The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study.

OBJECTIVES: Research on immigrant and refugee vaccination uptake in Canada shows that immunization decisions vary by vaccine type, location, age and migration status. Despite their diversity, these studies often treat immigrant and refugee populations as a single group relative to other Canadians. In this comparative study, we explored how previous risk communication and immunization experiences influence immunization decisions by immigrant and refugee women from three communities across Canada. METHODS: Participants included women from the Punjabi immigrant community located in Surrey and Abbotsford, British Columbia (n = 36), the Nigerian immigrant community located in Winnipeg, Manitoba (n = 43), and the Congolese refugee community in Edmonton, Alberta (n = 18). Using focus groups guided by focused ethnography methodology, we sought to understand immunization experiences in Canada and before arrival, and what information sources influenced the immunization decision-making process by the women in the three communities. RESULTS: Participants had differing past experiences in Canada and before their arrival that influenced how they used information in their vaccination decisions. Clear vaccination communications and dialogue with Canadian health care providers increased trust in Canadian health care and the likelihood of vaccine uptake. By contrast, weak vaccine recommendations and antivaccination information in the community prompted participants to decline future vaccines. CONCLUSION: Given our participants' different communication preferences and needs, we argue that a one-size-fits-all communication approach is inappropriate for immigrant and refugee populations. Instead, multi-pronged communication strategies are required to reach participants and respond to previous experiences and information that may lead to vaccination hesitancy.

'Stay home and stay safe but maybe you can have somebody over': public perceptions of official COVID-19 messages during the 2020 holiday season in Canada.

BACKGROUND: The COVID-19 pandemic triggered extreme preventive measures, including economic and social lockdowns. Many experts and commentators, however, have argued in favor of a harm reduction approach, giving individuals the liberty to assess their risk and potentially engage in risky behavior more safely. Drawing on concepts from harm reduction literature we examine how Canadians interpreted messages intended to mitigate harm during the 2020 end-of-year holiday season. METHODS: We conducted 12 focus groups in four Canadian cities to discuss public health guidance to reduce the spread of COVID-19, how these messages influenced their holiday celebration plans, and how they interpreted harm mitigation messages. RESULTS: Focus group participants (n = 82) described COVID-19 public health guidance as confusing and difficult to follow. Participants considered that messages intended to mitigate harm from official sources would contribute to deepening confusion and uncertainty, allow for personal interpretation of guidelines, and discourage those who follow guidelines diligently. CONCLUSION: Official public health messaging intended to mitigate harm in rapidly evolving crisis situations can be ineffective in reducing risky behaviors because it may instead encourage people to not abide the recommended guidelines. In these situations, harm reduction messaging should be limited to specific groups who cannot otherwise avoid risk exposure.

"None of it was especially easy": improving COVID-19 vaccine equity for people with disabilities.

OBJECTIVES: Our study aimed to (1) identify barriers to equitable access to COVID-19 vaccines for Canadians with disabilities and (2) present recommendations made by study participants to improve immunization programs in terms of inclusivity and equitable access. METHODS: We invited Manitobans living with disabilities to participate in online focus groups. Focus groups were conducted across multiple disability experiences, although one focus group was advertised explicitly as offering simultaneous American Sign Language interpretation to encourage people who are d/Deaf or hard of hearing to participate. Participants were asked about their perspectives on the management of COVID-19 public health measures and vaccination program rollout. Participants were also asked about barriers and facilitators of their vaccination experiences and if they had recommendations for improvement. RESULTS: The participants identified three areas where they encountered routine barriers in accessing the COVID-19 vaccines: (1) vaccine information and appointment booking, (2) physical access to vaccination clinics, and (3) vaccination experience. While participants identified specific recommendations to improve vaccine accessibility for people with disabilities, the single most crucial advice consistently identified was to involve people with disabilities in developing accessible immunization programs. CONCLUSION: Meaningful engagement with people living with disabilities in immunization program planning would help ensure that people with disabilities, who already face significant challenges due to COVID-19, are offered the same protections as the rest of the population. These recommendations could be easily transferred to the administration of other large-scale immunization campaigns (e.g., influenza vaccines).

