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Brooks SP, Sidhu K, Cooper E, Michelle Driedger S, Gisenya L, Kaur G, Kniseley M, Jardine CG. The influence of health service interactions and local policies on vaccination decision-making in immigrant women: A multi-site Canadian qualitative study. Vaccine 2024; 42:2793-2800. [PMID: 38514354 DOI: 10.1016/j.vaccine.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
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.
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Affiliation(s)
- Stephanie P Brooks
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Kamaljit Sidhu
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Elizabeth Cooper
- Faculty of Kinesiology and Health Sciences, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3, Canada.
| | - Linda Gisenya
- School of Public Health, University of Alberta, 3-300 Edmonton Clinical Health Academy, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
| | - Gagandeep Kaur
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Marinel Kniseley
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
| | - Cynthia G Jardine
- Faculty of Health Sciences, University of the Fraser Valley, 45190 Caen Ave, Chilliwack, B.C. V2R 0N3, Canada.
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Hakim H, Driedger SM, Gagnon D, Chevrier J, Roch G, Dubé E, Witteman HO. Digital Gamification Tools to Enhance Vaccine Uptake: Scoping Review. JMIR Serious Games 2024; 12:e47257. [PMID: 38421688 PMCID: PMC10906656 DOI: 10.2196/47257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/22/2023] [Accepted: 01/02/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gamification has been used successfully to promote various desired health behaviors. Previous studies have used gamification to achieve desired health behaviors or facilitate their learning about health. OBJECTIVE In this scoping review, we aimed to describe digital gamified tools that have been implemented or evaluated across various populations to encourage vaccination, as well as any reported effects of identified tools. METHODS We searched Medline, Embase, CINAHL, the Web of Science Core Collection, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Academic Search Premier, PsycInfo, Global Health, and ERIC for peer-reviewed papers describing digital gamified tools with or without evaluations. We also conducted web searches with Google to identify digital gamified tools lacking associated publications. We consulted 12 experts in the field of gamification and health behavior to identify any papers or tools we might have missed. We extracted data about the target population of the tools, the interventions themselves (eg, type of digital gamified tool platform, type of disease/vaccine, type and design of study), and any effects of evaluated tools, and we synthesized data narratively. RESULTS Of 1402 records, we included 28 (2%) peer-reviewed papers and 10 digital gamified tools lacking associated publications. The experts added 1 digital gamified tool that met the inclusion criteria. Our final data set therefore included 28 peer-reviewed papers and 11 digital gamified tools. Of the 28 peer-reviewed papers, 7 (25%) explained the development of the tool, 16 (57%) described evaluation, and 2 (7%) reported both development and evaluation of the tool. The 28 peer-reviewed papers reported on 25 different tools. Of these 25 digital gamified tools, 11 (44%) were web-based tools, 8 (32%) mobile (native mobile or mobile-enabled web) apps, and 6 (24%) virtual reality tools. Overall, tools that were evaluated showed increases in knowledge and intentions to receive vaccines, mixed effects on attitudes, and positive effects on beliefs. We did not observe discernible advantages of one type of digital gamified tool (web based, mobile, virtual reality) over the others. However, a few studies were randomized controlled trials, and publication bias may have led to such positive effects having a higher likelihood of appearing in the peer-reviewed literature. CONCLUSIONS Digital gamified tools appear to have potential for improving vaccine uptake by fostering positive beliefs and increasing vaccine-related knowledge and intentions. Encouraging comparative studies of different features or different types of digital gamified tools could advance the field by identifying features or types of tools that yield more positive effects across populations and contexts. Further work in this area should seek to inform the implementation of gamification for vaccine acceptance and promote effective health communication, thus yielding meaningful health and social impacts.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Dominique Gagnon
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Julien Chevrier
- Bibliothèque Louise-Lalonde-Lamarre, Polytechnique Montréal, Montréal, QC, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
| | - Eve Dubé
- Direction des risques biologiques, Institut national de santé publique du Québec, Quebec City, QC, Canada
- Département d'anthropologie, Université Laval, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Centre hospitalier universitaire (CHU) de Québec-Université Laval, Université Laval, Quebec City, QC, Canada
- VITAM Research Centre for Sustainable Health, Université Laval, Quebec City, QC, Canada
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Marfo EA, Manca T, Cha E, Aylsworth L, Driedger SM, Meyer SB, Pelletier C, Dubé È, MacDonald SE. Intersecting Inequities in COVID-19 Vaccination: A Discourse Analysis of Information Use and Decision-Making Among Ethnically Diverse Parents in Canada. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01940-2. [PMID: 38409490 DOI: 10.1007/s40615-024-01940-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Little is known about how intersecting social privilege and disadvantage contribute to inequities in COVID-19 information use and vaccine access. This study explored how social inequities intersect to shape access to and use of COVID-19 information and vaccines among parents in Canada. METHODS We conducted semi-structured interviews on COVID-19 vaccination information use with ethnically diverse parents of children ages 11 to 18 years from April to August 2022. We purposefully invited parents from respondents to a national online survey to ensure representation across diverse intersecting social identities. Five researchers coded transcripts in NVivo using a discourse analysis approach informed by intersectionality. Our analysis focused on use of vaccine information and intersecting privileges and oppressions, including identifying with equity-denied group(s). RESULTS Interview participants (N = 48) identified as ethnically diverse non-Indigenous (n = 40) and Indigenous (n = 8) Peoples from seven Canadian provinces. Racialized minority or Indigenous participants reflected on historical and contemporary events of racism from government and medical institutions as barriers to trust and access to COVID-19 information, vaccines, and the Canadian healthcare system. Participants with privileged social locations showed greater comfort in resisting public health measures. Despite the urgency to receive COVID-19 vaccines, information gaps and transportation barriers delayed vaccination among some participants living with chronic medical conditions. CONCLUSION Historicization of colonialism and ongoing events of racism are a major barrier to trusting public health information. Fostering partnerships with trusted leaders and/or healthcare workers from racialized communities may help rebuild trust. Healthcare systems need to continuously implement strategies to restore trust with Indigenous and racialized populations.
