Comparing barriers to employee assistance program utilization in Canada and the United States using natural language processing and machine learning

Employee Assistance Program (EAP)s provide critical mental health support, yet utilization remains low in both Canada and the United States. Although qualitative studies have examined general barriers to EAP use, few have compared country-specific perceptions. This study explores barriers to EAP usage and explores potential differences in barriers between Canadian and American workers using natural language processing (NLP). This mixed-methods study, involving data transformation, included 30 semi-structured interviews with EAP-eligible employees (aged 18-65 years) in Canada and the US who had not previously used EAP services. Interviews were analyzed thematically using an inductive approach in alignment with Braun and Clarke's Thematic Analysis. The qualitative portion of this study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. In Phase 2 of the study, a BERT-based NLP model was trained to classify qualitative quotes by country. In phase 1, three core themes were observed: (1) Structural, informational and systematic barriers influencing EAP accessibility and coverage; (2) Reluctance to use EAP services due to psychosocial and perceptual barriers; and (3) Service quality, scope and cultural relevance to those with multiple social identities. While most barriers were common across countries, US participants reported financial concerns exclusively. Comparatively, in the NLP analysis, financial accessibility and comprehensive support through diverse EAP offerings were important in classifying American quotes, while stigma, vulnerability, and fear of workplace judgement and perceived quality and cultural relevance of EAPs were important in classifying Canadian quotes. Although many barriers to using EAPs are shared, financial and perceptual differences exist between Canadian and American workers. EAPs may benefit from implementing country-specific strategies. This could include creating strategies reducing stigma and quality concerns in Canada, while addressing concerns about cost and alternative options in the United States. Further studies should focus on generalizability and explore sector-specific and longitudinal trends in EAP perceptions.