RéSUMé: OBJECTIFS: Notre étude visait à (1) identifier les obstacles à un accès équitable aux vaccins contre la COVID-19 pour les Canadiens vivant avec un handicap; et (2) présenter les recommandations faites par les participants à l'étude pour améliorer les programmes de vaccination en termes d'inclusivité et d'accès équitable. MéTHODES: Nous avons invité les Manitobains vivant avec un handicap à participer à des groupes de discussion en ligne. Les groupes de discussion ont été organisés pour divers types de handicap, bien qu'un groupe de discussion ait été explicitement annoncé comme offrant une interprétation simultanée en langue des signes américaine pour encourager les personnes sourdes ou malentendantes à participer. Les participants ont été interrogés sur leurs points de vue sur la gestion des mesures de santé publique contre la COVID-19 et le déploiement du programme d'immunisation. Les participants ont également été interrogés sur les obstacles et les facilitateurs de leurs expériences de vaccination et s'ils avaient des recommandations d'amélioration. RéSULTATS: Les participants ont identifié trois domaines dans lesquels ils ont rencontré des obstacles récurrents pour accéder aux vaccins contre la COVID-19 : 1) l'information sur les vaccins et la prise de rendez-vous, 2) l'accès physique aux cliniques de vaccination, et 3) l'expérience de la vaccination. Bien que les participants aient formulé des recommandations spécifiques pour améliorer l'accessibilité des vaccins pour les personnes handicapées, le conseil le plus crucial systématiquement identifié a été d'impliquer les personnes vivant avec un handicap dans l'élaboration de programmes d'immunisation accessibles. CONCLUSION: Un engagement significatif envers les personnes handicapées dans la planification du programme d'immunisation aiderait à garantir que les personnes vivant avec un handicap, qui sont déjà confrontées à des défis importants en raison de la COVID-19, bénéficient des mêmes protections que le reste de la population. Ces recommandations pourraient être facilement transférées à l'administration d'autres campagnes de vaccination à grande échelle (par exemple, le vaccin contre la grippe).

Moral panic about "covidiots" in Canadian newspaper coverage of COVID-19.

Moral panics are moments of intense and widespread public concern about a specific group, whose behaviour is deemed a moral threat to the collective. We examined public health guidelines in the first months of the COVID-19 pandemic in Canadian newspaper editorials, columns and letters to the editor, to evaluate how perceived threats to public interests were expressed and amplified through claims-making processes. Normalization of infection control behaviours has led to a moral panic about lack of compliance with preventive measures, which is expressed in opinion discourse. Following public health guidelines was construed as a moral imperative and a civic duty, while those who failed to comply with these guidelines were stigmatized, shamed as "covidiots," and discursively constructed as a threat to public health and moral order. Unlike other moral panics in which there is social consensus about what needs to be done, Canadian commentators presented a variety of possible solutions, opening a debate around infection surveillance, privacy, trust, and punishment. Public health communication messaging needs to be clear, to both facilitate compliance and provide the material conditions necessary to promote infection prevention behaviour, and reduce the stigmatization of certain groups and hostile reactions towards them.

Communicating scientific uncertainty in a rapidly evolving situation: a framing analysis of Canadian coverage in early days of COVID-19.

