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Nickel NC, Phillips-Beck W, Enns JE, Ekuma O, Taylor C, Fileatreault S, Eze N, Star L, Lavoie J, Katz A, Brownell M, Mahar A, Urquia M, Chateau D, Lix L, Chartier M, Brownell E, Tso Deh M, Durksen A, Romanescu R. COVID-19 diagnostic testing and vaccinations among First Nations in Manitoba: A nations-based retrospective cohort study using linked administrative data, 2020-2021. PLoS Med 2024; 21:e1004348. [PMID: 38363739 PMCID: PMC10871479 DOI: 10.1371/journal.pmed.1004348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/15/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Differential access to healthcare has contributed to a higher burden of illness and mortality among First Nations compared to other people in Canada. Throughout the Coronavirus Disease 2019 (COVID-19) pandemic, First Nations organizations in Manitoba partnered with public health and Manitoba government officials to ensure First Nations had early, equitable and culturally safe access to COVID-19 diagnostic testing and vaccination. In this study, we examined whether prioritizing First Nations for vaccination was associated with faster uptake of COVID-19 vaccines among First Nations versus All Other Manitobans (AOM). METHODS AND FINDINGS In this retrospective cohort study, we used linked, whole-population administrative data from the Manitoba healthcare system (February 2020 to December 2021) to determine rates of COVID-19 diagnostic testing, infection, and vaccination, and used adjusted restricted mean survival time (RMST) models to test whether First Nations received their first and second vaccine doses more quickly than other Manitobans. The cohort comprised 114,816 First Nations (50.6% female) and 1,262,760 AOM (50.1% female). First Nations were younger (72.3% were age 0 to 39 years) compared to AOM (51% were age 0 to 39 years) and were overrepresented in the lowest 2 income quintiles (81.6% versus 35.6% for AOM). The 2 groups had a similar burden of comorbidities (65.8% of First Nations had none and 6.3% had 3 or more; 65.9% of AOM had none and 6.0% had 3 or more) and existing mental disorders (36.9% of First Nations were diagnosed with a mood/anxiety disorder, psychosis, personality disorder, or substance use disorder versus 35.2% of AOM). First Nations had crude infection rates of up to 17.20 (95% CI 17.15 to 17.24) COVID-19 infections/1,000 person-months compared with up to 6.24 (95% CI 6.16 to 6.32) infections/1,000 person-months among AOM. First Nations had crude diagnostic testing rates of up to 103.19 (95% CI 103.06 to 103.32) diagnostic COVID-19 tests/1,000 person-months compared with up to 61.52 (95% CI 61.47 to 61.57) tests/1,000 person-months among AOM. Prioritizing First Nations to receive vaccines was associated with faster vaccine uptake among First Nations versus other Manitobans. After adjusting for age, sex, income, region of residence, mental health conditions, and comorbidities, we found that First Nations residents received their first vaccine dose an average of 15.5 (95% CI 14.9 to 16.0) days sooner and their second dose 13.9 (95% CI 13.3 to 14.5) days sooner than other Manitobans in the same age group. The study was limited by the discontinuation of population-based COVID-19 testing and data collection in December 2021. As well, it would have been valuable to have contextual data on potential barriers to COVID-19 testing or vaccination, including, for example, information on social and structural barriers faced by Indigenous and other racialized people, or the distrust Indigenous people may have in governments due to historical harms. CONCLUSION In this study, we observed that the partnered COVID-19 response between First Nations and the Manitoba government, which oversaw creation and enactment of policies prioritizing First Nations for vaccines, was associated with vaccine acceptance and quick uptake among First Nations. This approach may serve as a useful framework for future public health efforts in Manitoba and other jurisdictions across Canada.
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Affiliation(s)
- Nathan C. Nickel
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Jennifer E. Enns
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Okechukwu Ekuma
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Carole Taylor
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarah Fileatreault
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nkiru Eze
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Leona Star
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | - Josée Lavoie
- Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Dept of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Marni Brownell
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- School of Nursing, Faculty of Health Sciences, Queen’s University, Kingston, Canada
| | - Marcelo Urquia
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australia National University, Canberra, Australia
| | - Lisa Lix
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Mariette Chartier
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Emily Brownell
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Miyosha Tso Deh
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Anita Durksen
- Manitoba Centre for Health Policy, Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Razvan Romanescu
- Dept of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
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Fleury K, Chatwood S. Canadian Northern and Indigenous health policy responses to the first wave of COVID-19. Scand J Public Health 2023; 51:1016-1022. [PMID: 35676771 PMCID: PMC10599082 DOI: 10.1177/14034948221092185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022]
Abstract
Aims: This study aimed to compare COVID-19 health policy and programme responses in 16 Northern and Indigenous regions in Canada. The goal was to summarise strategies used to mitigate the initial spread of the pandemic while highlighting aspects that reflect Indigenous values. Methods: A scoping review of grey literature was completed, focusing on territorial, regional health authority, and community level websites. Further media analysis was conducted to reach saturation regarding policy changes and programmes implemented to prevent transmission, improve health communication, access testing, provide health services effectively, secure borders, and provide financial assistance. Common responses were mapped on the Women's College Hospital's Wholistic Framework for Safe Wellness to identify aspects that reflected Indigenous values. This framework utilises the medicine wheel to discuss physical health (body), ceremony (spirit), community health (heart), and assessment (mind). Results: The Women's College Hospital's Wholistic Framework for Safe Wellness quadrants of the body, spirit and heart were covered by most regions via health communication efforts, adaptations to traditional practices, and continuation of care during the pandemic, respectively. It was found that 13 regions had pandemic responses adapted for Indigenous populations. Conclusions: The responses in each Northern region show that protecting each community was a priority; however, policies and programmes were developed as a kaleidoscope of what can be done quickly and evaluated later. Assessment, risk, and prevention, covered by the mind quadrant of the Women's College Hospital's Wholistic Framework for Safe Wellness, were missing in initial emergency responses. Increasing capacity for emergency management in Northern and Indigenous regions will require contingency planning that acknowledges and builds off traditional knowledge.
