up. The primary outcome will be measured by the Difficulties in Emotion Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological symptoms and well-being via rating scales (eg, anxiety or depressive symptoms).
This paper examines how children and families of diverse ethnic backgrounds perceive, understand ... more This paper examines how children and families of diverse ethnic backgrounds perceive, understand and treat symptoms related to functional gastrointestinal disorders (FGIDs). It is questioned how different ways of dealing with medical uncertainty (symptoms, diagnosis) may influence treatment pathways. Semi-structured interviews were conducted with 43 children of 38 family groups of immigrant and non-immigrant backgrounds. The analysis takes into account (a) the perceived symptoms; (b) the meaning attributed to them; and (c) the actions taken to relieve them. The social and cultural contexts that permeate these symptoms, meanings and actions were also examined. It is found that, in light of diagnostic and therapeutic uncertainty, non-immigrant families are more likely to consult health professionals. Immigrant families more readily rely upon home remedies, family support and, for some, religious beliefs to temper the uncertainty linked to abdominal pain. Furthermore, non-immigrant children lead a greater quest for legitimacy of their pain at home while most immigrant families place stomach aches in the range of normality. Intracultural variations nuance these findings, as well as family dynamics. It is concluded that different courses of action and family dynamics reveal that uncertainty is dealt with in multiple ways. Family support, the network, and trust in a child's expression of distress are key elements in order to tolerate uncertainty. Lastly, the medical encounter is described as a space permeated with relational uncertainty given the different registers of expression inherent within a cosmopolitan milieu. Narrative practices being an essential dynamic of this encounter, it is questioned whether families' voices are equally heard in these clinical spaces.
Le mal de ventre chez les enfants est un lieu de metissage et de creolisation traverse par des di... more Le mal de ventre chez les enfants est un lieu de metissage et de creolisation traverse par des dimensions sociales et culturelles. Il est construit collectivement au sein des familles nucleaires avec leurs parcours migratoires et leurs souffrances. Par le biais d’entretiens menes aupres de familles haitiennes vivant a Montreal, nous documentons les trajectoires de ces douleurs, dans lesquelles les perceptions, les explications et les moyens mis en œuvre pour les soulager interagissent d’une maniere dynamique. En general, les enfants percoivent leurs maux de ventre comme une experience insaisissable, diffuse et ayant un impact sur leur vie sociale, tout en etant toleres par les enfants et par les meres. Ces familles n’ont pas recu de diagnostic medical et elles attribuent a ces maux des explications provisoires en constante recomposition. En general, elles ont recours a differentes methodes de prise en charge des maux de ventre. L’espace familial, les activites realisees au sein des ...
Objective: Aifred is an artificial intelligence (AI)-powered clinical decision support system (CD... more Objective: Aifred is an artificial intelligence (AI)-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician-patient interaction. Methods: Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-hour study at a clinical interaction simulation centre with standardized patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-minute clinical scenarios with standardized patients portraying mild, moderate, and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews, and standardized patient feedback. Results: All twenty participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible fo...
Le mal de ventre chez les enfants est un lieu de métissage et de créolisation traversé par des di... more Le mal de ventre chez les enfants est un lieu de métissage et de créolisation traversé par des dimensions sociales et culturelles. Il est construit collectivement au sein des familles nucléaires avec leurs parcours migratoires et leurs souffrances. Par le biais d’entretiens menés auprès de familles haïtiennes vivant à Montréal, nous documentons les trajectoires de ces douleurs, dans lesquelles les perceptions, les explications et les moyens mis en oeuvre pour les soulager interagissent d’une manière dynamique. En général, les enfants perçoivent leurs maux de ventre comme une expérience insaisissable, diffuse et ayant un impact sur leur vie sociale, tout en étant tolérés par les enfants et par les mères. Ces familles n’ont pas reçu de diagnostic médical et elles attribuent à ces maux des explications provisoires en constante recomposition. En général, elles ont recours à différentes méthodes de prise en charge des maux de ventre. L’espace familial, les activités réalisées au sein des églises et la médecine officielle sont des espaces thérapeutiques privilégiés
Social Psychiatry and Psychiatric Epidemiology, 2021
We present a cultural adaptation of the Growth and Empowerment Measure (GEM) from the Kanien’kehá... more We present a cultural adaptation of the Growth and Empowerment Measure (GEM) from the Kanien’kehá:ka people of Quebec (Canada). Our aim was to develop a culturally competent and safe tool to assess and promote well-being among this population. We followed a qualitative, collaborative, and participatory method that sought to benefit Indigenous participants and communities, while honouring their culture and philosophies. Twelve adults from health and community services of Kahnawà:ke participated in total five focus group meetings. We carried out a thematic analysis of the data collected through an advisory group that led a revision of the cultural and conceptual relevance of the tool and its content. The group integrated socio-culturally relevant elements and restructured the tool so that it reflected local well-being factors and showed its versatility of being an assessment tool and therapeutic support. A narrative and empowerement-driven approach, culturally based intervention, cultural safety and flexibility when using the instrument were considered successful strategies to improve wellness. This project provides valuable information about the perspectives of local Indigenous communities regarding mental health and factors of empowerment. Mutual understanding and integration of psychological and traditional knowledge can create a beneficial program to improve emotional, mental, spiritual, and physical well-being for the local population. It remains to be tested whether the Kanien’kehá:ka Growth and Empowerment Measure (K-GEM) is clinically useful in psychological and psychiatric intervention, and social and community services.
In this article, I examine blood transfusion from the point of view of families of diverse social... more In this article, I examine blood transfusion from the point of view of families of diverse social, national, and economic backgrounds who live in Montreal (Canada), whose children are being transfused. My objective is to explore the experience of receiving a transfusion and the opinions regarding the blood donation system. Based on a qualitative methodology centered on observations, semi-directed interviews, and thematic analysis, I discuss the participants’ perspectives within the framework of critical medical anthropology, and the social and dehumanizing scope of organic tissue treatment systems. Drawing on my fieldwork, I conclude that these families perceive the blood collection system ambivalently. Families have different reactions regarding anonymity, blood restitution, and donor-recipient connections.
Aifred is a clinical decision support system (CDSS) that uses artificial intelligence to assist p... more Aifred is a clinical decision support system (CDSS) that uses artificial intelligence to assist physicians in selecting treatments for major depressive disorder (MDD) by providing probabilities of remission for different treatment options based on patient characteristics. We evaluated the utility of the CDSS as perceived by physicians participating in simulated clinical interactions. Twenty psychiatry and family medicine staff and residents completed a study in which each physician had three 10-minute clinical interactions with standardized patients portraying mild, moderate, and severe episodes of MDD. During these scenarios, physicians were given access to the CDSS, which they could use in their treatment decisions. The perceived utility of the CDSS was assessed through self-report questionnaires, scenario observations, and interviews. 60% of physicians perceived the CDSS to be a useful tool in their treatment-selection process, with family physicians perceiving the greatest utility. Moreover, 50% of physicians would use the tool for all patients with depression, with an additional 35% noting they would reserve the tool for more severe or treatment-resistant patients. Furthermore, clinicians found the tool to be useful in discussing treatment options with patients. The efficacy of this CDSS and its potential to improve treatment outcomes must be further evaluated in clinical trials.
