News

By Kim Barnhardt

Communities, relationships, equity, respect and listening are part of the ethos at the Centre for Rural and Northern Health Research (CRaNHR), an OSSU Research Centre dedicated to the needs of communities in northern Ontario.

The Centre takes a very community-centric approach to its work, with a particular focus on rural, Indigenous and Francophone communities.

“Geography makes us unique – this is why it is so critical that it is about relationships, relationships, relationships,” says Dr. Diana Urajnik, Research Director of CRaNHR, at Laurentian University in Sudbury. “We are rural and northern and in capturing the voice of such an expansive area, we are meeting people where they are.”

Building on the work of Drs. Wayne Warry, Kristen Jacklin and Jennifer Walker whose research focused on Indigenous communities and seniors, and Dr. Alain Gauthier’s groundwork in Francophone health, she credits OSSU with laying the foundation for success.

“It’s a testament to SPOR funding and OSSU which have helped balloon this as all the other components have come from OSSU’s funding. Core OSSU funding has helped enable our ability to go after other types of funding – across the board and to meet community priorities,” says Dr. Urajnik.

Their approach is tailored to the needs of local communities, and while patient-oriented research is a natural evolution from CRaNHR’s earlier work, their perspective diverges from other parts of the province. “Patient-oriented research has been a natural extension, but for us, it was about how was it different? I like to say community engagement. “Patient” needs to be broadly used; in the north, it’s more about relationships with communities, family and the land – it’s a very different approach; it’s not the patient but family, community, relationships. The challenge is how you describe it,” she explains.

Francophone focus

Dr. Patrick Timony is Francophone health lead at CRaNHR and a senior associate researcher who is looking at language and health care. He is interested in how language affects care, Francophone health, quality of French language services and the patient experience.

As part of the Centre’s research, the team conducted a survey to see if the relationship between language spoken with a doctor correlated with satisfaction. They found that Francophone patients were happier when their provider proactively offered services in French, known as the active offer in government services to offer both official languages.

“It’s an organizing strategy that providers should be offering services in French, not waiting for the ask – the responsibility is on the provider to ask the patient which language they prefer,” says Dr. Timony. “It’s a patient-centred communications strategy with a beret on top.”

This work has spun off into other projects with French-speaking immigrants, determining how many are in Sudbury, what are their needs, and working with community organizations.  For example, in a collaborative project with the Centre de santé communautaire du Grand Sudbury, they created a series of “cheat sheets” for providers to ask specific questions of Francophone immigrants who may have different health concerns depending on their country of origin.

“We’re very interested in the health of Francophones in northern Canada and collaborate with experts in French immigrant health,” says Dr. Timony.

Another interesting research initiative, in collaboration with the Ontario Pharmacy Evidence Network, analyzed the geographic distribution of French pharmacists, building on a similar analysis of French-speaking physicians.  

“We keep finding the same story: as there are more Francophones in a community, the number of French-speaking providers goes down. The best availability of French-speaking-providers is in communities where less than 10% of the population is Francophone.”

He suggests this seemingly counter-intuitive result may be linked to the capacity of health care professionals to provide care.

“Although 11% of providers are able to provide care in French, only about 5% use it at work – that tells us there is untapped potential,” explains Dr. Timony. “French-speaking doctors in northern Francophone communities will work five hours more per week and see 20 patients more than their unilingual English-speaking counterparts. So there may be a fear that they’ll be inundated with Francophone patients if they identify French as a language of competence.”

Northern and rural geography

Just like the land is central to Indigenous communities, so too is the sense of place in shaping CRaNHR’s work, and that local relationships are essential.

“We are unique because of our geography – the needs here are much more pragmatic,” says Dr. Urajnik. “Supporting patient-oriented research takes a mindset, resources and investment in local personnel. Patient-oriented research capacity must be developed and maintained in the north and it means involving the perspectives of local people who understand context.”

They emphasize that all projects at a minimum have an Advisory Committee with patient partners and experts from the outset, who may also be invited to participate in running the project, conducting research, supporting knowledge translation and interpretation. Capacity-building with young researchers to understand the unique needs of northern communities is also an important aspect of their work.

Working in a large geographic area with a small population base, the researchers recognize there are limitations.

“One challenge with doing patient-oriented research in the north is the idea that it tends to be the same patient-partners who come time and time again – it ends up being the voice of a small group of people, the same voices – so it’s important to work with local community groups that have the perspective of the entire north,” acknowledges Dr. Timony. They cite the Réseau du mieux être francophone du Nord de l’Ontario,  Maamwesying North Shore Community Health Services as essential partners. “The foundation from the beginning of our time as an OSSU Centre has allowed us to enhance existing partnerships such as these and forge new ones,” states Dr. Urajnik.

With this unique perspective, broad links in the community and emphasis on relationships, CRaNHR is well-positioned to benefit northern communities, from long-time residents to newcomers and students at regional post-secondary institutions.