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Affiliation(s)
- Katherine Fleury
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Canada
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Susan Chatwood
- School of Public Health, University of Alberta, Edmonton, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
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3
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Kelly KJ, Mears K, Doak S, Macartney G, Burns M, Loo J, Michael L, Jia BB, Montelpare W. Characteristics of immunisation support programmes in Canada: a scoping review and environmental scan. BMJ Open 2023; 13:e070400. [PMID: 36990478 PMCID: PMC10069581 DOI: 10.1136/bmjopen-2022-070400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To identify, characterise and map the existing knowledge about programmes that provide immunisation support to Canadians and barriers and facilitators to their delivery. DESIGN Scoping review and environmental scan. INTRODUCTION Vaccine hesitancy may be associated with unmet support needs of individuals. Immunisation support programmes that provide multicomponent approaches can improve vaccine confidence and equitable access. INCLUSION CRITERIA Canadian programmes that focus on providing information about immunisation for the general public, but excluding articles targeting health professionals. The primary concept involves mapping the characteristics of programmes and our secondary concept examines barriers and facilitators to programme delivery. METHODS The Joanna Briggs Institute (JBI) methodology guided this review, reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A search strategy was developed and translated for six databases in November 2021 (updated October 2022). Unpublished literature was identified through the Canadian Agency for Drugs and Technologies in Health Grey Matters checklist and other relevant sources. Stakeholders (n=124) from Canadian regional health authorities were also contacted by email for publicly accessible information. Two independent raters screened and extracted data from identified material. Results are presented in tabular form. RESULTS The search strategy and environmental scan resulted in 15 287 sources. A total of 161 full-text sources were reviewed after applying eligibility criteria, resulting in 50 articles. Programmes were delivered in multiple Canadian provinces, focusing on various vaccine types. All programmes aimed to increase vaccine uptake and were mostly provided in person. Multidisciplinary delivery teams based on collaborations among multiple entities were credited as a facilitator to programme delivery across settings. Limitations on programme resources, attitudes of programme staff and participants, and systems organisation were identified as barriers to delivery. CONCLUSIONS This review highlighted characteristics of immunisation support programmes across various settings and described multiple facilitators and barriers. These findings can inform future interventions that aim to support Canadians in making decisions about immunisation.
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Affiliation(s)
- Katherine Jennifer Kelly
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Kim Mears
- Data and Research Services, Robertson Library, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Sarah Doak
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Gail Macartney
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Margie Burns
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Janet Loo
- Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Laurie Michael
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Bei Bei Jia
- Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - William Montelpare
- Health Research Network, Applied Human Sciences, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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Friedemann Smith C, Lunn H, Wong G, Nicholson BD. Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care. BMJ Qual Saf 2022; 31:541-554. [PMID: 35354664 PMCID: PMC9234415 DOI: 10.1136/bmjqs-2021-014529] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/19/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Safety-netting has become best practice when dealing with diagnostic uncertainty in primary care. Its use, however, is highly varied and a lack of evidence-based guidance on its communication could be harming its effectiveness and putting patient safety at risk. OBJECTIVE To use a realist review method to produce a programme theory of safety-netting, that is, advice and support provided to patients when diagnosis or prognosis is uncertain, in primary care. METHODS Five electronic databases, web searches, and grey literature were searched for studies assessing outcomes related to understanding and communicating safety-netting advice or risk communication, or the ability of patients to self-care and re-consult when appropriate. Characteristics of included documents were extracted into an Excel spreadsheet, and full texts uploaded into NVivo and coded. A random 10% sample was independently double -extracted and coded. Coded data wasere synthesised and itstheir ability to contribute an explanation for the contexts, mechanisms, or outcomes of effective safety-netting communication considered. Draft context, mechanism and outcome configurations (CMOCs) were written by the authors and reviewed by an expert panel of primary care professionals and patient representatives. RESULTS 95 documents contributed to our CMOCs and programme theory. Effective safety-netting advice should be tailored to the patient and provide practical information for self-care and reconsultation. The importance of ensuring understanding and agreement with advice was highlighted, as was consideration of factors such as previous experiences with healthcare, the patient's personal circumstances and the consultation setting. Safety-netting advice should be documented in sufficient detail to facilitate continuity of care. CONCLUSIONS We present 15 recommendations to enhance communication of safety-netting advice and map these onto established consultation models. Effective safety-netting communication relies on understanding the information needs of the patient, barriers to acceptance and explanation of the reasons why the advice is being given. Reduced continuity of care, increasing multimorbidity and remote consultations represent threats to safety-netting communication.