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Affiliation(s)
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada
| | - Eunah Cha
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Catherine Pelletier
- Centre de Recherche du CHU de Quebec- Université Laval, Quebec City, QC, Canada
| | - Ève Dubé
- Department of Anthropology, Université Laval, Quebec City, QC, Canada
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Crockett LK, Scott SD, Driedger SM, Khan M, Prabhu D, Askin N, Steliga D, Tefft O, Jansson A, Turner S, Sibley KM. Characterizing research partnerships in child health research: A scoping review. J Child Health Care 2024:13674935241231346. [PMID: 38319137 DOI: 10.1177/13674935241231346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Research partnerships between researchers and knowledge users (KUs) in child health are understudied. This study examined the scope of KU engagement reported in published child health research, inclusive of health research partnership approaches and KU groups. Search strategies were developed by a health research librarian. Studies had to be in English, published since 2007, and were not excluded based on design. A two-step, multiple-person hybrid screening approach was used for study inclusion. Data on study and engagement characteristics, barriers and facilitators, and effects were extracted by one reviewer, with 10% verified by a second reviewer. Three hundred fifteen articles were included, with 243 (77.1%) published between 2019 and 2021. Community-based participatory research was the most common approach used (n = 122, 38.3%). Most studies (n = 235, 74.6%) engaged multiple KU groups (range 1-11), with children/youth, healthcare professionals, and parents/families being most frequently engaged. Reporting of barriers and facilitators and effects were variable, reported in 170 (53.8%) and 197 (62.5%) studies, respectively. Publications have increased exponentially over time. There is ongoing need to optimize evaluation and reporting consistency to facilitate growth in the field. Additional studies are needed to further our understanding of research partnerships in child health.
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Affiliation(s)
- Leah K Crockett
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Masood Khan
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Devashree Prabhu
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Nicole Askin
- WRHA Virtual Library, University of Manitoba, Winnipeg, MB, Canada
| | - Dawn Steliga
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Olivia Tefft
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Ann Jansson
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sarah Turner
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
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Driedger SM, Maier R, Capurro G, Jardine C, Tustin J, Chartrand F, Sanguins J, Kloss O. "There's a little bit of mistrust": Red River Métis experiences of the H1N1 and COVID-19 pandemics. Risk Anal 2024. [PMID: 38286593 DOI: 10.1111/risa.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/24/2023] [Accepted: 12/28/2023] [Indexed: 01/31/2024]
Abstract
We examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID-19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID-19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID-19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine-safety test subjects before population-wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non-prioritization of the Métis during COVID-19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign-though understandable-interpretations.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Maier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gabriela Capurro
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cindy Jardine
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Frances Chartrand
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
| | - Julianne Sanguins
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
| | - Olena Kloss
- Health & Wellness Department, Manitoba Métis Federation, Winnipeg, Manitoba, Canada
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6
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Knisley L, Driedger SM, Hartling L, Chartrand F, Sanguins J, Scott SD. We're here too: child health information-seeking experiences and preferences of Red River Métis families - a qualitative study. Int J Equity Health 2023; 22:252. [PMID: 38057802 DOI: 10.1186/s12939-023-02069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Red River Métis families need access to meaningful and appropriate resources when their children are sick. At the invitation of the Manitoba Métis Federation (MMF) to partner in this research, our aim was to understand Red River Métis parents' experiences and preferences for seeking child health information when their child is acutely ill, to inform the adaptation of existing parent resources. METHODS A qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data. RESULTS Analysis generated four themes: (1) We're here too; (2) We are not all the same; (3) Finding trustworthy information; and (4) Information needs to be widely available. Red River Métis pride was prominent in the results. Parents provided tangible ways to modify existing parent resources, including adding information on how to access Elders, healers and/or traditional medicines and showing different family structures, transport, living situations, Métis names, and incorporating Métis languages. While most parents reported looking for child health information online, they also stressed the need to provide multiple options, including information sheets, recognizing that parents seek information in different contexts. Parents also emphasized the importance of accessible, safe spaces to find child health information, including local schools, community centres, healthcare organizations and the MMF. CONCLUSION There is a lack of child health information created specifically for Red River Métis families. The development of this information can support their information needs and preferences and the ongoing efforts to revitalize Red River Métis culture and language. Study findings will inform the adaptation and dissemination of existing child health resources to ensure they reflect Red River Métis parents' information needs and preferences. This research is a critical step in addressing an identified need for Red River Métis families to have culturally relevant and meaningful child health resources, and in the pursuit of equitable care for all children in Canada. TRIAL REGISTRATION N/A.
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Affiliation(s)
- Lisa Knisley
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, Edmonton, Canada
| | - S Michelle Driedger
- Rady Faculty of Health Sciences, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Julianne Sanguins
- Rady Faculty of Health Sciences, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Shannon D Scott
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Level 3, 11405 87 Avenue, Edmonton, Canada.