Social Psychiatry and Psychiatric Epidemiology, 2021
Purpose We present a study on selection of a psychometric scale to be clinically used among Indig... more Purpose We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec. Methods We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information. Results The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner. Conclusion This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.
Background
Recently, artificial intelligence-powered devices have been put
forward as potentially... more Background Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction. Aims Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction. Method Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback. Results All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system’s predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool’s impact on the physician–patient interaction. Conclusions The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
This thesis provides an anthropological approach to blood transfusion, given that this treatment ... more This thesis provides an anthropological approach to blood transfusion, given that this treatment is considered a social practice that is infused with meanings and values that are inscribed within a cultural environment and the clinic itself. The principle objective of this research is to examine the lived experience of blood transfusions from the point of view of the receivers and the varied meanings they attach to this procedure. The guiding thread of the thesis is the multidimensional and polysemic signification of blood and blood transfusions. We also examine the social connections that are woven or constrained around the procedure in a context of sociocultural diversity. This project sheds a new light on blood transfusion, an essential element of care, and provides new data and innovative insights. This research follows an ethnographic process inspired by medical anthropology, the sociology of health and the anthropology of kinship. The comparison of distinct social worlds is implicitly inscribed in the anthropological approach and consists of an analysis of each particular context chosen (the intensive care unit, the haematology clinic and the oncology centre at Sainte Justine mother and child university hospital center). These contexts are compared with each other in order to deconstruct their similarities and differences. Our research is qualitative and includes three pathways of data collection: 63 semi-structured interviews with patient and family members, 16 interviews with health professionals and ethnographic observations of blood transfusions and interactions between patients, their families and health care professionals. The research data was subjected to a descriptive content analysis. We present the religious, cultural, scientific, moralistic and other connotations of blood and the act of receiving blood. We have examined different elements of families involved and have identified which ones most influence their manner of living with a blood transfusion; for example, the hospital setting, the particularities of the clinical case, socioeconomic status, religious or ethnic identity, the level of education and the relationship between the family and health care professional. We question the manner in how the practice impacts the construction of bioidentity, biosociality, and notions of how the body is constituted by the various actors. We discuss this procedure and its implications on the formation of human identity. At the same time, we analyse how economic and social conditions colour the meanings attached to this treatment and how it is perceived. We show that not all of blood transfusions are experienced in the same way. Although, different elements come into play at this level, the hospital context where these practices take place and the quality of the family-health care professional relationships seem to exert the greatest influence. The families’ knowledge of the blood transfusion and the issues linked to informed consent are also discussed in the framework of divergences and convergences between expert knowledge and layperson knowledge. Finally, we explore attitudes toward anonymous donation, donation from a known donor and the system of collection and treatment of blood. The perspectives of participants are discussed in the framework of critical medical anthropology in relation to the pharmaceutical industry and the bioindustry of organic matter. We also discuss the social significance of these systems and their dehumanizing character.
La transfusion de sang est un élément essentiel des soins et contribue à sauver de nombreuses vie... more La transfusion de sang est un élément essentiel des soins et contribue à sauver de nombreuses vies (OMS, 2014). Elle peut toutefois soulever des questions d’ordre éthique et religieuse (Kleinman, 1994 ; Muramoto, 2001), questions peu traitées dans les écrits scientifiques. En réponse à cette lacune, nous avons consacré notre recherche en anthropologie à la perspective des enfants, de leurs familles et des soignants sur les usages thérapeutiques du sang. Notre recherche qualitative a été menée dans deux unités de soins du centre hospitalier universitaire Sainte-Justine. Parmi les principaux résultats, nous avons documenté une grande diversité de représentations et de perspectives religieuses à l’égard du sang et de son transfert. Malgré quelques réticences initiales, les personnes acceptent généralement la transfusion. Également, nous avons constaté que le sang a une charge émotionnelle importante pour les gens et qu’il est conçu d’une manière ambiguë (mélange entre des notions scientifiques et religieuses). Les soignants méconnaissent l’importance symbolique du sang pour les familles, ces dernières les passant généralement sous silence. Enfin, la question de l’anonymat du donneur demeure importante pour la majorité des gens. Cette situation est aussi méconnue des médecins. Les résultats de notre recherche contribuent aux connaissances en médecine transfusionnelle et à l’amélioration de la pratique transfusionnelle au profit des receveurs. Il s’agit d’une recherche originale en anthropologie de la santé, dont les résultats permettent d’avoir une meilleure appréciation des aspects socioculturels entourant la transfusion du point de vue des petits patients et de leur famille.
The fluidity and unruliness of diagnostic processes: Time, space and emotions, 2018
Stemming from a study with families of migrant & non-migrant backgrounds in Montréal on children’... more Stemming from a study with families of migrant & non-migrant backgrounds in Montréal on children’s stomach pains, this paper questions how ways of dealing with medical uncertainty has bearing on pathways to care. These pathways are enacted within and beyond the family space as well as in medical settings. While acknowledging that group practices call for nuance, non-migrant children lead a greater quest for legitimacy of their pain while most migrant families place stomach aches in the range of normality.
Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide cul... more Cognitive-behavioral psychotherapy (CBT) can be combined with virtual reality (VR) to provide culturally safe and remotely delivered emotion regulation interventions. We conducted a co-design process of a CBT treatment manual and complementary VR environments for the Inuit populations from Nunavik. Here, we describe the knowledge gained during the adaptation process on the approach to mental well-being and psychotherapy. We followed qualitative, participatory, and research co-design methods. After an initial concept of VR-CBT, an advisory group made up of 7 adults identifying as or working with Inuit participated in 4 focus group meetings. A thematic analysis of the discussions was carried out. A nonsymptom-focused approach with the therapist guiding the individual in empowerment and emotion management was accepted in the advisory group, replacing a symptom-focus. Several CBT in-and between-session techniques were seen critically or rejected, and time for working on a certain theme was increased. Some elements in the proposed landscape were rejected as unsafe, other elements added as culture-specific to increase safety. Future work should confirm broader acceptance and utility. Culturally specific factors play an essential role in acceptance of concepts and approaches used in psychotherapy. Accordingly, they can have an impact on acceptance and attendance in therapy. Access to Mental Health Services Among Inuit in Quebec 1077-7229/20/Ó 2024 Association for Behavioral and Cognitive Therapies. Published by Elsevier Ltd. This is an open access 1 First authorship shared. 2 First authorship shared.
Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance,... more Cultural adaptation of psychometric measures has become a process aimed at increasing acceptance, reliability, and validity among specific Indigenous populations. We present a systematic scoping review to: (1) identify the depression scales that have been culturally adapted for use among Indigenous populations worldwide, (2) globally report on the methods used in the cultural adaptation of those scales, and (3) describe the main features of those cultural adaptation methods. We included articles published from inception to April 2021, including 3 levels of search terms: Psychometrics, Indigenous, and Depression. The search was carried out in the Ovid Medline, PubMed, Embase, Global Health, PsycINFO, and CINAHL databases, following PRISMA guidelines. We identified 34 reports on processes of cultural adaptation that met the criteria. The scales were adapted for use among Indigenous populations from Africa, Australia, Asia, North America, and Latin America. The most common scales that underwent adaptation were the Patient Health Questionnaire (PHQ-9), the Center for Epidemiologic Studies Depression Scale (CES-D), and the Edinburgh Postnatal Depression Scale (EPDS). Methods of adaptation involved a revision of the measures' cultural appropriateness, standard/transcultural translation, revision of the administration process, and inclusion of visual supports. Culturally safe administration of scales was reported in some studies. To come to a consensus on most appropriate methods of improving cultural safety of psychometric measurement, most studies utilized qualitative methods or mixed methods to understand the specific community's needs. Revision of linguistic equivalence and cultural relevance of content, culturally safe administration procedures, qualitative methods, and participatory research were key features of developing safe culturally adapted measures for depressive symptoms among Indigenous populations. While for comparability, uniform scales would be ideal as mental health evaluations, an understanding of the cultural impact of measurements and local depression expressions would benefit the process of developing culturally sensitive psychometric scales. PROSPERO registration ID: CRD42023391439.