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Affiliation(s)
| | | | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Fitzpatrick K, Sehgal A, Montesanti S, Pianarosa E, Barnabe C, Heyd A, Kleissen T, Crowshoe L. Examining the role of Indigenous primary healthcare across the globe in supporting populations during public health crises. Glob Public Health 2022; 18:2049845. [PMID: 35343868 DOI: 10.1080/17441692.2022.2049845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
When health systems are overwhelmed during a public health crisis regular care is often delayed and deaths result from lapses in routine care. Indigenous primary healthcare (PHC) can include a range of programmes that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health (SDoH) and a focus on redressing health inequities. We examined how Indigenous PHC mobilises and innovates during a public health crisis to address patient needs and the broader SDoH. A rapid review methodology conducted from January 2021 - March 2021 was purposefully chosen given the urgency with COVID-19, to understand the role of Indigenous PHC during a public health crisis. Our review identified five main themes that highlight the role of Indigenous PHC during a public health crisis: (1) development of culturally appropriate communication and education materials about vaccinations, infection prevention, and safety; (2) Indigenous-led approaches for the prevention of infection and promotion of health; (3) strengthening intergovernmental and interagency collaboration; (4) maintaining care continuity; and (5) addressing the SDoH. The findings highlight important considerations for mobilising Indigenous PHC services to meet the needs of Indigenous patients during a public health crisis such as the COVID-19 pandemic.
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Affiliation(s)
- Kayla Fitzpatrick
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Anika Sehgal
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Emilie Pianarosa
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amber Heyd
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tessa Kleissen
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Crowshoe
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Fowler-Woods A, Smolik I, Anaparti V, O’Neil L, El-Gabalawy H. Can Studying Genetically Predisposed Individuals Inform Prevention Strategies for RA? Healthcare (Basel) 2021; 9:1301. [PMID: 34682981 PMCID: PMC8544392 DOI: 10.3390/healthcare9101301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 12/29/2022] Open
Abstract
Rheumatoid arthritis (RA) is a prevalent autoimmune disorder in which complex genetic predisposition interacts with multiple environmental factors to precipitate chronic and progressive immune-mediated joint inflammation. Currently, in most affected individuals, ongoing suppression of the inflammation is required to prevent irreversible damage and functional loss. The delineation of a protracted preclinical period in which autoimmunity is initially established and then evolves to become pathogenic provides unprecedented opportunities for interventions that have the potential to prevent the onset of this lifelong disease. Clinical trials aimed at assessing the impact of specific prevention strategies require the identification of individuals who are at high risk of future RA development. Currently, these risk factors include a strong family history of RA, and the detection of circulating RA-associated autoantibodies, particularly anti-citrullinated protein antibodies (ACPA). Yet, even in such individuals, there remains considerable uncertainty about the likelihood and the timeframe for future disease development. Thus, individuals who are approached to participate in such clinical trials are left weighing the risks and benefits of the prevention measures, while having large gaps in our current understanding. To address this challenge, we have undertaken longitudinal studies of the family members of Indigenous North American RA patients, this population being known to have a high prevalence of RA, early age of onset, and familial clustering of cases. Our studies have indicated that the concepts of "risk" and "prevention" need to be communicated in a culturally relevant manner, and proposed prevention interventions need to have an appropriate balance of effectiveness, safety, convenience, and cultural acceptability. We have focused our proposed prevention studies on immunomodulatory/anti-inflammatory nutritional supplements that appear to strike such a complex balance.
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Affiliation(s)
- Amanda Fowler-Woods
- Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3W 0W3, Canada;
| | - Irene Smolik
- Rheumatic Diseases Unit, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1M4, Canada;
| | - Vidyanand Anaparti
- Manitoba Center for Proteomics and Systems Biology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada; (V.A.); (L.O.)
| | - Liam O’Neil
- Manitoba Center for Proteomics and Systems Biology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada; (V.A.); (L.O.)
| | - Hani El-Gabalawy
- Manitoba Center for Proteomics and Systems Biology, Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P4, Canada; (V.A.); (L.O.)