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Furgal CM, Boyd AD, Mayeda AM, Jardine CG, Driedger SM. Risk communication and perceptions about lead ammunition and Inuit health in Nunavik, Canada. Int J Circumpolar Health 2023; 82:2218014. [PMID: 37262438 PMCID: PMC10236965 DOI: 10.1080/22423982.2023.2218014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 05/01/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
Lead ammunition is commonly used to hunt waterfowl and other wildlife in the Arctic. Hunting with lead is problematic because the toxicant can be transferred to the consumer. Therefore, it is critical to evaluate perceptions and awareness of the risks associated with using lead ammunition among Arctic populations. Results of the Nunavik Child Development Study (a longitudinal health study gathering information on health and well-being among Inuit in Nunavik, Canada) included advice to eliminate the use of lead ammunition in hunting practices. We surveyed 112 Nunavik residents (93 women; 18 men) about their awareness of lead related messages, use of lead ammunition and risk perceptions about contaminants. Sixty-seven participants (59.8%) reported there was an active hunter in their household. We found that only 27% of participants had heard or seen the messages about reducing lead ammunition. After participants viewed the Nunavik Child Development Study messages about lead, 44% stated they would stop using lead ammunition. However, 28% indicated that they would continue using lead ammunition. We conclude that, while messages had an overall positive effect, further study is required to understand why people continue to use lead ammunition.
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Affiliation(s)
- Chris M. Furgal
- Indigenous Environmental Studies & Sciences Program, Trent University, Peterborough, ON, Canada
| | - Amanda D. Boyd
- The Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Alyssa M. Mayeda
- The Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Cindy G. Jardine
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - S. Michelle Driedger
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, British Columbia, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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8
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Guay M, Maquiling A, Chen R, Lavergne V, Baysac DJ, Dubé È, MacDonald SE, Driedger SM, Gilbert NL. Racial disparities in COVID-19 vaccination in Canada: results from the cross-sectional Canadian Community Health Survey. CMAJ Open 2023; 11:E1075-E1082. [PMID: 37989513 PMCID: PMC10681669 DOI: 10.9778/cmajo.20230026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in COVID-19 vaccination coverage have been observed in Canada and in other countries. We aimed to compare vaccination coverage for at least 1 dose of a COVID-19 vaccine between First Nations people living off reserve and Métis, Black, Arab, Chinese, South Asian and White people. METHODS We used data collected between June 2021 and June 2022 by Statistics Canada's Canadian Community Health Survey, a large, nationally representative cross-sectional study. The analysis included 64 722 participants aged 18 years or older from the 10 provinces. We used a multiple logistic regression model to determine associations between vaccination status and race, controlling for collection period, region of residence, age, gender and education. RESULTS Nonvaccination against COVID-19 was more frequent in off-reserve First Nations people (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.2-2.7) and Black people (adjusted OR 1.7, 95% CI 1.1-2.6), and less frequent among South Asian people (adjusted OR 0.3, 95% CI 0.1-0.7) compared to White people. INTERPRETATION This analysis showed significant inequalities in COVID-19 vaccine uptake between racial/ethnic populations in Canada. Further research is needed to understand the sociocultural, structural and systemic facilitators of and barriers to vaccination across racial groups, and to identify strategies that may improve vaccination uptake among First Nations and Black people.
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Affiliation(s)
- Mireille Guay
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que.
| | - Aubrey Maquiling
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Ruoke Chen
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Valérie Lavergne
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Donalyne-Joy Baysac
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Ève Dubé
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Shannon E MacDonald
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - S Michelle Driedger
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
| | - Nicolas L Gilbert
- Public Health Agency of Canada (Guay, Maquiling, Chen, Lavergne, Baysac, Gilbert), Ottawa, Ont.; Institut national de santé publique du Québec (Dubé); Département d'anthropologie (Dubé), Université Laval, Québec, Que.; Faculty of Nursing (MacDonald) and School of Public Health (MacDonald), University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Driedger), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; École de santé publique (Gilbert), Université de Montréal, Montréal, Que
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Capurro G, Maier R, Tustin J, Jardine CG, Driedger SM. '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. J Commun Healthc 2023; 16:279-286. [PMID: 37859463 DOI: 10.1080/17538068.2022.2138243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
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.
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Affiliation(s)
- Gabriela Capurro
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Ryan Maier
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Canada
| | - Cynthia G Jardine
- Faculty of Health Sciences, University of Fraser Valley, Chilliwack, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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10
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Sibley KM, Khan M, Touchette AJ, Crockett LK, Driedger SM, Gainforth HL, Prabhu D, Steliga D, Tefft O, Graham ID. Characterizing Canadian funded partnered health research projects between 2011 and 2019: a retrospective analysis. Health Res Policy Syst 2023; 21:92. [PMID: 37684637 PMCID: PMC10492355 DOI: 10.1186/s12961-023-01046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND AND AIMS Involving research users in collaborative research approaches may increase the relevance and utility of research findings. Our primary objectives were to (i) identify and describe characteristics of Canadian federally and provincially funded health research projects that included research users and were funded between 2011 and 2019; (ii) explore changes over time; and (iii) compare characteristics between funder required and optional partnerships. METHODS Retrospective analysis. Inclusion criteria were projects that included research users. We analyzed publicly available project variables, and coded field and type of research using established classification systems. We summarized data with descriptive statistics and compared variables across three funding year blocks and partnership requirement status. RESULTS We identified 1153 partnered health research projects, representing 137 fields of research and 37 types of research categories. Most projects included a required partnership (80%) and fell into health and social care services research (66%). Project length and funding amount increased from average of 24.8 months and $266 248 CAD in 2011-2013 to 31.6 months and $438 766 CAD in 2017-2019. There were significantly fewer required partnerships in 2017-2019. CONCLUSIONS Between 2011 and 2019 Canadian federally and provincially funded partnered health research reflected primarily care services research across many fields. The observed breadth suggests that partnered health research approaches are applicable in many fields of research. Additional work to support partnered research across all types of health research (especially biomedical research) is warranted. The administration of larger grants that are funded for longer time periods may address previously identified concerns among research teams engaging in partnered research but may mean that fewer teams receive funding and risk delaying responding to time-sensitive data needs for users. Our process and findings can be used as a starting point for international comparison.