Background: Implementing culturally sensitive psychometric measures of depression may be an effec... more Background: Implementing culturally sensitive psychometric measures of depression may be an effective strategy to improve acceptance, response rate, and reliability of psychological assessment among Indigenous populations. However, the psychometric properties of depression scales after cultural adaptation remain unclear. Methods: We screened the Ovid Medline, PubMed, Embase, Global Health, PsycInfo, and CINAHL databases through three levels of search terms: Depression, Psychometrics, and Indigenous, following the PRISMA guidelines. We assessed metrics for reliability (including Cronbach's alpha), validity (including fit indices), and clinical utility (including predictive value). Results: Across 31 studies included the review, 13 different depression scales were adapted through language or content modification. Sample populations included Indigenous from the Americas, Asia, Africa, and Oceania. Most cultural adaptations had strong psychometric properties; however, few and inconsistent properties were reported. Where available, alphas, inter-rater and test-retest reliability, construct validity, and incremental validity often indicated increased cultural sensitivity of adapted scales. There were mixed results for clinical utility, criterion validity, cross-cultural validity, sensitivity, specificity, area under the receiver operating characteristic curve, predictive value, and likelihood ratio. Conclusions: Modifications to increase cultural relevance have the potential to improve fit and acceptance of a scale by the Indigenous population, however, these changes may decrease specificity and negative predictive value. There is an urgent need for suitable tools that are useful and reliable for identifying Indigenous individuals for clinical treatment of depression. This awaits future work for optimal specificity and validated cutoff points that take into account the high prevalence of depression in these populations. Impact statement The present study suggests that modifying depression scales to fit the Indigenous context through changes to language or question structure is a culturally sensitive strategy that increases acceptance of psychological evaluation and treatment in communities. However, increasing acceptability must be balanced with maintaining clinical utility of instruments. The high prevalence of depression in these populations must be taken into account when developing culturally sensitive but specific tools.
Background: Emotion regulation is an ability related to psychological well-being; when dysregulat... more Background: Emotion regulation is an ability related to psychological well-being; when dysregulated, individuals may have psychiatric symptoms and maladapted physiological responses. Virtual reality-assisted cognitive behavioral therapy (VR-CBT) is an effective psychotherapy to target and strengthen emotion regulation; however, it currently lacks cultural sensitivity and can be improved by adapting it to the cultural context of service users. During previous participatory research, we co-designed a culturally adapted cognitive behavioral therapy (CBT) manual and 2 virtual reality (VR) environments to function as a complement to therapy (VR-CBT) for Inuit who would like to access psychotherapy. Emotion regulation skill building will occur in virtual environments that have interactive components such as heart rate biofeedback. Objective: We describe a protocol for a proof-of-concept 2-arm randomized controlled trial (RCT) with Inuit (n=40) in Québec. The primary aims of this research are to investigate the feasibility, benefits, and challenges of the culturally adapted VR-CBT intervention versus an established VR self-management that is available commercially. We will also investigate self-rated mental well-being and objective psychophysiological measures. Finally, we will use proof-of-concept data to identify suitable primary outcome measures, conduct power calculations in a larger trial for efficacy, and collect information about preferences for on-site or at-home treatment. Methods: Trial participants will be randomly assigned to an active condition or active control condition in a 1:1 ratio. Inuit aged 14 to 60 years will receive a culturally adapted and therapist-guided VR-CBT with biofeedback or a VR relaxation program with nonpersonalized guided components over a 10-week period. We will collect pre-and posttreatment measures of emotion regulation and biweekly assessments over the treatment and at 3-month follow-up. The primary outcome will be measured by the Difficulties in Emotion Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological symptoms and well-being via rating scales (eg, anxiety or depressive symptoms).
This paper examines how children and families of diverse ethnic backgrounds perceive, understand ... more This paper examines how children and families of diverse ethnic backgrounds perceive, understand and treat symptoms related to functional gastrointestinal disorders (FGIDs). It is questioned how different ways of dealing with medical uncertainty (symptoms, diagnosis) may influence treatment pathways. Semi-structured interviews were conducted with 43 children of 38 family groups of immigrant and non-immigrant backgrounds. The analysis takes into account (a) the perceived symptoms; (b) the meaning attributed to them; and (c) the actions taken to relieve them. The social and cultural contexts that permeate these symptoms, meanings and actions were also examined. It is found that, in light of diagnostic and therapeutic uncertainty, non-immigrant families are more likely to consult health professionals. Immigrant families more readily rely upon home remedies, family support and, for some, religious beliefs to temper the uncertainty linked to abdominal pain. Furthermore, non-immigrant children lead a greater quest for legitimacy of their pain at home while most immigrant families place stomach aches in the range of normality. Intracultural variations nuance these findings, as well as family dynamics. It is concluded that different courses of action and family dynamics reveal that uncertainty is dealt with in multiple ways. Family support, the network, and trust in a child's expression of distress are key elements in order to tolerate uncertainty. Lastly, the medical encounter is described as a space permeated with relational uncertainty given the different registers of expression inherent within a cosmopolitan milieu. Narrative practices being an essential dynamic of this encounter, it is questioned whether families' voices are equally heard in these clinical spaces.
Le mal de ventre chez les enfants est un lieu de metissage et de creolisation traverse par des di... more Le mal de ventre chez les enfants est un lieu de metissage et de creolisation traverse par des dimensions sociales et culturelles. Il est construit collectivement au sein des familles nucleaires avec leurs parcours migratoires et leurs souffrances. Par le biais d’entretiens menes aupres de familles haitiennes vivant a Montreal, nous documentons les trajectoires de ces douleurs, dans lesquelles les perceptions, les explications et les moyens mis en œuvre pour les soulager interagissent d’une maniere dynamique. En general, les enfants percoivent leurs maux de ventre comme une experience insaisissable, diffuse et ayant un impact sur leur vie sociale, tout en etant toleres par les enfants et par les meres. Ces familles n’ont pas recu de diagnostic medical et elles attribuent a ces maux des explications provisoires en constante recomposition. En general, elles ont recours a differentes methodes de prise en charge des maux de ventre. L’espace familial, les activites realisees au sein des ...
Objective: Aifred is an artificial intelligence (AI)-powered clinical decision support system (CD... more Objective: Aifred is an artificial intelligence (AI)-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician-patient interaction. Methods: Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-hour study at a clinical interaction simulation centre with standardized patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-minute clinical scenarios with standardized patients portraying mild, moderate, and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews, and standardized patient feedback. Results: All twenty participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible fo...