BACKGROUND: The COVID-19 pandemic brought the production of scientific knowledge onto the public agenda in real-time. News media and commentators analysed the successes and failures of the pandemic response in real-time, bringing the process of scientific inquiry, which is also fraught with uncertainty, onto the public agenda. We examine how Canadian newspapers framed scientific uncertainty in their initial coverage of the COVID-19 pandemic and how journalists made sense of the scientific process. METHODS: We conducted a framing analysis of 1143 news stories and opinion during the first two waves of the COVID-19 pandemic. Using a qualitative analysis software, our analysis focused, first, on how scientific uncertainty was framed in hard news and opinion discourse (editorial, op-ed). Second, we compared how specialist health and science reporters discussed scientific evidence versus non-specialist reporters in hard news and columns. RESULTS: Uncertainty emerged as a "master frame" across the sample, and four additional framing strategies were used by reporters and commentators when covering the pandemic: (1), evidence -focusing on presence or absence of it-; (2) transparency and leadership -focusing on the pandemic response-; (3) duelling experts - highlighting disagreement among experts or criticizing public health decisions for not adhering to expert recommendations-; and (4) mixed messaging -criticizing public health communication efforts. While specialist journalists understood that scientific knowledge evolves and the process is fraught with uncertainty, non-specialist reporters and commentators expressed frustration over changing public health guidelines, leading to the politicization of the pandemic response and condemnation of elected officials' decisions. CONCLUSIONS: Managing scientific uncertainty in evolving science-policy situations requires timely and clear communication. Public health officials and political leaders need to provide clear and consistent messages and access to data regarding infection prevention guidelines. Public health officials should quickly engage in communication course corrections if original messages are missing the intended mark, and clearly explain the shift. Finally, public health communicators should be aware of and more responsive to a variety of media reporters, who will bring different interpretative frames to their reporting. More care and effort are needed in these communication engagements to minimize inconsistencies, uncertainty, and politicization.

"Keep it short and sweet": Improving risk communication to family physicians during public health crises.

OBJECTIVE: To identify recommendations from family physicians in Canada on how public health agencies and professional organizations might improve future crisis and emergency risk communications. DESIGN: Qualitative content analysis. SETTING: Canada. PARTICIPANTS: Sixteen family physicians who have experienced a public health crisis. METHODS: Semistructured interviews were conducted with 16 family physicians practising in various regions across Canada who had experienced what they defined as a public health crisis. These events included environmental crises, like forest fires and hurricanes, and infectious disease crises, like the SARS (severe acute respiratory syndrome) and H1N1 outbreaks. Interview transcripts were coded using an inductive qualitative content analysis method, specifically focusing on recommendations from participants on how to improve risk communication to family physicians in the event of a future public health crisis. MAIN FINDINGS: Based on their personal experiences, participants had many explicit recommendations on how to improve risk communication strategies in the event of a future public health crisis. These included having a single trusted source of information; having timely and succinct communication; having consideration for learners; ensuring access to information for all physicians; improving public health and family medicine collaboration; having crisis information for patients; and creating communication infrastructure before a crisis occurs. CONCLUSION: This research provides thoughtful and varied considerations and advice from practising family physicians on how to improve risk communication from public health agencies and professional organizations to this group in the event of a public health crisis. With improved communications between these bodies and family physicians, practitioners will be better informed and prepared to provide the best possible care to their patient populations during such events.

Connection to the land as a youth-identified social determinant of Indigenous Peoples' health.

BACKGROUND: Social determinants of Indigenous health are known to include structural determinants such as history, political climate, and social contexts. Relationships, interconnectivity, and community are fundamental to these determinants. Understanding these determinants from the perspective of Indigenous youth is vital to identifying means of alleviating future inequities. METHODS: In 2016, fifteen Yellowknives Dene First Nation (YKDFN) youth in the Canadian Northwest Territories participated in the 'On-the-Land Health Leadership Camp'. Using a strength- and community-based participatory approach through an Indigenous research lens, the YKDFN Wellness Division and university researchers crafted the workshop to provide opportunities for youth to practice cultural skills, and to capture the youth's perspectives of health and health agency. Perspectives of a healthy community, health issues, and health priorities were collected from youth through sharing circles, PhotoVoice, mural art, and surveys. RESULTS: The overall emerging theme was that a connection to the land is an imperative determinant of YKDFN health. Youth identified the importance of a relationship to land including practicing cultural skills, Elders passing on traditional knowledge, and surviving off the land. The youth framed future health research to include roles for youth and an on-the-land component that builds YKDFN culture, community relations, and traditional knowledge transfer. Youth felt that a symbiotic relationship between land, environment, and people is fundamental to building a healthy community. CONCLUSION: Our research confirmed there is a direct and critical relationship between structural context and determinants of Indigenous Peoples' health, and that this should be incorporated into health research and interventions.