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Affiliation(s)
- Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
| | - Masood Khan
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Alexie J Touchette
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Leah K Crockett
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Kelowna, BC, Canada
| | - Devashree Prabhu
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Dawn Steliga
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Olivia Tefft
- Knowledge Translation, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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11
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Dubé E, Trottier ME, Gagnon D, Bettinger JA, Greyson D, Graham J, MacDonald NE, MacDonald SE, Meyer SB, Witteman HO, Driedger SM. Exploring parents' views of the use of narratives to promote childhood vaccination online. PLoS One 2023; 18:e0284107. [PMID: 37467300 DOI: 10.1371/journal.pone.0284107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/23/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Negative information about vaccines that spreads online may contribute to parents' vaccine hesitancy or refusal. Studies have shown that false claims about vaccines that use emotive personal narratives are more likely to be shared and engaged with on social media than factual evidence-based public health messages. The aim of this study was to explore parents' views regarding the use of positive narratives to promote childhood vaccination. METHODS We identified three ∼4-minute video narratives from social media that counter frequent parental concerns about childhood vaccination: parents and informed decision-making (online misinformation about vaccines); a paediatrician's clinical experience with vaccine-preventable diseases (prevention of still existing diseases); and a mother's experience with vaccine-preventable disease (risks of the disease). Focus group discussions were held with parents of children aged 0 to 5 years to assess their views on these three narratives and their general opinion on the use of narratives as a vaccine promotion intervention. RESULTS Four focus groups discussions were virtually held with 15 parents in December 2021. In general, parents trusted both health care provider's and parent's narratives, but participants identified more with stories having a parent as the main character. Both narratives featuring personal stories with vaccine-preventable diseases were preferred by parents, while the story about informed decision-making was perceived as less influential. Parents expressed the need for reliable and nuanced information about vaccines and diseases and felt that a short video format featuring a story was an efficient vaccine promotion intervention. However, many mentioned that they generally are not watching such videos while navigating the Web. CONCLUSION While vaccine-critical stories are widely shared online, evidence on how best public health could counter these messages remains scarce. The use of narratives to promote vaccination was well-perceived by parents. Future studies are needed to assess reach and impact of such an intervention.
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Affiliation(s)
- Eve Dubé
- Department of Anthropology, Laval University, Quebec, Quebec, Canada
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Marie-Eve Trottier
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Dominique Gagnon
- Department of Biohazard, Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Julie A Bettinger
- Department of Pediatrics, Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Devon Greyson
- Department of Pediatrics, Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University, University of Alberta, Edmonton, Alberta, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Holly O Witteman
- Department of Family Medicine, Laval University, Quebec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Malo B, Labbé F, Meyer SB, Filice E, Graham JE, MacDonald NE, Bettinger JA, Greyson D, MacDonald SE, Driedger SM, Kawchuk G, Dubé E. "I Want People to Be Able to Make an Informed Choice": How Quebec naturopaths discuss vaccination in their practice. Vaccine 2023:S0264-410X(23)00553-4. [PMID: 37210310 DOI: 10.1016/j.vaccine.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/22/2023] [Accepted: 05/09/2023] [Indexed: 05/22/2023]
Abstract
Health care providers' recommendations can play an important role in individuals' vaccination decisions. Despite being one of the most popular complementary and alternative medicine (CAM), naturopathy is understudied in relation to vaccination decisions. We sought to address this gap through this study of vaccination perspectives of naturopathy practitioners in the province of Quebec, Canada. We conducted in-depth interviews with 30 naturopaths. Thematic analysis was conducted. Main themes were developed deductively (i.e., based on prior literature) and expanded through inductive coding of the data. Participants noted that they discuss vaccination in their practice, but only when clients asked questions or wanted advice. Naturopaths described refraining from explicitly recommending for or against vaccination. Instead, they focus on empowering their clients to make their own informed decision regarding vaccination. Most participants noted that they direct clients towards sources of information so that clients could decide for themselves, but some mentioned they discussed with clients what they considered to be risks associated with vaccination, as well as its benefits. These discussions were framed through a personalized and individual approach with clients.
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Affiliation(s)
- Benjamin Malo
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; Département d'anthropologie, Université Laval, Québec, Canada
| | - Fabienne Labbé
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Eric Filice
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Janice E Graham
- Department of Pediatrics, Dalhousie University, Halifax, Canada
| | | | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada
| | | | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Gregory Kawchuk
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Eve Dubé
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada; Département d'anthropologie, Université Laval, Québec, Canada; Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, Canada.