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McCalman J, Longbottom M, Fagan S, Fagan R, Andrews S, Miller A. Leading with local solutions to keep Yarrabah safe: a grounded theory study of an Aboriginal community-controlled health organisation's response to COVID-19. BMC Health Serv Res 2021; 21:732. [PMID: 34301256 PMCID: PMC8301739 DOI: 10.1186/s12913-021-06761-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pandemics such as COVID-19 are a serious public health risk for Australian Aboriginal and Torres Strait Islander communities, yet primary healthcare systems are not well resourced to respond to such urgent events. At the start of the COVID-19 pandemic, a federal government advisory group recommended a rapid, tailored Indigenous response to prevent predicted high morbidity and mortality rates. This paper examines the efforts of one ACCHO, which in the absence of dedicated funding, pivoted its operations in response to COVID-19. Gurriny Yealamucka Health Service (Gurriny) is the only primary healthcare service in the discrete Indigenous community of Yarrabah, Far North Queensland. METHODS The research was conducted at the request of the Chief Executive Officer of Gurriny. Using grounded theory methods, thirteen Gurriny staff and five Yarrabah and government leaders and community members were interviewed, transcripts of these interviews and 59 documents were imported into NVIVO-12 and coded, and key concepts were compared, organised into higher order constructs, then structured into a theoretical framework. RESULTS Gurriny responded to COVID-19 by leading with local solutions to keep Yarrabah safe. Four key strategies were implemented: managing the health service operations, realigning services, educating and supporting community, and working across agencies. These strategies were enabled or hindered by five conditions: the governance and leadership capacity of Gurriny, relying on the health taskforce, locking the door, "copping it", and (not) having resources. A year after the first case was experienced in Australia and on the eve of vaccine rollout to Indigenous communities, there have been no COVID-19 cases in Yarrabah. DISCUSSION The success of the locally led, holistic, comprehensive and culturally safe response of Gurriny suggests that such tailored place-based approaches to pandemics (and other health issues) are appropriate, but require dedicated resourcing. Key challenges were the fragmented and rapidly changing government processes, poorly coordinated communication and resource allocation channels, and bottlenecks in hierarchical funding approval processes. CONCLUSIONS The COVID-19 response in Yarrabah demonstrates the need for governance reform towards greater resourcing and support for local decision making by Aboriginal community-controlled health organisations.
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Affiliation(s)
- Janya McCalman
- Centre for Health Equity Research, School of Health, Medical and Applied Sciences, CQUniversity Australia, Lvl 2 Cairns Square, Cnr Abbott & Shields St, Qld, 4870, Cairns, Australia.
| | - Marlene Longbottom
- Ngarruwan Ngadju First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Sara Fagan
- Centre for Health Equity Research, School of Health, Medical and Applied Sciences, CQUniversity Australia, Lvl 2 Cairns Square, Cnr Abbott & Shields St, Qld, 4870, Cairns, Australia
| | - Ruth Fagan
- Gurriny Yealamucka Health Service Aboriginal Corporation, 1 Bukki Rd, Yarrabah, QLD, 4871, Australia
| | - Suzanne Andrews
- Gurriny Yealamucka Health Service Aboriginal Corporation, 1 Bukki Rd, Yarrabah, QLD, 4871, Australia
| | - Adrian Miller
- Centre for Health Equity Research, School of Health, Medical and Applied Sciences, CQUniversity Australia, Lvl 2 Cairns Square, Cnr Abbott & Shields St, Qld, 4870, Cairns, Australia
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Berg SH, O'Hara JK, Shortt MT, Thune H, Brønnick KK, Lungu DA, Røislien J, Wiig S. Health authorities' health risk communication with the public during pandemics: a rapid scoping review. BMC Public Health 2021; 21:1401. [PMID: 34266403 PMCID: PMC8280576 DOI: 10.1186/s12889-021-11468-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Responses from the H1N1 swine flu pandemic and the recent COVID-19 coronavirus pandemic provide an opportunity for insight into the role of health authorities' ways of communicating health risk information to the public. We aimed to synthesise the existing evidence regarding different modes of communication used by health authorities in health risk communication with the public during a pandemic. METHODS We conducted a rapid scoping review. MEDLINE and EMBASE were searched for publications in English from January 2009 through October 2020, covering both the full H1N1 pandemic and the response phase during the COVID-19 pandemic. The search resulted in 1440 records, of which 48 studies met our eligibility criteria. RESULTS The present review identified studies across a broad interdisciplinary field of health risk communication. The majority focused on the H1N1 pandemic and the COVID-19 pandemic. A content analysis of the studies identified three categories for modes of communication: i) communication channels, ii) source credibility and iii) how the message is communicated. The identified studies on social media focused mainly on content and engagement, while studies on the effect of the use of social media and self-protective behaviour were lacking. Studies on the modes of communication that take the diversity of receivers in the field into account are lacking. A limited number of studies of health authorities' use of graphic and audio-visual means were identified, yet these did not consider/evaluate creative communication choices. CONCLUSION Experimental studies that investigate the effect of health authorities' videos and messages on social media platforms and self-protective behaviour are needed. More studies are needed across the fields of health risk communication and media studies, including visual communication, web design, video and digital marketing, at a time when online digital communication is central to reaching the public.