The More the Better? A Comparison of the Information Sources Used by the Public during Two Infectious Disease Outbreaks.

Recent infectious disease outbreaks have resulted in renewed recognition of the importance of risk communication planning and execution to public health control strategies. Key to these efforts is public access to information that is understandable, reliable and meets their needs for informed decision-making on protective health behaviours. Learning from the trends in sources used in previous outbreaks will enable improvements in information access in future outbreaks. Two separate random-digit dialled telephone surveys were conducted in Alberta, Canada, to explore information sources used by the public, together with their perceived usefulness and credibility, during the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic (n = 1209) and 2009-2010 H1N1 pandemic (n = 1206). Traditional mass media were the most used information sources in both surveys. Although use of the Internet increased from 25% during SARS to 56% during H1N1, overall use of social media was not as high as anticipated. Friends and relatives were commonly used as an information source, but were not deemed very useful or credible. Conversely, doctors and health professionals were considered credible, but not consulted as frequently. The use of five or more information sources increased by almost 60% between the SARS and H1N1 surveys. There was a shift to older, more educated and more affluent respondents between the surveys, most likely caused by a decrease in the use of landlines amongst younger Canadians. It was concluded that people are increasingly using multiple sources of health risk information, presumably in a complementary manner. Subsequently, although using online media is important, this should be used to augment rather than replace more traditional information channels. Efforts should be made to improve knowledge transfer to health care professionals and doctors and provide them with opportunities to be more accessible as information sources. Finally, the future use of telephone surveys needs to account for the changing demographics of the respondents accessed through such surveys.

"If they tell me to get it, I'll get it. If they don't...": Immunization decision-making processes of immigrant mothers.

OBJECTIVE: To understand information-gathering and decision-making processes of immigrant mothers for scheduled childhood vaccines, vaccination during pregnancy, seasonal flu and pandemic vaccination. METHODS: We conducted 23 qualitative semi-structured interviews with immigrated mothers from Bhutanese refugee, South Asian and Chinese communities. Participants lived in Edmonton, Alberta and had at least one child under eight years old. Using NVivo qualitative software, we generated an inductive coding scheme through content analysis of interview transcripts. RESULTS: Our three main findings on information gathering and use in vaccination decisions were: 1) participants in all three communities passively received immunization information. Most mothers learned about vaccine practices exclusively from health care practitioners during scheduled visits. Social networks were primary sources of information in origin countries but were lost during immigration to Canada; 2) participants demonstrated universal trust in vaccines (i.e., no anti-vaccination sentiment). They were comfortable in receiving vaccines for themselves and their children, regardless of past adverse reactions; 3) participants' recollection of the H1N1 vaccination campaign was almost nil, demonstrating the lack of reach of public health vaccination campaigns to designated priority groups (pregnant women and children) in Alberta. CONCLUSION: Our results highlight the limitations of Alberta's current vaccination communication strategies in reaching immigrant women. When immigrant mothers receive vaccination information, our results indicate they will likely follow recommendations. However, our study shows that current communication strategies are not making this information accessible to immigrant women, which limits their ability to make informed vaccination decisions for themselves and their children.

Risk communication and trust in decision-maker action: a case study of the Giant Mine Remediation Plan.

