Kendall Ho

Background: Canada’s culturally diverse populations (CDPs) experience difficulties such as language barriers, difficulty navigating the healthcare system, and lack of culturally tailored resources compared to the general population when accessing mental health services. These surmountable barriers may be addressed by e-mental health (eMH) technologies that allow for mental healthcare to be delivered through the Internet and related technologies. However, little attention has been devoted to understanding the cultural responsiveness of these services among CDPs. Objectives: This study investigates the use of eMH among CDPs for anxiety and depressive disorders in an urban area. Our objectives are to (1) explore the experience of eMH services and gauge their cultural responsiveness, (2) examine participants’ digital health literacy, mental health status, and usage of eMH; and (3) develop recommendations based on participants’ experiences to improve eMH services. Methods: Participants (N=136) completed a survey regarding their eMH use, the severity of their depression and anxiety symptoms, and socio-demographic characteristics. Participants (N=14) shared experiences through semi-structured focus group discussions. From this, we developed a set of guidelines based on the experiences and recommendations from participants for future eMH resources. Participants (N=5) were invited to provide feedback through one-on-one interviews. Results: Survey participants’ ages ranged from 19 to 74 years, with 43% within young adult ages of 19 to 24. Of these participants, 65% were women, 22% were men, while 3% identified as Trans Male, Non-Binary, or Other. Most survey participants identified as South Asian (40%) or Chinese (28%). The majority of participants (68%) indicated that the eMH resources they used, overall, were not culturally tailored. However, most participants (65%) agreed that the resource was available in their preferred language. Focus group discussions revealed themes of facilitators and barriers of help-seeking behaviours and sociocultural contexts. eMH recommendations suggested by participants’ responses focused on including culturally tailored content, graphics and phrases, and lived experiences of CDPs while reducing culturally linked stigma. Conclusion: The findings showcase the need for more culturally responsive eMH beyond language translation, while providing healthcare professionals with a greater and nuanced understanding of treatment needs in cultural groups.

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Clinical Practice Guidelines (CPGs) guide optimal utilization of clinical delivery of health care through evidence-based medicine, where care procedures are rigorously evaluated and improved through the examination of evidence. Care mapping is the technique of using flowcharts to graphically capture CPGs as discrete, actionable steps. Health professionals can create and use care maps to expedite and ensure excellence in optimal process workflow in patient care. Analysis of care maps would provide insight into similarities and differences in care procedures. However, quantitative analysis of care maps is difficult to perform manually, and becomes impossible as the set of care maps for comparison increases. Computational methods could be employed to obtain the required quantitative data, but current document standards for developing, sharing and visualizing care maps are not rigorous enough for computational analysis to take place. By using Bioinformatics approaches, we can solve these problems. Firstly, we can develop a standard care map file format for electronic storage. Systems Biology Markup Language (SBML), a document format used to describe biological pathways, can be used to develop the required file format. This method works because care maps are notionally very similar to biological pathways. It allows use of multiple alignment algorithms (traditionally used to align and cluster biological pathways) with these transformed care maps in order to derive quantitative data.This project involved the development of a software suite that is able to generate care maps in the SBML format and align them using an existing global multiple pathway alignment algorithm. It is part of a larger project that examines efficacy of CPGs. This would allow for two important studies to be conducted: a breadth study across multiple EDs and a longitudinal study over time within a single ED to see how it has been able to implement and adapt to the CPGs. By utilizing Bioinformatics approaches in care mapping, two important objectives were realized: the creation of a document standard for care maps, and computational comparison and contrast of CPGs. This opens up the exciting new field of Translational Informatics, which applies existing Bioinformatics concepts to e-Health, e-Medicine and Health Informatics.

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