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Affiliation(s)
- Siv Hilde Berg
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway.
| | - Jane K O'Hara
- Faculty of Medicine & Health, School of Healthcare, University of Leeds, Leeds, England
| | - Marie Therese Shortt
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Henriette Thune
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Kolbjørn Kallesten Brønnick
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
- Centre for Age-Related Medicine (SESAM), Helse Stavanger, Stavanger, Norway
| | - Daniel Adrian Lungu
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Jo Røislien
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
| | - Siri Wiig
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, 4021, Stavanger, Norway
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Mosby I, Swidrovich J. L’expérimentation médicale et les causes de la réticence à la vaccination contre la COVID-19 chez les peuples autochtones du Canada. CMAJ 2021; 193:E892-E894. [PMID: 34099479 PMCID: PMC8203258 DOI: 10.1503/cmaj.210112-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ian Mosby
- Département d'histoire de l'Université Ryerson, Toronto, Ont
| | - Jaris Swidrovich
- École de pharmacie et de nutrition de l'Université de la Saskatchewan, Saskatoon, Sask
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Gesser-Edelsburg A. Using Narrative Evidence to Convey Health Information on Social Media: The Case of COVID-19. J Med Internet Res 2021; 23:e24948. [PMID: 33674257 PMCID: PMC7962859 DOI: 10.2196/24948] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/09/2020] [Accepted: 03/05/2021] [Indexed: 01/14/2023] Open
Abstract
During disease outbreaks or pandemics, policy makers must convey information to the public for informative purposes (eg, morbidity or mortality rates). They must also motivate members of the public to cooperate with the guidelines, specifically by changing their usual behavior. Policy makers have traditionally adopted a didactic and formalistic stance by conveying dry, statistics-based health information to the public. They have not yet considered the alternative of providing health information in the form of narrative evidence, using stories that address both cognitive and emotional aspects. The aim of this viewpoint paper is to introduce policy makers to the advantages of using narrative evidence to provide health information during a disease outbreak or pandemic such as COVID-19. Throughout human history, authorities have tended to employ apocalyptic narratives during disease outbreaks or pandemics. This viewpoint paper proposes an alternative coping narrative that includes the following components: segmentation; barrier reduction; role models; empathy and support; strengthening self-efficacy, community efficacy, and coping tools; preventing stigmatization of at-risk populations; and communicating uncertainty. It also discusses five conditions for using narrative evidence to produce an effective communication campaign on social media: (1) identifying narratives that reveal the needs, personal experiences, and questions of different subgroups to tailor messaging to produce targeted behavioral change; (2) providing separate and distinct treatment of each information unit or theory that arises on social networks; (3) identifying positive deviants who found creative solutions for stress during the COVID-19 crisis not found by other members of the community; (4) creating different stories of coping; and (5) maintaining a dialogue with population subgroups (eg, skeptical and hesitant groups). The paper concludes by proposing criteria for evaluating the effectiveness of a narrative.
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Affiliation(s)
- Anat Gesser-Edelsburg
- School of Public Health, University of Haifa, Haifa, Israel.,Health and Risk Communication Research Center, University of Haifa, Haifa, Israel
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11
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Mosby I, Swidrovich J. Medical experimentation and the roots of COVID-19 vaccine hesitancy among Indigenous Peoples in Canada. CMAJ 2021; 193:E381-E383. [PMID: 33627413 PMCID: PMC8096406 DOI: 10.1503/cmaj.210112] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ian Mosby
- Department of History, Ryerson University, Toronto, Ont
| | - Jaris Swidrovich
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Sask
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12
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Lawes-Wickwar S, Ghio D, Tang MY, Keyworth C, Stanescu S, Westbrook J, Jenkinson E, Kassianos AP, Scanlan D, Garnett N, Laidlaw L, Howlett N, Carr N, Stanulewicz N, Guest E, Watson D, Sutherland L, Byrne-Davis L, Chater A, Hart J, Armitage CJ, Shorter GW, Swanson V, Epton T. A Rapid Systematic Review of Public Responses to Health Messages Encouraging Vaccination against Infectious Diseases in a Pandemic or Epidemic. Vaccines (Basel) 2021; 9:72. [PMID: 33498395 PMCID: PMC7909419 DOI: 10.3390/vaccines9020072] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/08/2023] Open
Abstract
Public health teams need to understand how the public responds to vaccination messages in a pandemic or epidemic to inform successful campaigns encouraging the uptake of new vaccines as they become available. A rapid systematic review was performed by searching PsycINFO, MEDLINE, healthevidence.org, OSF Preprints and PsyArXiv Preprints in May 2020 for studies including at least one health message promoting vaccine uptake of airborne-, droplet- and fomite-spread viruses. Included studies were assessed for quality using the Mixed Methods Appraisal Tool (MMAT) or the Assessment of Multiple Systematic Reviews (AMSTAR), and for patient and public involvement (PPI) in the research. Thirty-five articles were included. Most reported messages for seasonal influenza (n = 11; 31%) or H1N1 (n = 11; 31%). Evidence from moderate to high quality studies for improving vaccine uptake included providing information about virus risks and vaccination safety, as well as addressing vaccine misunderstandings, offering vaccination reminders, including vaccination clinic details, and delivering mixed media campaigns across hospitals or communities. Behavioural influences (beliefs and intentions) were improved when: shorter, risk-reducing or relative risk framing messages were used; the benefits of vaccination to society were emphasised; and beliefs about capability and concerns among target populations (e.g., vaccine safety) were addressed. Clear, credible, messages in a language target groups can understand were associated with higher acceptability. Two studies (6%) described PPI in the research process. Future campaigns should consider the beliefs and information needs of target populations in their design, including ensuring that vaccine eligibility and availability is clear, and messages are accessible. More high quality research is needed to demonstrate the effects of messaging interventions on actual vaccine uptake.