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13
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Driedger SM, Kirby S, Maier R, Süss R, Thorlacius L, Saranchuk JW, Bohm E, Singer A. Strategies used in managing conversations about prostate-specific antigen (PSA) testing among family physicians (FPs): a qualitative study. BMJ Open 2023; 13:e073415. [PMID: 37117002 PMCID: PMC10151868 DOI: 10.1136/bmjopen-2023-073415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES Screening for prostate cancer in healthy asymptomatic men using the prostate-specific antigen (PSA) test is controversial due to conflicting recommendations from and a lack of strong evidence regarding the benefit of population-based screening. In Canada and internationally, there is variability in how family physicians (FPs) approach PSA testing in asymptomatic men. The purpose of our study was to explore how family FPs approach discussions with their male patients around PSA testing in Manitoba, Canada. DESIGN Qualitative descriptive study. SETTING AND PARTICIPANTS High-ordering and median-ordering FPs were invited to participate in an interview. In addition to exploring practice behaviours around PSA testing, participants were asked to elaborate on their typical discussion with asymptomatic men who request a PSA test or other tests and procedures that they do not feel are clinically warranted. Data were analysed inductively using a constant-comparison approach. RESULTS There were important variations between high-ordering and median-ordering FP's approaches to discussing PSA testing. Strategies to facilitate conversations were more frequently identified by median-ordering physicians and often included methods to facilitate assessing their patient's understanding and values. In addition to decision aids, median-ordering FPs used motivational interviewing to tailor a discussion, organised their practice structure and workflow habits in a way that enhanced patient-provider discussions and leveraged 'new' evidence and other aids to guide conversations with men. CONCLUSION We found that high-ordering FPs tended to use the PSA test for screening asymptomatic men with limited shared decision-making. Median-ordering FPs used conversational strategies that emphasised uncertainty of benefit and potential risk and did not present the test as a recommendation.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Kirby
- George & Fay Yee Centre for Healthcare Innovation, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ryan Maier
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roger Süss
- Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laurel Thorlacius
- Department of Pathology, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jeffery W Saranchuk
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada
| | - Eric Bohm
- Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Surgery, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alexander Singer
- Department of Family Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Knisley L, Linton J, Driedger SM, Hartling L, Sun Y, Scott SD. Examining the experiences of Indigenous families seeking health information about caring for sick or injured children: a scoping review. BMJ Open 2023; 13:e069697. [PMID: 36948561 PMCID: PMC10040012 DOI: 10.1136/bmjopen-2022-069697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE Mapping literature on Indigenous families' experiences seeking child health information and identifying barriers and facilitators to information access. DESIGN Scoping review. DATA SOURCES We searched Medline, EMBASE, PsycINFO, Scopus and CINAHL for peer-reviewed literature and Google Advanced for grey literature. We screened tables of contents of two Indigenous research journals not consistently indexed in online health databases and used snowball sampling to supplement searches. ELIGIBILITY CRITERIA We included full-text, English-language articles, published from 2000 to the time of the search in April 2021, based on: participants (Indigenous families), concept (experiences of families seeking health information) and context (child health). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted: citation details, study purpose, country of study, publication type, study design, data collection method, Indigenous group, family member participants, home/healthcare setting, child health area, how health information was accessed, and information-seeking barriers and facilitators. Data were examined for patterns and trends, results and implications. RESULTS Among 19 papers (representing 16 research projects) included, nine described family/friends and 19 described healthcare professionals as sources of child health information. Barriers include racism/discrimination during healthcare visits, ineffective communication with healthcare providers and structural barriers (eg, transportation). Facilitators include easy access, improved communication and relationships with healthcare providers, and culturally safe healthcare. CONCLUSION Indigenous families perceive they do not have access to necessary child health information, which can lead to insensitive, ineffective and unsafe healthcare. A critical gap exists in understanding Indigenous families' information needs and preferences when making decisions about children's health.
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Affiliation(s)
- Lisa Knisley
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Janice Linton
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Manitoba, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Yuting Sun
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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15
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Michelle Driedger S, Capurro G, Tustin J, Jardine CG. "I won't be a guinea pig": Rethinking public health communication and vaccine hesitancy in the context of COVID-19. Vaccine 2023; 41:1-4. [PMID: 36460532 PMCID: PMC9691450 DOI: 10.1016/j.vaccine.2022.11.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/27/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
At the beginning of 2021, when Canada started distribution of COVID-19 vaccines, the unprecedented scope and severity of the pandemic led to very high levels of public awareness and attention, with Canadians actively seeking information. We argue that while there was continuous public health communication about COVID-19 and the newly available vaccines, these messages did not address the specific anxieties elicited by the novel vaccines, even as vaccination guidelines changed. Instead, public health messages about COVID-19 vaccines resembled those aimed at reducing vaccine hesitancy for routine immunization and did not sufficiently address the constant changes to COVID-19 vaccine recommendations. In a context of heightened public concern and significant public attention, it is crucial for communicators to acknowledge that hesitancy is vaccine-specific, and that novel diseases and new vaccines produce specific concerns. Long-term strategies should address the novelty of the technology and of the risk, thoroughly explain the reasons for shifting vaccination guidelines, and leverage trusted sources, such as community leaders. Further, as COVID-19 vaccines become less effective against some of the more recent variants of the virus, vaccine messaging needs to be tailored to evolve with shifting realities to not lose productive gains in the COVID-19 vaccination campaign to date.
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Affiliation(s)
- S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3, Canada,Corresponding author
| | - Gabriela Capurro
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3, Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Toronto Metropolitan University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada
| | - Cindy G. Jardine
- Faculty of Health Sciences, University of Fraser Valley, 45190 Caen Ave, Chilliwack, BC V2R 0N3, Canada
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16
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Capurro G, Tustin J, Jardine CG, Driedger SM. When good messages go wrong: Perspectives on COVID-19 vaccines and vaccine communication from generally vaccine accepting individuals in Canada. Hum Vaccin Immunother 2022; 18:2145822. [PMID: 36452995 PMCID: PMC9762838 DOI: 10.1080/21645515.2022.2145822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Vaccines are one of the most important and successful public health interventions to reduce the spread of infectious diseases. However, unlike childhood diseases and routine vaccines, COVID-19 is a novel threat, and COVID-19 vaccines may elicit specific anxieties. Through focus groups, we examine the concerns and attitudes toward the COVID-19 vaccine expressed by individuals who accept routine vaccinations in Canada. We also conducted a pre-focus group survey to document participant attitudes towards vaccines in general. While most participants had received at least one dose of the COVID-19 vaccine or had the intention to get it, many had concerns. First, participants felt anxious about the quick development and approval of the vaccines, even if they recognized that the vaccines have undergone clinical trials. Second, participants felt confused about shifting public health guidelines regarding vaccine safety, changing the interval between doses, and mixing different vaccine brands. Finally, participants said they felt abandoned when deciding whether to get vaccinated or not. People who generally accept vaccines expressed concerns about COVID-19 vaccines, mostly related to the inevitable uncertainties of a new vaccine (i.e. novelty, safety, mandates, etc.). COVID-19 vaccine hesitancy, understood as concerns about the novelty of a vaccine and the rapid implementation of it, could be useful for understanding questioning attitudes towards COVID-19 vaccines from people who accept routine vaccinations. Understanding COVID-19 vaccine hesitancy can also provide valuable insights as booster doses are periodically needed and people may not be as accepting of these additional doses.
