What Happens When You Invite People In

FEATURE STORY

When Mabel Ho walked into an early Bridging Divides meeting in 2023, the conversation was centred on immigrant health. As a social worker and then Director of Education and Research at a non-profit providing community and long-term care to older adults, she listened, and she noticed who was missing from the discussion.

“The conversation often revolves around youth and adults,” Ho says. “I thought, what about the older immigrants from diverse backgrounds receiving community care or long-term care?”

She described residents who spoke limited English or French, or who forgot those languages as dementia progressed. She talked about people reverting to village dialects that even bilingual staff could not understand, and about care interactions reduced to pointing and guesswork.

“In community care or long-term care, it is not just about ‘I need a glass of water’ or ‘I need to go to the bathroom,’” Ho explains. “It is much more than that, there’s often a cultural component. How do we communicate that with the care provider?”

That first interaction was the genesis of a new research project, one that looks at ways in which we can empower providers and patients through digital innovation. It was a reminder that immigrant health is also about older adults in institutional settings, and about the everyday communication that makes care feel human rather than transactional.

Starting from a problem partners name Research as something you do with people, not to them

For Josephine Wong, professor in Toronto Metropolitan University’s Faculty of Community Services and co-lead of the project, how research questions are formed matters. The problem was not defined in a proposal and then taken to partners. It emerged from a dialogue between community leaders, service providers, and researchers based on what partners were witnessing on the ground.

“When we were applying for the grant, we needed to go around finding partners,” Wong says. “They themselves raised the issue, which existed for a long time.”

Wong and Rosanra (Rosie) Yoon, Assistant Professor at the University of Toronto and a Bridging Divides affiliate, began by looking at what was already known. Together with students and research assistants, they conducted a scoping review of language technology in long-term care and community care settings.

The result was stark. “We did a scoping review of the current state of evidence specific to the adoption and use of language technology tools in long-term care,” Yoon says. “We found one article. We thought we did something wrong and double checked our methodology, our strategy, we checked with the library again. Just the one.” By contrast, a search for translation technology in hospitals and acute care returns thousands of studies.

“Within the healthcare space, you see inequity even in the research,” Yoon argues. “There is tech interest in emergency departments and surgical units, but nobody is doing research in long-term care. Older adults with language barriers are a neglected space.”

Ho had seen earlier attempts to improve communication, such as picture books and bilingual word lists. They helped with simple tasks, but not with feelings. “At that time we probably just focused on something very tangible and essential,” she says. “While I was working on this project I also learned about how we can be more human in terms of providing care as well as doing research.” At the same time, partners were describing very practical problems with staff in long-term care homes caring for residents who could not express pain, fear or basic needs in a language their caregivers understood.

From the outset, Wong and Yoon framed the project as a partnership effort rather than a study led from the outside.

Older adults and families are not treated as subjects who supply data and disappear. Their experiences inform the questions, guide the methods and ground the findings. “I always think that to have meaningful research is not just about the researchers coming with ideas,” Ho says. “It is always about the researchers, the practitioners, the older adults, families, community partners, everybody working together. That is the beauty of partnership, and I think partnership is at the heart of meaningful research.”

For Wong, this is also about what happens after data collection.

“Research is about finding knowledge and not allowing it to sit on a shelf. And knowledge translation is about making that research accessible.”

So rather than moving directly from literature review to tool testing, the team focused on dialogue. They wanted to know how different groups understood the same problem, and what they would need from any future solution. And they invited more people in.

Bringing technologists to the table

As the work unfolded, Abdolreza Akbarian, now at Women’s College Hospital and a member of the Bridging Divides team, worked on another gap. The project involved long-term care staff, community partners and researchers, but not yet the people building translation tools.

“This is a very multidisciplinary, interdisciplinary kind of project,” Akbarian says. “We need technology experts. We need people from long-term care homes, people with clinical experience. What we were lacking was that outside view from vendors and other stakeholders.”

Driven by what he calls a fascination with how technology is developing, he began reaching out to companies producing language translation devices and apps. He anticipated polite refusals or no answer at all. Instead, he found a surprising openness.