BACKGROUND: The development and implementation of a remediation plan for the residual arsenic trioxide stored at the former Giant Mine site in the Canadian Northwest Territories has raised important issues related to trust. Social and individual trust of those responsible for making decisions on risks is critically important in community judgements on risk and the acceptability of risk management decisions. Trust is known to be affected by value similarity and confidence in past performance, which serve as interacting sources of cooperation in acting toward a common goal. OBJECTIVE: To explore the elements of trust associated with the development and implementation of the Giant Mine Remediation Plan. DESIGN: Semi-structured interviews were conducted with eight purposively selected key informants representing both various interested and affected parties and the two government proponents. RESULTS: Five primary issues related to trust were identified by the participants: (1) a historical legacy of mistrust between the community (particularly Aboriginal peoples) and government; (2) barriers to building trust with the federal government; (3) limited community input and control over the decision-making process; (4) the conflicted and confounded role of the government agencies being both proponent and regulator, and the resulting need for independent oversight; and (5) distrust of the government to commit to the perpetual care required for the remediation option selected. CONCLUSIONS: The dual-mode model of trust and confidence was shown to be a useful framework for understanding the pivotal role of trust in the development of the Giant Mine Remediation Plan. Failure to recognize issues of trust based on value dissimilarity and lack of confidence based on past performance have resulted in a lack of cooperation characterized by delayed remediation and a prolonged and expensive consultation process. Government recognition of the importance of trust to these issues will hopefully improve future communication and public engagement endeavours.

Access and benefits sharing of genetic resources and associated traditional knowledge in northern Canada: understanding the legal environment and creating effective research agreements.

BACKGROUND: Research in northern Canada focused on Aboriginal peoples has historically benefited academia with little consideration for the people being researched or their traditional knowledge (TK). Although this attitude is changing, the complexity of TK makes it difficult to develop mechanisms to preserve and protect it. Protecting TK becomes even more important when outside groups become interested in using TK or materials with associated TK. In the latter category are genetic resources, which may have commercial value and are the focus of this article. OBJECTIVE: This article addresses access to and use of genetic resources and associated TK in the context of the historical power-imbalances in research relationships in Canadian north. DESIGN: Review. RESULTS: Research involving genetic resources and TK is becoming increasingly relevant in northern Canada. The legal framework related to genetic resources and the cultural shift of universities towards commercial goals in research influence the environment for negotiating research agreements. Current guidelines for research agreements do not offer appropriate guidelines to achieve mutual benefit, reflect unequal bargaining power or take the relationship between parties into account. CONCLUSIONS: Relational contract theory may be a useful framework to address the social, cultural and legal hurdles inherent in creating research agreements.

Consultation and remediation in the north: meeting international commitments to safeguard health and well-being.

BACKGROUND: International commitments exist for the safeguarding of health and the prevention of ill health. One of the earliest commitments is the Declaration of Alma-Ata (1978), which provides 5 principles guiding primary health care: equity, community participation, health promotion, intersectoral collaboration and appropriate technology. These broadly applicable international commitments are premised on the World Health Organization's multifaceted definition of health. The environment is one sector in which these commitments to safeguarding health can be applied. Giant Mine, a contaminated former gold mine in the Northwest Territories, Canada, represents potential threats to all aspects of health. Strategies for managing such threats usually involve an obligation to engage the affected communities through consultation. OBJECTIVE: To examine the remediation and consultation process associated with Giant Mine within the context of commitments to safeguard health and well-being through adapting and applying the principles of primary health care. METHODS: Semi-structured interviews with purposively selected key informants representing government proponents and community members were conducted. RESULTS: in reviewing themes which emerged from a series of interviews exploring the community consultation process for the remediation of Giant Mine, the principles guiding primary health were mapped to CONSULTATION IN the North: (a) "equity" is the capacity to fairly and meaningfully participate in the consultation; (b) "community participation" is the right to engage in the process through reciprocal dialogue; (c) "health promotion" represents the need for continued information sharing towards awareness; (d) "intersectoral collaboration" signifies the importance of including all stakeholders; and (e) "appropriate technology" is the need to employ the best remediation actions relevant to the site and the community. CONCLUSIONS: Within the context of mining remediation, these principles form an appropriate framework for viewing consultation as a means of meeting international obligations to safeguard health.

Youth researching youth: benefits, limitations and ethical considerations within a participatory research process.