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Affiliation(s)
- Gabriela Capurro
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Canada
| | - Cindy G. Jardine
- Faculty of Health Sciences, University of Fraser Valley, Chilliwack, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada,CONTACT S. Michelle Driedger Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, Manitoba R3E 0W3, Canada
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17
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Aylsworth L, Manca T, Dubé È, Labbé F, Driedger SM, Benzies K, MacDonald N, Graham J, MacDonald SE. A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada. Hum Vaccin Immunother 2022; 18:2129827. [PMID: 36218335 DOI: 10.1080/21645515.2022.2129827] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.
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Affiliation(s)
- Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Noni MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice Graham
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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18
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Dubé E, Labbé F, Malo B, Manca T, Aylsworth L, Driedger SM, Graham J, Greyson D, MacDonald N, Meyer SB, Parsons Leigh J, Sadarangani M, Wilson S, MacDonald SE. " I don't think there's a point for me to discuss it with my patients": exploring health care providers' views and behaviours regarding COVID-19 vaccination. Hum Vaccin Immunother 2022; 18:2088970. [PMID: 35767434 PMCID: PMC9621068 DOI: 10.1080/21645515.2022.2088970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Health care providers' knowledge and attitudes about vaccines are important determinants of their own vaccine uptake, their intention to recommend vaccines, and their patients' vaccine uptake. This qualitative study' objective was to better understand health care providers' vaccination decisions, their views on barriers to COVID-19 vaccine acceptance and proposed solutions, their opinions on vaccine policies, and their perceived role in discussing COVID-19 vaccination with patients. METHODS Semi-structured interviews on perceptions of COVID-19 vaccines were conducted with Canadian health care providers (N = 14) in spring 2021. A qualitative thematic analysis using NVivo was conducted. RESULTS Participants had positive attitudes toward vaccination and were vaccinated against COVID-19 or intended to do so once eligible (two delayed their first dose). Only two were actively promoting COVID-19 vaccination to their patients; others either avoided discussing the topic or only provided answers when asked questions. Participants' proposed solutions to enhance COVID-19 vaccine uptake in the public were in relation to access to vaccination services, information in multiple languages, and community outreach. Most participants were in favor of mandatory vaccination policies and had mixed views on the potential impact of the Canadian vaccine-injury support program. CONCLUSIONS While health care providers are recognized as a key source of information regarding vaccines, participants in our study did not consider it their role to provide advice on COVID-19 vaccination. This is a missed opportunity that could be avoided by ensuring health care providers have the tools and training to feel confident in engaging in vaccine discussions with their patients.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec, QC, Canada
| | - Benjamin Malo
- Axe Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Noni MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Samantha B. Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Wilson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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19
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Feldman LY, Merrill K, Golding MA, Memauri T, Driedger SM, Ross NL, Protudjer JLP. Children's Perspectives on Food Allergy in Schools: A Qualitative Study. J Sch Nurs 2022:10598405221130694. [PMID: 36217767 DOI: 10.1177/10598405221130694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Approximately 7% of children live with food allergy, a condition that requires dietary avoidance to prevent an allergic reaction. In this qualitative study, we aimed to understand food allergy-related experiences, beliefs and learning preferences among children with and without food allergies, to inform a school-based, food allergy education program. Data were analysed thematically. We virtually interviewed children in Kindergarten-Grade 8 in Manitoba, Canada, with (n = 7) and without (n = 9) parent-reported, physician-diagnosed food allergies. We identified three themes: Naive reliance on peers and school staff to assist with food allergy management; Limited food allergy knowledge; and, Recommended food allergy curricula: complementary perspective. Our findings will help inform the development of a school-based, food allergy education program, with a long-term goal of minimizing food allergy-related worries and optimizing safety for children with food allergy. Ongoing, school-based food allergy education is needed.
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Affiliation(s)
| | - Kaitlyn Merrill
- Department of Pediatrics and Child Health, 8664University of Manitoba, Winnipeg, MB, Canada
- 423136Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Michael A Golding
- Department of Pediatrics and Child Health, 8664University of Manitoba, Winnipeg, MB, Canada
- 423136Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Tessa Memauri
- Department of Foods and Human Nutritional Sciences, 8664University of Manitoba, Winnipeg, MB, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, 8664University of Manitoba, Winnipeg, MB, Canada
| | - Nancy L Ross
- Children's Allergy and Asthma Education Centre, Winnipeg, MB, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, 8664University of Manitoba, Winnipeg, MB, Canada
- 423136Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Foods and Human Nutritional Sciences, 8664University of Manitoba, Winnipeg, MB, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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20