Le mal de ventre chez les enfants est un lieu de métissage et de créolisation traversé par des di... more Le mal de ventre chez les enfants est un lieu de métissage et de créolisation traversé par des dimensions sociales et culturelles. Il est construit collectivement au sein des familles nucléaires avec leurs parcours migratoires et leurs souffrances. Par le biais d’entretiens menés auprès de familles haïtiennes vivant à Montréal, nous documentons les trajectoires de ces douleurs, dans lesquelles les perceptions, les explications et les moyens mis en oeuvre pour les soulager interagissent d’une manière dynamique. En général, les enfants perçoivent leurs maux de ventre comme une expérience insaisissable, diffuse et ayant un impact sur leur vie sociale, tout en étant tolérés par les enfants et par les mères. Ces familles n’ont pas reçu de diagnostic médical et elles attribuent à ces maux des explications provisoires en constante recomposition. En général, elles ont recours à différentes méthodes de prise en charge des maux de ventre. L’espace familial, les activités réalisées au sein des églises et la médecine officielle sont des espaces thérapeutiques privilégiés
Social Psychiatry and Psychiatric Epidemiology, 2021
We present a cultural adaptation of the Growth and Empowerment Measure (GEM) from the Kanien’kehá... more We present a cultural adaptation of the Growth and Empowerment Measure (GEM) from the Kanien’kehá:ka people of Quebec (Canada). Our aim was to develop a culturally competent and safe tool to assess and promote well-being among this population. We followed a qualitative, collaborative, and participatory method that sought to benefit Indigenous participants and communities, while honouring their culture and philosophies. Twelve adults from health and community services of Kahnawà:ke participated in total five focus group meetings. We carried out a thematic analysis of the data collected through an advisory group that led a revision of the cultural and conceptual relevance of the tool and its content. The group integrated socio-culturally relevant elements and restructured the tool so that it reflected local well-being factors and showed its versatility of being an assessment tool and therapeutic support. A narrative and empowerement-driven approach, culturally based intervention, cultural safety and flexibility when using the instrument were considered successful strategies to improve wellness. This project provides valuable information about the perspectives of local Indigenous communities regarding mental health and factors of empowerment. Mutual understanding and integration of psychological and traditional knowledge can create a beneficial program to improve emotional, mental, spiritual, and physical well-being for the local population. It remains to be tested whether the Kanien’kehá:ka Growth and Empowerment Measure (K-GEM) is clinically useful in psychological and psychiatric intervention, and social and community services.
In this article, I examine blood transfusion from the point of view of families of diverse social... more In this article, I examine blood transfusion from the point of view of families of diverse social, national, and economic backgrounds who live in Montreal (Canada), whose children are being transfused. My objective is to explore the experience of receiving a transfusion and the opinions regarding the blood donation system. Based on a qualitative methodology centered on observations, semi-directed interviews, and thematic analysis, I discuss the participants’ perspectives within the framework of critical medical anthropology, and the social and dehumanizing scope of organic tissue treatment systems. Drawing on my fieldwork, I conclude that these families perceive the blood collection system ambivalently. Families have different reactions regarding anonymity, blood restitution, and donor-recipient connections.
Aifred is a clinical decision support system (CDSS) that uses artificial intelligence to assist p... more Aifred is a clinical decision support system (CDSS) that uses artificial intelligence to assist physicians in selecting treatments for major depressive disorder (MDD) by providing probabilities of remission for different treatment options based on patient characteristics. We evaluated the utility of the CDSS as perceived by physicians participating in simulated clinical interactions. Twenty psychiatry and family medicine staff and residents completed a study in which each physician had three 10-minute clinical interactions with standardized patients portraying mild, moderate, and severe episodes of MDD. During these scenarios, physicians were given access to the CDSS, which they could use in their treatment decisions. The perceived utility of the CDSS was assessed through self-report questionnaires, scenario observations, and interviews. 60% of physicians perceived the CDSS to be a useful tool in their treatment-selection process, with family physicians perceiving the greatest utility. Moreover, 50% of physicians would use the tool for all patients with depression, with an additional 35% noting they would reserve the tool for more severe or treatment-resistant patients. Furthermore, clinicians found the tool to be useful in discussing treatment options with patients. The efficacy of this CDSS and its potential to improve treatment outcomes must be further evaluated in clinical trials.
Social Psychiatry and Psychiatric Epidemiology, 2021
Purpose We present a study on selection of a psychometric scale to be clinically used among Indig... more Purpose We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec. Methods We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information. Results The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner. Conclusion This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.
Background
Recently, artificial intelligence-powered devices have been put
forward as potentially... more Background Recently, artificial intelligence-powered devices have been put forward as potentially powerful tools for the improvement of mental healthcare. An important question is how these devices impact the physician-patient interaction. Aims Aifred is an artificial intelligence-powered clinical decision support system (CDSS) for the treatment of major depression. Here, we explore the use of a simulation centre environment in evaluating the usability of Aifred, particularly its impact on the physician–patient interaction. Method Twenty psychiatry and family medicine attending staff and residents were recruited to complete a 2.5-h study at a clinical interaction simulation centre with standardised patients. Each physician had the option of using the CDSS to inform their treatment choice in three 10-min clinical scenarios with standardised patients portraying mild, moderate and severe episodes of major depression. Feasibility and acceptability data were collected through self-report questionnaires, scenario observations, interviews and standardised patient feedback. Results All 20 participants completed the study. Initial results indicate that the tool was acceptable to clinicians and feasible for use during clinical encounters. Clinicians indicated a willingness to use the tool in real clinical practice, a significant degree of trust in the system’s predictions to assist with treatment selection, and reported that the tool helped increase patient understanding of and trust in treatment. The simulation environment allowed for the evaluation of the tool’s impact on the physician–patient interaction. Conclusions The simulation centre allowed for direct observations of clinician use and impact of the tool on the clinician–patient interaction before clinical studies. It may therefore offer a useful and important environment in the early testing of new technological tools. The present results will inform further tool development and clinician training materials.
This thesis provides an anthropological approach to blood transfusion, given that this treatment ... more This thesis provides an anthropological approach to blood transfusion, given that this treatment is considered a social practice that is infused with meanings and values that are inscribed within a cultural environment and the clinic itself. The principle objective of this research is to examine the lived experience of blood transfusions from the point of view of the receivers and the varied meanings they attach to this procedure. The guiding thread of the thesis is the multidimensional and polysemic signification of blood and blood transfusions. We also examine the social connections that are woven or constrained around the procedure in a context of sociocultural diversity. This project sheds a new light on blood transfusion, an essential element of care, and provides new data and innovative insights. This research follows an ethnographic process inspired by medical anthropology, the sociology of health and the anthropology of kinship. The comparison of distinct social worlds is implicitly inscribed in the anthropological approach and consists of an analysis of each particular context chosen (the intensive care unit, the haematology clinic and the oncology centre at Sainte Justine mother and child university hospital center). These contexts are compared with each other in order to deconstruct their similarities and differences. Our research is qualitative and includes three pathways of data collection: 63 semi-structured interviews with patient and family members, 16 interviews with health professionals and ethnographic observations of blood transfusions and interactions between patients, their families and health care professionals. The research data was subjected to a descriptive content analysis. We present the religious, cultural, scientific, moralistic and other connotations of blood and the act of receiving blood. We have examined different elements of families involved and have identified which ones most influence their manner of living with a blood transfusion; for example, the hospital setting, the particularities of the clinical case, socioeconomic status, religious or ethnic identity, the level of education and the relationship between the family and health care professional. We question the manner in how the practice impacts the construction of bioidentity, biosociality, and notions of how the body is constituted by the various actors. We discuss this procedure and its implications on the formation of human identity. At the same time, we analyse how economic and social conditions colour the meanings attached to this treatment and how it is perceived. We show that not all of blood transfusions are experienced in the same way. Although, different elements come into play at this level, the hospital context where these practices take place and the quality of the family-health care professional relationships seem to exert the greatest influence. The families’ knowledge of the blood transfusion and the issues linked to informed consent are also discussed in the framework of divergences and convergences between expert knowledge and layperson knowledge. Finally, we explore attitudes toward anonymous donation, donation from a known donor and the system of collection and treatment of blood. The perspectives of participants are discussed in the framework of critical medical anthropology in relation to the pharmaceutical industry and the bioindustry of organic matter. We also discuss the social significance of these systems and their dehumanizing character.
