Culture, ethnicity and health

Research on culture, ethnicity, and health literacy focuses on socio-cultural determinants of health, aiming to address health disparities and inequalities in accessing needed health information and care services among patient groups from ethnic minority and low socio-economic status cohorts.

The main aim of our research projects is to contribute to the body of knowledge on cultural competence, health literacy, and community engagement.

Objectives: Our research team provides a forum for basic and applied population health research on relationships among ethnicity, culture, socioeconomic status, and health literacy. We endeavour to develop new interdisciplinary frameworks for understanding these relationships in patient communities with chronic respiratory diseases while promoting effective collaborations among health and academic sectors, health providers, healthcare decision makers, and the community.

The core foundation of our research is built on:

  1. Patient engagement as research partners from the beginning of study design
  2. Patient-oriented health outcome(s)
  3. Involvement of young and junior scholars from the target communities in research to facilitate our connection to the community and receive training on becoming change agents to lead future research in their own communities.

Our research is organized into five Streams:

  • Culturally and linguistically appropriate educational interventions
  • Health and ethnic relations: social, cultural and behavioural perspectives
  • Patient engagement and community empowerment
  • Conceptualizing health literacy in chronic disease management
  • Digital health and disease outcomes

Current research:

Application of health literacy concepts in asthma and COPD self-management practices in ethnic minority groups:

PI (Lead researcher): Mark FitzGerald. Co-investigators: Iraj Poureslami, Stephen Lam, Susan Kwan, Nadia Khan. Research Staff: Jessica Shum, Michele Shum, Jing Liu, Vahid Mehrnoosh, Nikki Najafi, Marion Santos, John Lee

We have successfully launched intervention research projects to fully engage patients and family caregivers from ethno-cultural communities in designing, developing and evaluation of educational materials (in video and written format) related to chronic respiratory disease management. Our aim was to facilitate patients’ access the linguistically and culturally appropriate information that is developed in patient-friendly language and is relevant to their routine disease management practices. The anticipated outcomes were the empowered patients who were informed about their disease and how to manage it. Patients’ and caregivers’ viewpoints were applied in the development of intervention design and procedures. The results of this intervention demonstrated that culturally and linguistically appropriate educational interventions designed specifically to meet the needs of patients were associated with significantly better understanding of self-management practices, which led to improved proper use of medications and self-efficacy to manage exacerbation.

Application of Telehealth in asthma self-management:

PI (Lead researcher): Mark FitzGerald. Co-investigators: Iraj Poureslami, Rich Lester, Mohsen Sadatsafavi, Delbert Dorscheid. Research Staff: Jessica Shum, Selva Bayat, Nelson Gorrin

We undertook a clinical trial of assessing the effectiveness of electronic asthma action plans (eAAP) supported by automated text messaging service (SMS) versus written asthma action plans (AAP) on asthma control improvement. Our intervention delivered a tailored care service that was acceptable to our patients. We demonstrated the feasibility of Telehealth intervention in promoting asthma self-management. Improvements were noticed among the intervention group when the Telehealth approach was added to the current standard of care, including fewer exacerbations and more improvement in Asthma control and Quality of life.

Development of functional health literacy measurement tools for asthma and COPD management:

PIs (Lead researchers): Mark FitzGerald and Jacek Kopec. Co-investigators: Iraj Poureslami, Rick Sawatzky, Laura Nimmon, Iriving Rootman, Nadia Khan, Delbert Dorscheid, Wan Tan. Research Staff: Jessica Shum, Selva Bayat, Roya Hakami, Nilou Aron, Iris van der Heide, Darrin Wiebe.

Currently, our program is undergoing a 5-year nationwide study aiming to develop a Canadian version functional/skill-based measurement tool to properly assess the health literacy (defined as being able to access, understand, evaluate, communicate, and use health information to make informed decisions) of asthma and COPD patients. Focus groups and interviews were conducted with patients, healthcare professionals, researchers, and policymakers to determine the potential topics of self-management practices as well as domains of health literacy that could be applied in the tool. A preliminary draft of the measurement tool was then developed and pretested with the patient community and a new group of experts for difficulty, clarity, and relevancy. The tool was then revised and is currently being pilot tested with 500 asthma and COPD patients across Canada. We anticipate that the final measurement tool will be adequately capture the deficiencies and gaps in patients’ health literacy and self-management practices, ultimately enabling researchers and clinicians to identify and develop the appropriate interventions addressing these issues. 

Application of culturally and linguistically appropriate smoking cessation consultations on quit smoking practice:

PI (Lead researcher): Iraj Poureslami. Co-investigators: Mark FitzGerald and Milan Khara. Research Staff: Jenny Ip, Liping Liang, Marcus Woo.

We initiated a study on smoking cessation targeting current adult smokers from Mandarin, Cantonese and English-speaking communities.  The aim of this study is to empower smokers from the targeted communities to change their smoking habits and apply behavioural modification strategies in helping them live a smoke-free life.  The consultation procedure involves applying comprehensive behavioral therapy consultations and engaging the smoker and a family member/friend in the process, developing individualized action plans for each participant base on their needs and smoking patterns, and engaging community leaders to advocate and promote smoke-free environment.  Case-by-case team consultation approach will also be used in devising the initial action plans and further modifications in the consultation procedures that would be relevant to each participant’s personal and cultural needs.

Creating change agents to exercise cultural competency and apply health literacy in their research and practice:

Research Team: Iraj Poureslami and Mark FitzGerald.

Health agencies in Canada have recommended training early-career health researchers and practitioners (Scholars) in terms of properly communicating with patients/clients, actively involving patient and family members in self-management practices, and properly assessing and improving the health literacy of patients. The aim of this project is to improve Scholars’ understanding of the effect of low health literacy skills and socio-cultural issues on health outcomes and adopt the knowledge and understanding in their research and clinical practice. The outcome of such a competency would be empowered scholars who recognize and respond appropriately to their clients’ needs by providing related information and services. In this research, we endeavour to train young and motivated scholars to work with community members from diverse cultural backgrounds with chronic respiratory disease, to foster competence in handling cultural issues, to raise awareness of health literacy, and to engage patients and family caregivers in decision making and disease management process. The goal of this project is to develop a model for creating change agents that will support increased health literacy and improved health outcomes for people living with chronic respiratory diseases.

For further information, please contact Iraj Poureslami or Jessica Shum.