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Dube E, MacDonald SE, Manca T, Bettinger JA, Driedger SM, Graham J, Greyson D, MacDonald NE, Meyer S, Roch G, Vivion M, Aylsworth L, Witteman H, Gélinas-Gascon F, Marques Sathler Guimaraes L, Hakim H, Gagnon D, Béchard B, Gramaccia JA, Khoury R, Tremblay S. Understanding the influence of online information, misinformation, disinformation and reinformation on COVID-19 vaccine acceptance: Protocol for a multicomponent study. JMIR Res Protoc 2022; 11:e41012. [PMID: 36191171 PMCID: PMC9578524 DOI: 10.2196/41012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic has generated an explosion in the amount of information shared on the internet, including false and misleading information on SARS-CoV-2 and recommended protective behaviors. Prior to the pandemic, web-based misinformation and disinformation were already identified as having an impact on people’s decision to refuse or delay recommended vaccination for themselves or their children. Objective The overall aims of our study are to better understand the influence of web-based misinformation and disinformation on COVID-19 vaccine decisions and investigate potential solutions to reduce the impact of web-based misinformation and disinformation about vaccines. Methods Based on different research approaches, the study will involve (1) the use of artificial intelligence techniques, (2) a web-based survey, (3) interviews, and (4) a scoping review and an environmental scan of the literature. Results As of September 1, 2022, data collection has been completed for all objectives. The analysis is being conducted, and results should be disseminated in the upcoming months. Conclusions The findings from this study will help with understanding the underlying determinants of vaccine hesitancy among Canadian individuals and identifying effective, tailored interventions to improve vaccine acceptance among them. International Registered Report Identifier (IRRID) DERR1-10.2196/41012
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Affiliation(s)
- Eve Dube
- Anthropology Department, Laval University, Pavillon Charles-De Koninck, 1030 Avenue des Sciences humaines, Quebec, CA
| | | | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, CA
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, CA
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, CA
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, CA
| | - Devon Greyson
- School of Population and Public Health, University of British Columbia, Vancouver, CA
| | | | - Samantha Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, CA
| | | | - Maryline Vivion
- Department of Social and Preventive medicine, Laval University, Quebec, CA
| | | | - Holly Witteman
- Department of Family and Emergency Medicine, Laval University, Quebec, CA
| | - Félix Gélinas-Gascon
- Department of Computer Science and Software Engineering, Laval University, Quebec, CA
| | | | - Hina Hakim
- Department of Family and Emergency Medicine, Laval University, Quebec, CA
| | - Dominique Gagnon
- Department of Biohazard, Quebec National Institute of Public Health, Québec, CA
| | | | | | - Richard Khoury
- Department of Computer Science and Software Engineering, Laval University, Quebec, CA
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21
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Reifferscheid L, Marfo E, Assi A, Dubé E, MacDonald NE, Meyer SB, Bettinger JA, Driedger SM, Robinson J, Sadarangani M, Wilson SE, Benzies K, Lemaire-Paquette S, Gagneur A, MacDonald SE. COVID-19 vaccine uptake and intention during pregnancy in Canada. Can J Public Health 2022; 113:547-558. [PMID: 35476258 PMCID: PMC9045023 DOI: 10.17269/s41997-022-00641-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
Objective To investigate COVID-19 vaccine uptake and intent among pregnant people in Canada, and determine associated factors. Methods We conducted a national cross-sectional survey among pregnant people from May 28 through June 7, 2021 (n = 193). Respondents completed a questionnaire to determine COVID-19 vaccine acceptance (defined as either received or intend to receive a COVID-19 vaccine during pregnancy), factors associated with vaccine acceptance, and rationale for accepting/not accepting the vaccine. Results Of 193 respondents, 57.5% (n = 111) reported COVID-19 vaccine acceptance. Among those who did not accept the vaccine, concern over vaccine safety was the most commonly cited reason (90.1%, n = 73), and 81.7% (n = 67) disagreed with receiving a vaccine that had not been tested in pregnant people. Confidence in COVID-19 vaccine safety (aOR 16.72, 95% CI: 7.22, 42.39), Indigenous self-identification (aOR 11.59, 95% CI: 1.77, 117.18), and employment in an occupation at high risk for COVID-19 exposure excluding healthcare (aOR 4.76, 95% CI: 1.32, 18.60) were associated with vaccine acceptance. Perceived personal risk of COVID-19 disease was not associated with vaccine acceptance in the multivariate model. Conclusion Vaccine safety is a primary concern for this population. Safety information should be communicated to this population as it emerges, along with clear messaging on the benefits of vaccination, as disease risk is either poorly understood or poorly valued in this population.
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Affiliation(s)
| | - Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Québec City, QC, Canada.,Department of Anthropology, Université Laval, Québec City, QC, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah E Wilson
- ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Arnaud Gagneur
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada.,Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
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22
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MacDonald SE, Reifferscheid L, Bettinger JA, Robinson J, Sadarangani M, Dubé E, MacDonald NE, Marfo E, Assi A, Gagneur A, Driedger SM. Authors' response: Re: Reifferscheid et al., "COVID-19 vaccine uptake and intention during pregnancy in Canada". Can J Public Health 2022; 113:560-561. [PMID: 35641850 PMCID: PMC9154208 DOI: 10.17269/s41997-022-00657-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Québec City, QC, Canada.,Department of Anthropology, Université Laval, Québec City, QC, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Arnaud Gagneur
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada.,Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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23
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Sebring JCH, Capurro G, Kelly C, Jardine CG, Tustin J, Driedger SM. "None of it was especially easy": improving COVID-19 vaccine equity for people with disabilities. Can J Public Health 2022; 113:887-897. [PMID: 35419700 PMCID: PMC9007398 DOI: 10.17269/s41997-022-00621-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/22/2022] [Indexed: 12/14/2022]
Abstract
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).