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Affiliation(s)
- Sadie Lawes-Wickwar
- Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Daniela Ghio
- Department of Psychology, Faculty of Health and Society, University of Salford, Manchester M6 6PU, UK;
| | - Mei Yee Tang
- Behavioural Science Policy Research Unit, Population Health Sciences, Newcastle University, Newcastle upon Tyne NE2 4AX, UK;
| | - Chris Keyworth
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
| | - Sabina Stanescu
- School of Psychology, University of Southampton, Southampton SO17 1BJ, UK;
| | | | - Elizabeth Jenkinson
- Department of Health and Social Sciences, University of West England, Bristol BS16 1QY, UK; (E.J.); (N.G.); (E.G.)
| | - Angelos P. Kassianos
- Department of Applied Health Research, University College London, London WC1E 6BT, UK;
| | - Daniel Scanlan
- Department of Communication, Policy, and Research, Education Support, London N5 1EW, UK;
| | - Natalie Garnett
- Department of Health and Social Sciences, University of West England, Bristol BS16 1QY, UK; (E.J.); (N.G.); (E.G.)
| | - Lynn Laidlaw
- Public Contributor, Health Psychology Exchange Patient and Public Involvement (PPI) Group, UK;
| | - Neil Howlett
- Department of Psychology, Sports, and Geography, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hertfordshire AL10 9AB, UK;
| | - Natalie Carr
- Faculty of Health, Psychology, and Social Care, Manchester Metropolitan University, Manchester M15 6BH, UK;
| | - Natalia Stanulewicz
- Faculty of Health and Life Sciences, School of Applied Social Sciences, De Montfort University, Leicester LE1 9BH, UK;
| | - Ella Guest
- Department of Health and Social Sciences, University of West England, Bristol BS16 1QY, UK; (E.J.); (N.G.); (E.G.)
| | - Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK;
| | | | - Lucie Byrne-Davis
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
- Division of Medical Education, University of Manchester, Manchester M13 9PT, UK
| | - Angel Chater
- Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, Bedfordshire MK41 9EA, UK;
| | - Jo Hart
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
- Division of Medical Education, University of Manchester, Manchester M13 9PT, UK
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
- Manchester Academic Health Science Centre, Health Innovation Manchester, Manchester M13 9NQ, UK
| | - Gillian W. Shorter
- Centre for Improving Health Related Quality of Life, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Vivien Swanson
- Department of Psychology, University of Stirling, Stirling FK9 4LA, UK;
| | - Tracy Epton
- Manchester Centre for Health Psychology, University of Manchester, Manchester M13 9PL, UK; (C.K.); (L.B.-D.); (J.H.); (C.J.A.); (T.E.)
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Crooks K, Casey D, Ward JS. First Nations peoples leading the way in COVID-19 pandemic planning, response and management. Med J Aust 2020; 213:151-152.e1. [PMID: 32691433 PMCID: PMC7404903 DOI: 10.5694/mja2.50704] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Kristy Crooks
- Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Dawn Casey
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT
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14
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Boholm Å. Risk Communication as Government Agency Organizational Practice. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2019; 39:1695-1707. [PMID: 30884551 PMCID: PMC6849713 DOI: 10.1111/risa.13302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/01/2019] [Accepted: 02/25/2019] [Indexed: 05/20/2023]
Abstract
The dynamics of organizational risk communication is an understudied topic in risk research. This article investigates how public officials at six government agencies in Sweden understand and relate to risk communication and its uses in the context of agency organizational work on policy and regulation. Qualitative interviews were used to explore the practitioners' views on some key topics in the academic literature on risk communication. A main finding is that there is little consensus on what the goals of risk communication are; if, and how, uncertainty should be communicated; and what role is to be played by transparency in risk communication. However, the practitioners agree that dissemination (top down) to the public of robust scientific and expert knowledge is a crucial element. Dialogue and participation is used mainly with other agencies and elite stakeholders with whom agencies collaborate to implement policy goals. Dialogue with the public on issues of risk is very limited. Some implications of the findings for the practice of risk communication by government agencies are suggested.
