Summary

In the field of occupational health and safety (OHS), language and cultural barriers are often described as factors in worker vulnerability. The literature reports that such barriers have been, or continue to be, the cause of diagnostic errors and of incomplete or inaccurate clinical evaluations, thus complicating the rehabilitation and return-to-work (RTW) process. Yet the problem of rehabilitation and return to work in an intercultural relations context has been little documented globally. It is becoming imperative that we understand the experience and perspective of each stakeholder and target specific needs and problems where research and development efforts should be concentrated. The general objective of this study was to identify the strategies adopted by various stakeholders to facilitate workers’ rehabilitation and return-to-work process in an intercultural relations context. It sought to describe the experiences and perspectives of each of the concerned parties (workers, clinicians, Workers’ Compensation Board (WCB) rehabilitation experts, workplaces) in order to shed more light on the constraints, obstacles, facilitators, and specific needs at play.

A purposive sample was recruited. It consisted of 40 individuals (n=40) divided into four stakeholder categories: workers (n=9), clinicians (n=15), WCB experts (compensation agents and rehabilitation counsellors) (n=14), and workplace representatives (n=2). Two focus groups were formed (with a total of 7 participants) in addition to the compensation agent/rehabilitation counsellor group. The semi-structured interviews, averaging 80 minutes in length, were conducted using an interview guide for each group met. All the interviews were recorded and then transcribed for purposes of coding with the qualitative analysis software NVivo (version 10). The data analysis procedure drew from the principles of grounded theory.

Based on the OHS and rehabilitation/RTW trajectories of the workers concerned, key moments came to light, as did specific forms of interaction and the problems they can create. Important factors in the building of intervention strategies that overcome language and cultural barriers and that maximize their clients’ potential to return work were established for each stakeholder group. Five factors were identified in the context of the problems associated with intercultural relations: (a) the rupture of the work re-entry project and the feeling of injustice; (b) the cumulative stigma affixed to immigrant and minority workers who have sustained an occupational injury; (c) the building of a relationship of trust, the mainstay of the therapeutic alliance; (d) the increased length and frequency of the interventions, and the adaptation of the intervention strategies; and (e) language barriers and cultural gaps.

Our study highlighted key moments and various forms of interaction specific to the intercultural context. Based on these findings, the various rehabilitation partners were asked to revisit their clinical and case management approach, taking into account the disconnect that occurs between the migration trajectory and the work re-entry trajectory of immigrant and workers who have suffered an occupational injury, a disconnect that goes well beyond difficulties in overcoming language and cultural barriers. These aspects of the integration context should be taken into account in order to maximize the RTW potential of immigrant and minority clients and improve the training content offered to rehabilitation professionals.