La transfusion de sang est un élément essentiel des soins et contribue à sauver de nombreuses vie... more La transfusion de sang est un élément essentiel des soins et contribue à sauver de nombreuses vies (OMS, 2014). Elle peut toutefois soulever des questions d’ordre éthique et religieuse (Kleinman, 1994 ; Muramoto, 2001), questions peu traitées dans les écrits scientifiques. En réponse à cette lacune, nous avons consacré notre recherche en anthropologie à la perspective des enfants, de leurs familles et des soignants sur les usages thérapeutiques du sang. Notre recherche qualitative a été menée dans deux unités de soins du centre hospitalier universitaire Sainte-Justine. Parmi les principaux résultats, nous avons documenté une grande diversité de représentations et de perspectives religieuses à l’égard du sang et de son transfert. Malgré quelques réticences initiales, les personnes acceptent généralement la transfusion. Également, nous avons constaté que le sang a une charge émotionnelle importante pour les gens et qu’il est conçu d’une manière ambiguë (mélange entre des notions scientifiques et religieuses). Les soignants méconnaissent l’importance symbolique du sang pour les familles, ces dernières les passant généralement sous silence. Enfin, la question de l’anonymat du donneur demeure importante pour la majorité des gens. Cette situation est aussi méconnue des médecins. Les résultats de notre recherche contribuent aux connaissances en médecine transfusionnelle et à l’amélioration de la pratique transfusionnelle au profit des receveurs. Il s’agit d’une recherche originale en anthropologie de la santé, dont les résultats permettent d’avoir une meilleure appréciation des aspects socioculturels entourant la transfusion du point de vue des petits patients et de leur famille.
The fluidity and unruliness of diagnostic processes: Time, space and emotions, 2018
Stemming from a study with families of migrant & non-migrant backgrounds in Montréal on children’... more Stemming from a study with families of migrant & non-migrant backgrounds in Montréal on children’s stomach pains, this paper questions how ways of dealing with medical uncertainty has bearing on pathways to care. These pathways are enacted within and beyond the family space as well as in medical settings. While acknowledging that group practices call for nuance, non-migrant children lead a greater quest for legitimacy of their pain while most migrant families place stomach aches in the range of normality.
Le mal de ventre chez les enfants est un lieu de métissage et de créolisation traversé par des di... more Le mal de ventre chez les enfants est un lieu de métissage et de créolisation traversé par des dimensions sociales et culturelles. Il est construit collectivement au sein des familles nucléaires avec leurs parcours migratoires et leurs souffrances. Par le biais d’entretiens menés auprès de familles haïtiennes vivant à Montréal, nous documentons les trajectoires de ces douleurs, dans lesquelles les perceptions, les explications et les moyens mis en oeuvre pour les soulager interagissent d’une manière dynamique. En général, les enfants perçoivent leurs maux de ventre comme une expérience insaisissable, diffuse et ayant un impact sur leur vie sociale, tout en étant tolérés par les enfants et par les mères. Ces familles n’ont pas reçu de diagnostic médical et elles attribuent à ces maux des explications provisoires en constante recomposition. En général, elles ont recours à différentes méthodes de prise en charge des maux de ventre. L’espace familial, les activités réalisées au sein des églises et la médecine officielle sont des espaces thérapeutiques privilégiés
El presente libro es el resultado de un riguroso trabajo sobre las medicinas alternativas y popul... more El presente libro es el resultado de un riguroso trabajo sobre las medicinas alternativas y populares tal como ellas se practican en una ciudad cosmpolita como lo es la Bogotá (Colombia) de comienzos del siglo XXI. El análisis de estos procesos socio-culturales, es hecho a través de una lectura socio-antropológica que tiene en cuenta las dinámicas globales-locales y el marco social dentro de la cual se inscriben estas prácticas. Así mismo, una perspectiva antropológica del cuerpo y de las emociones, y una mirada de las relaciones históricas y biopolíticas entre los diferentes saberes sobre el cuerpo bonifican el tratamiento del tema. La autora nos invita a viajar a través de los itinerarios terapéuticos de experimentados especialistas en terapias alternativas y en medicinas populares. Así mismo, los relatos de sus pacientes, mujeres y hombres de carne y hueso, nos llevan a descubrir como se entretejen los procesos de salud y enfermedad junto con su vida familiar y la realidad social de la que forman parte. Este trabajo es un aporte significativo a la etnografía y al análisis crítico de los saberes alternativos, escrito en un lenguaje accesible y agradable.
La transfusion de sang est un élément essentiel des soins et contribue à sauver de nombreuses vie... more La transfusion de sang est un élément essentiel des soins et contribue à sauver de nombreuses vies (OMS 2012). Par contre, les transfusions posent des problèmes d'ordre éthique, moral et religieux (Kleinman 1994, Muramoto 2001, Meyer 2006, Schwarz 2009) qui demeurent rarement abordés par la littérature scientifique. En réponse à cette lacune, nous avons consacré notre recherche doctorale en anthropologie aux perspectives des enfants et de leur famille sur l'utilisation thérapeutique du sang. Notre recherche qualitative (observations et entretiens en profondeur) a été menée auprès des patients, leurs proches et des soignants de deux unités cliniques de l'hôpital pédiatrique CHU Sainte-Justine à Montréal.. Nous avons documenté les représentations du sang et de sa transfusion par le vécu des enfants et de leur famille. Parmi les principaux résultats, nous avons constaté une diversité et une ambigüité d'idées entourant le sang chez les receveurs/bénéficiaires des transfusions sanguines. Nous avons également constaté une méconnaissance des dimensions symboliques du sang chez les soignants qui pratiquent la médecine transfusionnelle. Ces derniers sont souvent incapables d'identifier les raisons des hésitations des patients vis-à-vis la transfusion, par-delà la résistance « classique » des Témoins de Jéhovah à cet égard. Nous avons aussi documenté les différentes perspectives quant à la question de l'anonymat des dons de sang et les principaux motifs qui sont à la base de privilégier, ou non, un donateur connu ou inconnu. Les types de liens noués, ou qui peuvent se développer entre les individus qui se trouvent aux deux extrémités de l'échange de sang ainsi que la portée sociale du système de collecte de sang sont autant de questions que ressortent de notre enquête.