OBJECTIVES: To examine the benefits, limitations and ethical issues associated with conducting participatory research on tobacco use using youth to research other youth. STUDY DESIGN: Community-based participatory research. METHODS: Research on tobacco use was conducted with students in the K'àlemì Dene School and Kaw Tay Whee School in the Northwest Territories, Canada, using PhotoVoice. The Grade 9-12 students acted as researchers. Researcher reflections and observations were assessed using "member checking," whereby students, teachers and community partners could agree or disagree with the researcher's interpretation. The students and teachers were further asked informally to share their own reflections and observations on this process. RESULTS AND CONCLUSIONS: Using youth to research other youth within a participatory research framework had many benefits for the quality of the research, the youth researchers and the community. The research was perceived by the researchers and participants to be more valid and credible. The approach was more appropriate for the students, and the youth researchers gained valuable research experience and a sense of ownership of both the research process and results. Viewing smoking through their children's eyes was seen by the community to be a powerful and effective means of creating awareness of the community environment. Limitations of the approach were residual response bias of participants, the short period of time to conduct the research and failure to fully explore student motivations to smoke or not to smoke. Ethical considerations included conducting research with minors, difficulties in obtaining written parental consent, decisions on cameras (disposable versus digital) and representation of all participants in the final research product.

Trends in the study of Aboriginal health risks in Canada.

OBJECTIVE: To identify trends in the study of health risk in peer-reviewed and grey literature in Canadian Aboriginal populations from 1960 to 2007. STUDY DESIGN: Systematic literature review and analysis. METHODS: Peer-reviewed literature was searched using 5 electronic library databases. The grey literature was searched using 3 online search engines, 4 agency websites and 2 online compiled databases. The search terms used were "Canada," synonyms for Canadian Aboriginal peoples and "risk." Citations were screened for relevance to Aboriginal populations and risks to aspects of human health. RESULTS: Both literatures show an exponential growth in risk-focused study of Canadian Aboriginal health issues over time. There is a geographic foci in the North with the Prairies and the West under-represented. Risk is most commonly used in relation to general health, environmental, zoonotic infections and chronic diseases in the peer-reviewed literature, and general health or environment in the grey literature. Most publications in both literatures are on generalized Aboriginal populations. When specified, a larger proportion of the publications relate to First Nations people, followed by Inuit. Little literature exists on Métis health risks in Canada. CONCLUSIONS: There has been an increase in publications about Aboriginal health risk in Canada over time. Trends reflect a research focus on the North and an increased interest in environment and health issues. Greater attention to mental health, addictions and Métis health is required. The increasing use of a risk-based analytical focus has potential implications for understanding the nature of Aboriginal health today and in the future.

Canadian media representations of mad cow disease.

A Canadian case of bovine spongiform encephalopathy (BSE) or "mad cow disease" was confirmed in May, 2003. An in-depth content analysis of newspaper articles was conducted to understand the portrayal of BSE and variant Creutzfeldt-Jakob disease (vCJD) in the Canadian media. Articles in the "first 10 days" following the initial discovery of a cow with BSE in Canada on May 20, 2003, were examined based on the premise that these initial stories provide the major frames that dominate news media reporting of the same issue over time and multiple occurrences. Subsequent confirmed Canadian cases were similarly analyzed to determine if coverage changed in these later media articles. The results include a prominence of economic articles, de-emphasis of health aspects, and anchoring the Canadian outbreak to that of Britain's crisis. The variation in media representations between those in Canada and those documented in Britain are explored in this study.

Development of a public participation and communication protocol for establishing fish consumption advisories.

Enabling people to make an informed choice on whether to change consumption behavior is ultimately the objective of any fish consumption advisory. This will occur only if people are aware of the advisory, know and understand the advisory information, and believe the information to be true. Interactive, meaningful communication and the opportunity to participate in the process to develop and review advisories are key to achieving these attributes. A case study was undertaken in a community in Alberta, Canada (where an existing advisory was under consideration for review) to determine public awareness, knowledge, compliance, communication effectiveness, information needs, and desire for involvement related to the advisory. The information obtained from this case study was used to develop 14 guiding principles as a foundation for the incorporation of public participation and risk communication into the process of developing and reviewing fish consumption advisories.