“To my surprise they were very responsive, and they really wanted to collaborate with researchers,” he says. “I was thinking these vendors are always looking for money or profit. But these technologies are so novel, they want researchers to use them because it adds to their data sets and helps validate their models.”

Some vendors agreed to provide devices at no cost so the team could explore basic questions: how well do they recognize accents, how do they handle different dialects, are they comfortable for older adults to hold and see, do they fit into care routines without causing disruption.

For Akbarian, this changed how he viewed the relationship between research and industry. “We live in an era of connectivity,” he says.

“The time for armchair scientists is over. If you want better research and better evidence, you need to find ways to connect.”

A forum for mutual learning

To gather perspectives systematically, the team hosted a community knowledge exchange forum focused on culture- and language-concordant care. Ninety-one participants took part, including researchers, long-term care staff, home and community care providers, community agencies, engineers and technology developers. Using a World Café format, the group rotated through discussions and compared notes across sectors before working together to identify common themes.

Two themes came up repeatedly. The first was financial constraint. Translation tools that comply with health privacy standards are expensive, and long-term care homes and community agencies operate with limited budgets. The second was the double-edged nature of technology. “Technology can be an enabler of social connection and well-being, but it can also inadvertently create disconnection by replacing humans,” Yoon says. “In this space, we need to grab control of who is creating the discourse.”

The Forum also served as an unexpected connector. People who rarely meet in the same room — front-line staff, researchers, engineers, and early-stage tech developers — ended up sharing business cards, continuing conversations in the hallway, and beginning side projects that extended past the event. The Forum made clear that dealing with language barriers in long-term care would require coordination well beyond any single sector.

As a follow-up, the team hosted another event several months later to broaden the conversation and bring stakeholders together once more. At one point, Yoon asked how many in the room had had to translate for an older relative. Most hands went up. “We are not talking about strangers,” she said. “We are talking about us.”

Among the speakers was Jordan D’Souza, Manager of Innovation at VHA Home HealthCare, whose team explores tools that could help staff communicate more clearly with clients in their first language. Long-term care leaders shared what it means to work with residents who revert to mother tongues and local dialects. Researchers and technologists raised questions about privacy, regulation and the limits of existing tools.

From the practice side, the key message was that any tool has to work in the conditions front-line staff actually face.

“Technology only works if it fits the realities of care,” D’Souza notes. “If it gets in the way, people will abandon it.”

Building towards impact, one relationship at a time

While the project is still underway, the team is preparing new publications, formalizing the partnership so that testing can be done in a systematic way, and laying the groundwork for changes that could influence day-to-day practice in long-term care. What began as a problem identified by partners is now becoming a model for collaborative innovation, where older adults, families, practitioners, technologists and researchers work together from the very beginning.

Wong is honest about what is at stake. “We need to think of the human aspect in the service provider, the technology development, the research,” she says. “We simply cannot lose the human-centred approach as we focus on the technology part.”

For Ho, the collaboration has reinforced what she believed when she first raised her hand in that meeting. “When community organizations, academic researchers, older adults and families work side by side, we are not just collecting data,” she says. “We are co-creating solutions that reflect real lives and real needs, so that we can provide better care to older adults.”

Few countries are experimenting with translation tools in long-term care in such a coordinated, research-informed way, and what is happening in these facilities is beginning to position Canada as an innovator in culturally and linguistically concordant care. For Akbarian, the lesson is simple. “If you want to build better solutions, if you want to have better research, better evidence, a better future, you need to find a way to connect. ”Those who are at the forefront of connecting disciplines will do better. It’s the only way.”

In this issue of Bridges:

What Happens When You Invite People In

Narratives of Citizenship: Seeing Belonging Through a Newcomer Lens

Listening to Learn in Canada’s Housing Research

AI Takes a Village: How Collaboration is Powering Canada’s Digital Future

Challenge Accepted: Mentorship Beyond the Data

Reporting Across Borders

Plus: Fall 2025 Allies in Action