L’administration d’un des composants du sang constitue un élément essentiel des soins aux patient... more L’administration d’un des composants du sang constitue un élément essentiel des soins aux patients et contribue à sauver de nombreuses vies (OMS 2009). Cependant, la transfusion est une biotechnologie qui intervient non seulement sur le plan de la santé des gens, mais aussi sur la construction de leurs identités ainsi que sur leurs relations cliniques et sociales. Elle pose également des problèmes d’ordre éthique et légal. Peu de chercheurs s’intéressent au point de vue des receveurs de sang et de leurs proches. La plupart des études portent sur les systèmes de collecte de sang et sur la prévention de risques d’infection. Le but de cette communication est de présenter les résultats préliminaires de mon projet de recherche doctorale en anthropologie, lequel vise à approfondir la perspective de patient(e)s et de leurs proches par rapport à la transfusion de sang. D’abord, je situe la problématique et les objectifs. Puis, je présente quelques pistes soulevées par une étude pilote menée dans un hôpital pédiatrique à Montréal, basée sur des entrevues en profondeur auprès de 23 patients et leurs parents. Ces résultats ouvrent de voies qui permettent de mieux comprendre le vécu transfusionnel et apportent une information précieuse pour les médecins en ce qui concerne les aspects culturels et sociaux de la transfusion.
"La transfusión sanguínea es una tecnología médica que se inscribe dentro de un marco social ampl... more "La transfusión sanguínea es una tecnología médica que se inscribe dentro de un marco social amplio, caracterizado por la coexistencia de diferentes valores e identidades socio-culturales.Es empleada en numerosos contextos clínicos y en el tratamiento de enfermedades de la sangre, que tienen repercusiones importantes sobre la vida de las personas.Sin embargo,también conlleva problemas éticos y tiene implicaciones sobre las representaciones del cuerpo, sobre la identidad de los individuos y sobre los imaginarios (Faure y Romero 1994). A pesar de ello, el punto de vista de las personas que reciben transfusiones ha sido poco estudiado desde una perspectiva socio-antropológica. Esta ausencia llama la atención si tenemos en cuenta que la sangre tiene una riqueza simbólica importante dentro de los diferentes grupos humanos. Precisamente, mi proyecto de investigación doctoral responde a la escasez de investigaciones socio-antropológicas sobre la transfusión y al interés que algunos profesionales de la salud tienen de conocer el punto de vista de los pacientes (y su entorno) con respecto de este procedimiento.
La metodología es cualitativa y se basa en entrevistas semi-estructuradas, observaciones y estudios de caso. La población está conformada por pacientes que han recibido mínimo una transfusión sanguínea, sus familiares y los profesionales de la salud implicados. El grupo de pacientes se divide en dos sub-grupos : un sub-grupo afectado por condiciones de salud crónicas que ha recibido varias transfusiones; y el segundo grupo afectado por condiciones de salud agudas que ha recibido la transfusión dentro en un contexto de corta duración. Los profesionales de salud son médicos hematólogos, enfermeras, un psicólogo y/o trabajador social. El trabajo de campo se desarrolla en el CHU Sainte-Justine con la colaboración del GRTS ("Grupo de investigación sobre la transfusión sanguínea"), el cual es financiado por el FRSQ ("Fondo de investigación sobre la salud de Quebec). El estudio piloto previo a esta investigación se basó en una metodología cualitativa (entrevistas en profundidad a 23 pacientes y sus parientes) y se llevó a cabo en dos unidades clínicas del mismo hospital pediátrico en Montreal.
El análisis de la información es temático. En primer lugar, un análisis individual de cada entrevista. Posteriormente, un análisis intra-grupo para tener un panorama general de cada uno de los grupos. Finalmente, un análisis inter-grupo para comparar las familias de cada unidad clínica. Este último nivel de análisis permite poner en perspectiva la dimensión temporal, sobre la cual se desarrolla la trayectoria terapéutica, para observar sus efectos sobre la manera de vivir la transfusión, sobre la identidad y sobre la representación del cuerpo.
Varias constataciones resultaron del estudio piloto realizado, entre las cuales mencionamos las más significativas. Existe una importante ambigüedad de ideas asociadas a la sangre y su transfusión. Para algunas personas, este procedimiento se ha vuelto algo « natural », mientras que para otras esta concepción constituye una banalización de la sangre. También hay ambigüedad con respecto de la propiedad de la sangre, ya que se constata la existencia de ideas transmitidas por las compañías que tratan la sangre junto con distintas nociones religiosas. Por otro lado, algunas personas manifestaron preocupaciones frente al hecho de recibir sangre de alguien que no comparte sus convicciones religiosas.
Los resultados de esta investigación contribuyen a los conocimientos en medicina transfusional y se dirigen a mejorar la transfusión sanguínea para el beneficio de las personas que la reciben. Ellos permitirán tener una mejor apreciación de los aspectos socio-culturales de la transfusión sanguínea y del punto de vista de las personas que reciben transfusiones. Compartiremos estos resultados en reuniones de trabajo en contexto clínico, utilizando « casos típicos » que sirvan para ilustrar la(s) realidad(es) vivida(s) por las personas concernidas. Por otro lado, el trabajo etnográfico dentro de las instituciones de salud nos permite observar los valores y la sociedad en las cuales se sitúa la clínica. La etnografía nos ayuda a tener una mejor comprensión del impacto que las tecnologías médicas tienen sobre las distintas poblaciones y personas, sobre su vida cotidiana, sus valores y sobre vivencias.
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Dans cette présentation, j’ai voulu partager mon projet de recherche doctorale en anthropologie e... more Dans cette présentation, j’ai voulu partager mon projet de recherche doctorale en anthropologie et quelques résultats préliminaires d’une étude pilote qui le précède. Il porte sur les technologies médicales, plus spécifiquement sur la transfusion sanguine, et sur les implications que celles-ci a dans un contexte clinique caractérisé par la diversité des patients. Ce projet répond à la fois à la pénurie de recherches socio-anthropologiques qui traitent de la transfusion de sang et aux intérêts des médecins par rapport à la perspective des patients et de leurs proches vis-à-vis de cette procédure. Également, ce projet rejoint les idées de plusieurs chercheurs en sciences sociales quant à la complexité que représente cette procédure sociale et clinique, complexité qui s’exprime en termes éthiques, politiques et économiques.
Kalpana DAS est accompagnée de Roy DUPUIS pour nous faire découvrir l'héritage d'un organisme qui... more Kalpana DAS est accompagnée de Roy DUPUIS pour nous faire découvrir l'héritage d'un organisme qui travailla durant près d'un demi-siècle à favoriser une meilleure compréhension du pluralisme. UNE TERRE 1001 MONDES nous entraine dans un grand voyage vers l'autre, sur la route de l'Institut Interculturel de Montréal. Bienvenus à tous! Suite à la fermeture de l'organisme en 2012, des collaborateurs ont été invités à venir partager leur expérience personnelle afin de mettre en valeur les fruits du travail accompli. L'aspect résolument avant-gardiste des réflexions qui ont émergé de ce regroupement de penseurs depuis le début des années 60, devient manifeste alors que plusieurs d'entre elles demeurent d'actualité. En phase avec chaque époque, l'Institut Interculturel de Montréal (IIM) organise diverses activités dans le but de favoriser le dialogue interculturel en créant des espaces de rencontre : séminaires, conférences, ateliers de formation et activités culturelles. Dans la nature, la biodiversité est reconnue comme une caractéristique inhérente à la vie sur terre. Alors pourquoi en serait-il autrement avec la diversité culturelle pour la vie humaine? À partir de cette prémisse, notre regard se porte sur le Québec; une société confrontée à plusieurs questionnements sur les rapports entre les peuples, en commençant par les relations avec les Premières Nations, les relations entre anglophones et francophones, la laïcité de l'état et les accommodements raisonnables; la liste est longue. Tant à l'échelle locale qu'internationale, les sociétés modernes se dirigent inexorablement vers le pluralisme. Plus que jamais, il est essentiel de poursuivre la réflexion sur notre rapport à l'autre.