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15
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Cooper E, Driedger S. Creative, strengths-based approaches to knowledge translation within indigenous health research. Public Health 2018; 163:61-66. [DOI: 10.1016/j.puhe.2018.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/31/2018] [Accepted: 06/30/2018] [Indexed: 11/26/2022]
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Dubé E, Bettinger JA, Fisher WA, Naus M, Mahmud SM, Hilderman T. Vaccine acceptance, hesitancy and refusal in Canada: Challenges and potential approaches. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2016; 42:246-251. [PMID: 29769995 PMCID: PMC5757714 DOI: 10.14745/ccdr.v42i12a02] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
"Vaccine hesitancy" is a concept used frequently in vaccination discourse and is challenging previously held perspective that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. Given the importance of achieving high vaccine coverage in Canada to avoid vaccine preventable diseases and their consequences, vaccine hesitancy is an important issue that needs to be addressed. This article describes the scope and causes of vaccine hesitancy in Canada and proposes potential approaches to address it.
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Affiliation(s)
- E Dubé
- Institut national de santé publique du Québec, Québec, QC
| | - JA Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC
| | - WA Fisher
- University of Western Ontario, London, ON
| | - M Naus
- BC Centre for Disease Control, Vancouver, BC
| | - SM Mahmud
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB
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17
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Carlsen B, Glenton C. The swine flu vaccine, public attitudes, and researcher interpretations: a systematic review of qualitative research. BMC Health Serv Res 2016; 16:203. [PMID: 27338141 PMCID: PMC4919843 DOI: 10.1186/s12913-016-1466-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/20/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND During pandemics, health authorities may be uncertain about the spread and severity of the disease and the effectiveness and safety of available interventions. This was the case during the swine flu (H1N1) pandemic of 2009-2010, and governments were forced to make decisions despite these uncertainties. While many countries chose to implement wide scale vaccination programmes, few accomplished their vaccination goals. Many research studies aiming to explore barriers and facilitators to vaccine uptake have been conducted in the aftermath of the pandemic, including several qualitative studies. AIMS 1. To explore public attitudes to the swine flu vaccine in different countries through a review of qualitative primary studies. 2. To describe and discuss the implications drawn by the primary study authors. METHODS Systematic review of qualitative research studies, using a broadly comparative cross case-study approach. Study quality was appraised using an adaptation of the Critical Appraisal Skills Programme (CASP) quality assessment tool. RESULTS The review indicates that the public had varying opinions about disease risk and prevalence and had concerns about vaccine safety. Most primary study authors concluded that participants were uninformed, and that more information about the disease and the vaccine would have led to an increase in vaccine uptake. We find these conclusions problematic. We suggest instead that people's questions and concerns were legitimate given the uncertainties of the situation at the time and the fact that the authorities did not have the necessary information to convince the public. Our quality assessment of the included studies points to a lack of reflexivity and a lack of information about study context. We suggest that these study weaknesses are tied to primary study authors' lack of acknowledgement of the uncertainties surrounding the disease and the vaccine. CONCLUSION While primary study authors suggest that authorities could increase vaccine uptake through increased information, we suggest instead that health authorities should be more transparent in their information and decision-making processes in future pandemic situations.
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Affiliation(s)
| | - Claire Glenton
- />Norwegian Institute of Public Health, PO Box 7004, St. Olavs plass, N-0130 Oslo, Norway
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18
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The Public Sphere in Emerging Infectious Disease Communication: Recipient or Active and Vocal Partner? Disaster Med Public Health Prep 2016; 9:447-58. [PMID: 26186579 DOI: 10.1017/dmp.2015.31] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Recent years have seen advances in theories and models of risk and crisis communication, with a focus on emerging epidemic infection. Nevertheless, information flow remains unilateral in many countries and does not take into account the public's polyvocality and the fact that its opinions and knowledge often "compete" with those of health authorities. This article addresses the challenges organizations face in communicating with the public sphere. METHODS Our theoretical approach is conceptualized through a framework that focuses on the public sphere and that builds upon existing guidelines and studies in the context of health and pandemics. We examine how health organizations cope with the public's transformation from recipients to an active and vocal entity, ie, how and to what extent health organizations address the public's anxiety and concerns arising in the social media during outbreaks. RESULTS Although international organizations have aspired to relate to the public as a partner, this article identifies notable gaps. CONCLUSIONS Organizations must involve the public throughout the crisis and conduct dialogues free of prejudices, paternalism, and preconceptions. Thereby, they can impart precise and updated information reflecting uncertainty and considering cultural differences to build trust and facilitate cooperation with the public sphere.
