Multilingual Qualitative Study Targets Care Barriers for Racialised Older Adults in Canada
Racialised immigrant older adults in Canada face a familiar but underexamined problem: poorer self-rated health, more chronic illness, and repeated friction when they try to use the healthcare system. A new qualitative protocol in BMJ Open sets out to examine those experiences directly and to turn what participants say into practical engagement tools.
The study is built around a simple clinical question with broad implications for access and chronic disease care. How do racialised immigrant older adults understand their own role in healthcare, where do caregivers and clinicians see the process breaking down, and what kind of support would make patient engagement more workable in daily practice?
Rather than limiting the work to a single language group or a single viewpoint, investigators plan to hear from older adults, caregivers, and healthcare providers across nine languages: Arabic, Bangla, Cantonese, Hindi, Mandarin, Punjabi, Tamil, Urdu, and English. The design recognizes that communication barriers are not a side issue in this population. They can shape whether symptoms are described accurately, whether treatment plans are understood, and whether follow-up actually happens.
Three-Phase Participatory Design in the Waterloo-Wellington Region
The protocol uses a cross-cultural participatory action research approach and unfolds in three phases. First, the team will strengthen existing partnerships with racialised older adults, community agencies, and cultural associations. That step matters because trust, recruitment, and interpretation are all inseparable in a study asking people to describe difficult experiences with care.
Phase 2 moves into individual interviews. After informed consent, investigators plan in-depth interviews with approximately 45 racialised immigrant older adults and caregivers, along with about 10 healthcare providers. Professional interpretation will be used when needed, allowing participants to speak in the language that best fits their daily lives rather than forcing a narrower English-only conversation. The interviews will take place in the Waterloo-Wellington region of Ontario, an area where the study team expects to capture a range of migration histories, family structures, and care experiences.
Phase 3 is where the study moves from description to design. Participants will take part in interpreted sessions to codesign culturally and linguistically aligned tools, resources, or other solutions intended to support patient engagement. The protocol does not presume that one intervention will solve every barrier. Instead, it creates a structured path for people who live the problem to help shape the response.
One practical strength of the design is its openness to different participant perspectives. Older adults may describe confusion about medications, referral pathways, or how to raise concerns during brief appointments. Caregivers may speak to the burden of interpretation, coordination, and advocacy. Clinicians may identify pressure points in time-limited encounters, incomplete histories, or communication gaps that do not show up in routine documentation.
Patient Engagement and Language Access as Clinical Issues
The study is not focused on a single disease, yet the clinical implications are broad because patient engagement affects chronic disease management, preventive care, and continuity across settings. For older adults managing multiple conditions, a failed conversation is not a minor inconvenience. It can change adherence, delay escalation of symptoms, and worsen the fit between the care plan and the reality of daily life.
Language access sits at the center of that problem. Interpreted interviews in multiple languages are not just a convenience for recruitment; they are part of the methodology. If a participant can explain how they understand pain, medication, caregiver support, or trust in clinicians in their own language, the resulting data are more likely to reflect the real barrier rather than a translated version of the barrier.
The protocol also places caregivers in the analytic frame rather than treating them as passive companions. In many families, caregivers act as informal translators, appointment planners, and advocates. Their perspective can expose how much hidden work is required to keep an older adult connected to care, especially when systems are fragmented or culturally unfamiliar.
Data Handling and Analysis Plan
Interview data will be transcribed, cleaned, and entered into NVivo V.12 for team-based analysis. The investigators plan to code, theme, and interpret the data, then prepare narrative descriptions that summarize each language group and each participant group. Those narratives will be used to illustrate recurring themes across older adults, caregivers, and healthcare providers.
This analytic plan is intentionally layered. It should allow the team to see both common patterns and language-specific differences, which is essential in a study that spans multiple cultural communities. A problem that appears similar across groups may have different causes in each setting. A communication gap in one language community may stem from different expectations about clinician authority, family decision-making, or health system navigation.
The protocol avoids overpromising what the data will deliver. It does not claim that the team will produce a single universal fix. Instead, it aims to generate linguistically sensitive and culturally sensitive tools that can be shaped by the people most likely to use them.
A short interview guide can reveal a long list of system failures.
Ethics Approval and the Limits of Translation Alone
Ethics clearance was obtained through the University of Waterloo Office of Research Ethics, under ORE #43297. The findings will be shared through peer-reviewed publications, presentations, and translated summary reports for partners and participants.
The dissemination plan is important because communities that contribute to qualitative research often never see the results in a usable form. Returning findings in translated summaries acknowledges that the knowledge generated in the study belongs, at least in part, to the people who made it possible.
This protocol also exposes a harder truth about healthcare equity. Translation alone does not equal access. A person may be able to understand the words in a conversation and still leave without a workable plan if the system ignores cultural context, family roles, health literacy, or the realities of navigating appointments, referrals, and chronic disease follow-up.
By centering racialised immigrant older adults and involving caregivers and clinicians together, the study is positioned to capture the mismatch between what health systems assume patients can do and what patients are actually able to do. The resulting tools will be judged less by their elegance than by whether they help older adults take part in care in ways that are understandable, respectful, and usable across languages.