Background: Emotion regulation is an ability related to psychological well-being; when dysregulat... more Background: Emotion regulation is an ability related to psychological well-being; when dysregulated, individuals may have psychiatric symptoms and maladapted physiological responses. Cognitive behavioural therapy combined with virtual reality (VRCBT or CBT-VR) is an effective psychotherapy to target and strengthen emotion regulation, but currently lacks cultural sensitivity and could be improved by adapting it to the cultural context of service users. Objective: We describe a protocol for a proof-of-concept two-arm randomized controlled trial (RCT) with n=40 Inuit in Quebec. Methods: In a ten-week intervention, Inuit aged 14-60 will receive a culturally adapted VR-CBT with biofeedback or selfguided VR relaxation program. The trial will assess emotion regulation with objective and subjective measures at baseline, throughout and after the treatment and at a 3-month follow-up. The primary outcome is measured by the Difficulties in Emotion Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological symptoms and wellbeing via rating scales. Results: NA Conclusions: The proposed study responds to community desire for accessible and appropriate resources for psychological wellbeing, as it was developed in active collaboration with the Inuit community in Quebec. We compare a culturally adapted psychotherapy to a commercial self-management program, incorporate novel technology and measurement, and fulfill needs for RCT evidence of culturally adapted psychotherapies.
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thematic analysis, I discuss the participants’ perspectives within the framework of critical medical anthropology, and the social and dehumanizing scope of organic tissue treatment systems. Drawing on my fieldwork, I conclude that these families perceive the blood collection system ambivalently. Families have different reactions regarding anonymity, blood restitution, and donor-recipient connections.
Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec.
Methods We selected three depression scales and three protective factor scales based on: strong validity for psychometric
properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity,
and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of
Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory
committees, and carried out a thematic analysis of the information.
Results The advisory groups considered the measurement scales to be unsafe. The major components that hindered their
acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive
factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They
voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person
and the practitioner.
Conclusion This project provides valuable information about the perspectives of local Indigenous peoples regarding mental
health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as
compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could
be used in psychological and psychiatric intervention as well as in social and community services.
Recently, artificial intelligence-powered devices have been put
forward as potentially powerful tools for the improvement of
mental healthcare. An important question is how these devices
impact the physician-patient interaction.
Aims
Aifred is an artificial intelligence-powered clinical decision support
system (CDSS) for the treatment of major depression. Here,
we explore the use of a simulation centre environment in
evaluating the usability of Aifred, particularly its impact on the
physician–patient interaction.
Method
Twenty psychiatry and family medicine attending staff and residents
were recruited to complete a 2.5-h study at a clinical
interaction simulation centre with standardised patients. Each
physician had the option of using the CDSS to inform their
treatment choice in three 10-min clinical scenarios with standardised
patients portraying mild, moderate and severe episodes
of major depression. Feasibility and acceptability data
were collected through self-report questionnaires, scenario
observations, interviews and standardised patient feedback.
Results
All 20 participants completed the study. Initial results indicate
that the tool was acceptable to clinicians and feasible for use
during clinical encounters. Clinicians indicated a willingness to
use the tool in real clinical practice, a significant degree of trust in
the system’s predictions to assist with treatment selection, and
reported that the tool helped increase patient understanding of
and trust in treatment. The simulation environment allowed for
the evaluation of the tool’s impact on the physician–patient
interaction.
Conclusions
The simulation centre allowed for direct observations of clinician
use and impact of the tool on the clinician–patient interaction
before clinical studies. It may therefore offer a useful and
important environment in the early testing of new technological
tools. The present results will inform further tool development
and clinician training materials.
This research follows an ethnographic process inspired by medical anthropology, the sociology of health and the anthropology of kinship. The comparison of distinct social worlds is implicitly inscribed in the anthropological approach and consists of an analysis of each particular context chosen (the intensive care unit, the haematology clinic and the oncology centre at Sainte Justine mother and child university hospital center). These contexts are compared with each other in order to deconstruct their similarities and differences. Our research is qualitative and includes three pathways of data collection: 63 semi-structured interviews with patient and family members, 16 interviews with health professionals and ethnographic observations of blood transfusions and interactions between patients, their families and health care professionals. The research data was subjected to a descriptive content analysis.
We present the religious, cultural, scientific, moralistic and other connotations of blood and the act of receiving blood. We have examined different elements of families involved and have identified which ones most influence their manner of living with a blood transfusion; for example, the hospital setting, the particularities of the clinical case, socioeconomic status, religious or ethnic identity, the level of education and the relationship between the family and health care professional. We question the manner in how the practice impacts the construction of bioidentity, biosociality, and notions of how the body is constituted by the various actors. We discuss this procedure and its implications on the formation of human identity. At the same time, we analyse how economic and social conditions colour the meanings attached to this treatment and how it is perceived.
We show that not all of blood transfusions are experienced in the same way. Although, different elements come into play at this level, the hospital context where these practices take place and the quality of the family-health care professional relationships seem to exert the greatest influence. The families’ knowledge of the blood transfusion and the issues linked to informed consent are also discussed in the framework of divergences and convergences between expert knowledge and layperson knowledge. Finally, we explore attitudes toward anonymous donation, donation from a known donor and the system of collection and treatment of blood. The perspectives of participants are discussed in the framework of critical medical anthropology in relation to the pharmaceutical industry and the bioindustry of organic matter. We also discuss the social significance of these systems and their dehumanizing character.
thematic analysis, I discuss the participants’ perspectives within the framework of critical medical anthropology, and the social and dehumanizing scope of organic tissue treatment systems. Drawing on my fieldwork, I conclude that these families perceive the blood collection system ambivalently. Families have different reactions regarding anonymity, blood restitution, and donor-recipient connections.
Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec.
Methods We selected three depression scales and three protective factor scales based on: strong validity for psychometric
properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity,
and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of
Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory
committees, and carried out a thematic analysis of the information.
Results The advisory groups considered the measurement scales to be unsafe. The major components that hindered their
acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive
factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They
voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person
and the practitioner.
Conclusion This project provides valuable information about the perspectives of local Indigenous peoples regarding mental
health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as
compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could
be used in psychological and psychiatric intervention as well as in social and community services.
Recently, artificial intelligence-powered devices have been put
forward as potentially powerful tools for the improvement of
mental healthcare. An important question is how these devices
impact the physician-patient interaction.
Aims
Aifred is an artificial intelligence-powered clinical decision support
system (CDSS) for the treatment of major depression. Here,
we explore the use of a simulation centre environment in
evaluating the usability of Aifred, particularly its impact on the
physician–patient interaction.
