Background: Canada has two official languages, English and French. French is the main language in Quebec while English is widely spoken in other provinces and territories. Canadian census data has shown that there is a significant portion of the population in the English speaking provinces that identify French as their mother tongue; and prefer to be served in French when they seek healthcare. This means that they are not able to speak, read, write, or understand the English language in a way that enables them to interact with others daily in English, let alone participate in research conducted in English. Thus the designation, English Language Barrier (ELB). The ELB populations can be difficult to sample for research purposes especially when language affiliation becomes an important identifying variable, thus, can be described as a potentially hard to-reach populations. Inadequate sampling compromises quality of data from which inferences are derived.