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19
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Driedger SM, Maier R, Furgal C, Jardine C. Factors influencing H1N1 vaccine behavior among Manitoba Metis in Canada: a qualitative study. BMC Public Health 2015; 15:128. [PMID: 25884562 PMCID: PMC4334920 DOI: 10.1186/s12889-015-1482-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/27/2015] [Indexed: 11/11/2022] Open
Abstract
Background During the first wave of the H1N1 influenza pandemic in 2009, Aboriginal populations in Canada experienced disproportionate rates of infection, particularly in the province of Manitoba. To protect those thought to be most at-risk, health authorities in Manitoba listed all Aboriginal people, including Metis, among those able to receive priority access to the novel vaccine when it first became available. Currently, no studies exist that have investigated the attitudes, influences, and vaccine behaviors among Aboriginal communities in Canada. This paper is the first to systematically connect vaccine behavior with the attitudes and beliefs that influenced Metis study participants’ H1N1 vaccine decision-making. Methods Researchers held focus groups (n = 17) with Metis participants in urban, rural, and remote locations of Manitoba following the conclusion of the H1N1 pandemic. Participants were asked about their vaccination decisions and about the factors that influenced their decisions. Following data collection, responses were coded into the broad categories of a social-ecological model, nuanced by categories stemming from earlier research. Responses were then quantified to show the most influential factors in positively or negatively affecting the vaccine decision. Results Media reporting, the influence of peer groups, and prioritization all had positive and negative influential effects on decision making. Whether vaccinated or not, the most negatively influential factors cited by participants were a lack of knowledge about the vaccine and the pandemic as well as concerns about vaccine safety. Risk of contracting H1N1 influenza was the biggest factor in positively influencing a vaccine decision, which in many cases trumped any co-existing negative influencers. Conclusions Metis experiences of colonialism in Canada deeply affected their perceptions of the vaccine and pandemic, a context that health systems need to take into account when planning response activities in the future. Participants felt under-informed about most aspects of the vaccine and the pandemic, and many vaccine related misconceptions and fears existed. Recommendations include leveraging doctor-patient interactions as a site for sharing vaccine-related knowledge, as well as targeted, culturally-appropriate, and empowering public information strategies to supply reliable vaccine and pandemic information to potentially at-risk Aboriginal populations.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Canada.
| | - Ryan Maier
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, Canada.
| | - Chris Furgal
- Indigenous Environment Studies Program, Trent University, 1600 West Bank Drive, Peterborough, Canada.
| | - Cindy Jardine
- School of Public Health, University of Alberta, 11405 - 87 Ave, Edmonton, Canada.
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Morrison KT, Buckeridge DL, Xiao Y, Moghadas SM. The impact of geographical location of residence on disease outcomes among Canadian First Nations populations during the 2009 influenza A(H1N1) pandemic. Health Place 2013; 26:53-9. [PMID: 24370747 DOI: 10.1016/j.healthplace.2013.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 12/03/2013] [Accepted: 12/08/2013] [Indexed: 12/11/2022]
Abstract
We sought to evaluate the effect of geographical location of residence on disease burden in Canadian First Nations (FN) populations during the 2009 pandemic influenza A(H1N1). Descriptive statistics and regression analysis of data for cases of pandemic A(H1N1) infection and hospitalization in the province of Manitoba, Canada, were conducted to estimate the odds of hospitalization and delay in time-to-hospitalization for on-reserve and off-reserve FN populations, while considering their geographical proximity to urban centers. We found that on-reserve FN individuals experienced a longer delay between infection and hospitalization compared to off-reserve FN individuals (p<0.001). The average fraction of FN cases that experienced a delay longer than 4 days for hospitalization was 20% higher for on-reserve compared to off-reserve residence. The odds of hospitalization were twice as high for FN people living on-reserve as compared to off-reserve (odds ratio=2.34; 95% CI: 1.16-4.73). Given the independent effect of on-reserve residency, higher disease burden among FN people cannot be attributed entirely to limited healthcare access due to remoteness from urban centers.
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Affiliation(s)
- Kathryn T Morrison
- Surveillance Laboratory, McGill Clinical and Health Informatics, McGill University, Montreal, Quebec, Canada H3A 1A3; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada H3A 1A3
| | - David L Buckeridge
- Surveillance Laboratory, McGill Clinical and Health Informatics, McGill University, Montreal, Quebec, Canada H3A 1A3; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada H3A 1A3
| | - Yanyu Xiao
- Agent-Based Modelling Laboratory, York Institute for Health Research, York University, Toronto, Ontario, Canada M3J 1P3.
| | - Seyed M Moghadas
- Agent-Based Modelling Laboratory, York Institute for Health Research, York University, Toronto, Ontario, Canada M3J 1P3
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