Method
Twenty psychiatry and family medicine attending staff and residents
were recruited to complete a 2.5-h study at a clinical
interaction simulation centre with standardised patients. Each
physician had the option of using the CDSS to inform their
treatment choice in three 10-min clinical scenarios with standardised
patients portraying mild, moderate and severe episodes
of major depression. Feasibility and acceptability data
were collected through self-report questionnaires, scenario
observations, interviews and standardised patient feedback.
Results
All 20 participants completed the study. Initial results indicate
that the tool was acceptable to clinicians and feasible for use
during clinical encounters. Clinicians indicated a willingness to
use the tool in real clinical practice, a significant degree of trust in
the system’s predictions to assist with treatment selection, and
reported that the tool helped increase patient understanding of
and trust in treatment. The simulation environment allowed for
the evaluation of the tool’s impact on the physician–patient
interaction.
Conclusions
The simulation centre allowed for direct observations of clinician
use and impact of the tool on the clinician–patient interaction
before clinical studies. It may therefore offer a useful and
important environment in the early testing of new technological
tools. The present results will inform further tool development
and clinician training materials.
This research follows an ethnographic process inspired by medical anthropology, the sociology of health and the anthropology of kinship. The comparison of distinct social worlds is implicitly inscribed in the anthropological approach and consists of an analysis of each particular context chosen (the intensive care unit, the haematology clinic and the oncology centre at Sainte Justine mother and child university hospital center). These contexts are compared with each other in order to deconstruct their similarities and differences. Our research is qualitative and includes three pathways of data collection: 63 semi-structured interviews with patient and family members, 16 interviews with health professionals and ethnographic observations of blood transfusions and interactions between patients, their families and health care professionals. The research data was subjected to a descriptive content analysis.
We present the religious, cultural, scientific, moralistic and other connotations of blood and the act of receiving blood. We have examined different elements of families involved and have identified which ones most influence their manner of living with a blood transfusion; for example, the hospital setting, the particularities of the clinical case, socioeconomic status, religious or ethnic identity, the level of education and the relationship between the family and health care professional. We question the manner in how the practice impacts the construction of bioidentity, biosociality, and notions of how the body is constituted by the various actors. We discuss this procedure and its implications on the formation of human identity. At the same time, we analyse how economic and social conditions colour the meanings attached to this treatment and how it is perceived.
We show that not all of blood transfusions are experienced in the same way. Although, different elements come into play at this level, the hospital context where these practices take place and the quality of the family-health care professional relationships seem to exert the greatest influence. The families’ knowledge of the blood transfusion and the issues linked to informed consent are also discussed in the framework of divergences and convergences between expert knowledge and layperson knowledge. Finally, we explore attitudes toward anonymous donation, donation from a known donor and the system of collection and treatment of blood. The perspectives of participants are discussed in the framework of critical medical anthropology in relation to the pharmaceutical industry and the bioindustry of organic matter. We also discuss the social significance of these systems and their dehumanizing character.
La metodología es cualitativa y se basa en entrevistas semi-estructuradas, observaciones y estudios de caso. La población está conformada por pacientes que han recibido mínimo una transfusión sanguínea, sus familiares y los profesionales de la salud implicados. El grupo de pacientes se divide en dos sub-grupos : un sub-grupo afectado por condiciones de salud crónicas que ha recibido varias transfusiones; y el segundo grupo afectado por condiciones de salud agudas que ha recibido la transfusión dentro en un contexto de corta duración. Los profesionales de salud son médicos hematólogos, enfermeras, un psicólogo y/o trabajador social. El trabajo de campo se desarrolla en el CHU Sainte-Justine con la colaboración del GRTS ("Grupo de investigación sobre la transfusión sanguínea"), el cual es financiado por el FRSQ ("Fondo de investigación sobre la salud de Quebec). El estudio piloto previo a esta investigación se basó en una metodología cualitativa (entrevistas en profundidad a 23 pacientes y sus parientes) y se llevó a cabo en dos unidades clínicas del mismo hospital pediátrico en Montreal.
El análisis de la información es temático. En primer lugar, un análisis individual de cada entrevista. Posteriormente, un análisis intra-grupo para tener un panorama general de cada uno de los grupos. Finalmente, un análisis inter-grupo para comparar las familias de cada unidad clínica. Este último nivel de análisis permite poner en perspectiva la dimensión temporal, sobre la cual se desarrolla la trayectoria terapéutica, para observar sus efectos sobre la manera de vivir la transfusión, sobre la identidad y sobre la representación del cuerpo.
Varias constataciones resultaron del estudio piloto realizado, entre las cuales mencionamos las más significativas. Existe una importante ambigüedad de ideas asociadas a la sangre y su transfusión. Para algunas personas, este procedimiento se ha vuelto algo « natural », mientras que para otras esta concepción constituye una banalización de la sangre. También hay ambigüedad con respecto de la propiedad de la sangre, ya que se constata la existencia de ideas transmitidas por las compañías que tratan la sangre junto con distintas nociones religiosas. Por otro lado, algunas personas manifestaron preocupaciones frente al hecho de recibir sangre de alguien que no comparte sus convicciones religiosas.
Los resultados de esta investigación contribuyen a los conocimientos en medicina transfusional y se dirigen a mejorar la transfusión sanguínea para el beneficio de las personas que la reciben. Ellos permitirán tener una mejor apreciación de los aspectos socio-culturales de la transfusión sanguínea y del punto de vista de las personas que reciben transfusiones. Compartiremos estos resultados en reuniones de trabajo en contexto clínico, utilizando « casos típicos » que sirvan para ilustrar la(s) realidad(es) vivida(s) por las personas concernidas. Por otro lado, el trabajo etnográfico dentro de las instituciones de salud nos permite observar los valores y la sociedad en las cuales se sitúa la clínica. La etnografía nos ayuda a tener una mejor comprensión del impacto que las tecnologías médicas tienen sobre las distintas poblaciones y personas, sobre su vida cotidiana, sus valores y sobre vivencias.
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psychiatric symptoms and maladapted physiological responses. Cognitive behavioural therapy combined with virtual reality (VRCBT or CBT-VR) is an effective psychotherapy to target and strengthen emotion regulation, but currently lacks cultural
sensitivity and could be improved by adapting it to the cultural context of service users.
Objective: We describe a protocol for a proof-of-concept two-arm randomized controlled trial (RCT) with n=40 Inuit in Quebec.
Methods: In a ten-week intervention, Inuit aged 14-60 will receive a culturally adapted VR-CBT with biofeedback or selfguided VR relaxation program. The trial will assess emotion regulation with objective and subjective measures at baseline,
throughout and after the treatment and at a 3-month follow-up. The primary outcome is measured by the Difficulties in Emotion
Regulation Scale (DERS-16) and a novel psychophysiological reactivity paradigm. Secondary measures include psychological
symptoms and wellbeing via rating scales.
Results: NA
Conclusions: The proposed study responds to community desire for accessible and appropriate resources for psychological wellbeing, as it was developed in active collaboration with the Inuit community in Quebec. We compare a culturally adapted
psychotherapy to a commercial self-management program, incorporate novel technology and measurement, and fulfill needs for
RCT evidence of culturally adapted psychotherapies.