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Affiliation(s)
- Jennifer C. H. Sebring
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
| | - Gabriela Capurro
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
| | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
| | - Cynthia G. Jardine
- Faculty of Health Sciences, University of Fraser Valley, 45190 Caen Ave, Chilliwack, BC V2R 0N3 Canada
| | - Jordan Tustin
- School of Occupational and Public Health, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3 Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
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24
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MacDonald SE, Paudel YR, Kiely M, Rafferty E, Sadarangani M, Robinson JL, Driedger SM, Svenson LW. Impact of the COVID-19 pandemic on vaccine coverage for early childhood vaccines in Alberta, Canada: a population-based retrospective cohort study. BMJ Open 2022; 12:e055968. [PMID: 35078849 PMCID: PMC8795926 DOI: 10.1136/bmjopen-2021-055968] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the impact of the COVID-19 pandemic on early childhood vaccination coverage in Alberta, Canada. SETTING Alberta, a western Canadian province, which has a population of 4.4 million and approximately 50 000 births annually. DESIGN In this retrospective cohort study, population-based administrative health data were analysed to determine the vaccination coverage for measles-containing, pertussis-containing and rotavirus vaccines. PRIMARY OUTCOME MEASURE We measured monthly and cumulative vaccine coverage. We assessed the absolute difference in monthly and cumulative coverage for each vaccine dose by comparing children due for vaccination in each month of 2019 and 2020, with follow-up to determine if missed doses were caught up later. PARTICIPANTS We included 114 178 children in the 2019 analysis cohort and 106 530 children in the 2020 analysis cohort. RESULTS Monthly vaccination coverage in 2020 was higher than 2019 until March, when coverage significantly declined. Comparing April 2020 to 2019, coverage was 9.9% (95% CI 7.9% to 12.0%) lower for measles vaccine; 4.9% (95% CI 3.3% to 6.5%), 7.1% (95% CI 5.2% to 9.1%), 5.2% (95% CI 3.1% to 7.4%) and 8.8% (95% CI 6.6% to 10.9%) lower for first, second, third and fourth doses of pertussis-containing vaccine, respectively; and 4.0% (95% CI 2.3% to 5.7%), 7.1% (95% CI 5.1% to 9.2%) and 4.6% (95% CI 2.4% to 6.7%) lower for first, second and third doses of rotavirus vaccine, respectively. Monthly coverage improved during May to July 2020; however, some doses experienced a second decline during September to October 2020. The cumulative coverage analysis showed that the measles-containing vaccine had the largest difference in coverage at the end of follow-up. CONCLUSIONS Children who were due for vaccination early in the pandemic and in Fall 2020, especially those due for measles vaccination, may require additional catch-up.
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Affiliation(s)
- Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Yuba Raj Paudel
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Marilou Kiely
- Institut national de santé publique du Québec, Quebec, Quebec, Canada
- Département de médecine sociale et préventive, Université Laval, Quebec, Quebec, Canada
| | - Ellen Rafferty
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence W Svenson
- Alberta Health, Government of Alberta, Edmonton, Alberta, Canada
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
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25
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Nickel NC, Enns JE, Sanguins J, O'Conaill C, Chateau D, Driedger SM, Taylor C, Detillieux G, Deh MT, Brownell E, Chartrand AF, Katz A. Patterns of prescription opioid dispensing among Red River Métis in Manitoba, Canada: a retrospective longitudinal cross-sectional study. CMAJ Open 2022; 10:E288-E295. [PMID: 35351781 PMCID: PMC9259467 DOI: 10.9778/cmajo.20210025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Amid rising concern about opioid use across Canada, Métis leaders in Manitoba are seeking information on prescription opioid dispensing in Red River Métis populations to assist with planning and implementing appropriate evidence-based harm-reduction strategies in their communities. We examined patterns of prescription opioid dispensing among Red River Métis and compared them to those among other residents of Manitoba. METHODS We conducted a population-based retrospective cross-sectional study for fiscal years 2006/07-2018/19 using administrative data from the Manitoba Population Research Data Repository and a study designed in partnership with researchers from the Manitoba Métis Federation. We compared age- and sex-adjusted rates of prescription opioid dispensing and mean morphine equivalents (MEQ) between Red River Métis and all other Manitobans aged 10 years or older, in accordance with Indigenous data sovereignty principles. To better understand what was driving any differences in patterns of prescription opioid dispensing between the 2 groups, we stratified the groups by age, sex, urbanicity, number of comorbidities, income quintile and opioid type, and compared patterns in MEQ/person. RESULTS The 2018/19 cohort included 76 755 Red River Métis and 1 117 854 other Manitobans. Other Manitobans were more likely than Red River Métis to be in higher income quintiles and to live in urban areas, and were less likely to have been diagnosed with a mood or anxiety disorder or a substance use disorder in the previous 5 years. The rate of prescription opioid dispensing and the opioid-associated MEQ/person were consistently higher among Red River Métis than among other Manitobans in each study year (p < 0.001). The rate of prescription opioid dispensing declined and the MEQ/person rose among other Manitobans over the study period but did not change among Red River Métis. INTERPRETATION The rate of prescription opioid dispensing and the potency of prescribed opioids were higher among Red River Métis in Manitoba than among other Manitobans. Further investigation into the different dispensing patterns between the 2 groups and the potential opioid-related harms they may herald is warranted.
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Affiliation(s)
- Nathan C Nickel
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man.
| | - Jennifer E Enns
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Julianne Sanguins
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man.
| | - Carrie O'Conaill
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Dan Chateau
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - S Michelle Driedger
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Carole Taylor
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Gilles Detillieux
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Miyosha Tso Deh
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Emily Brownell
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - A Frances Chartrand
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
| | - Alan Katz
- Manitoba Centre for Health Policy (Nickel, Enns, Chateau, Taylor, Detillieux, Tso Deh, Brownell, Katz), Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; Departments of Community Health Sciences (Nickel, O'Conaill, Chateau, Driedger) and Family Medicine (Katz), Rady Faculty of Health Sciences, University of Manitoba; National Centre for Epidemiology and Population Health (Chateau), Australian National University, Canberra, Australia; Health and Wellness Department (Sanguins) and Early Learning and Child Care Department (Chartrand), Manitoba Métis Federation, Winnipeg, Man
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26
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Kiely M, Mansour T, Brousseau N, Rafferty E, Paudel YR, Sadarangani M, Svenson LW, Robinson JL, Gagneur A, Driedger SM, MacDonald SE. COVID-19 pandemic impact on childhood vaccination coverage in Quebec, Canada. Hum Vaccin Immunother 2021; 18:2007707. [PMID: 34920686 PMCID: PMC9553134 DOI: 10.1080/21645515.2021.2007707] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Response measures to mitigate the coronavirus disease 2019 pandemic impacted access to routine vaccination services. We evaluate the impact of the pandemic on routine infant vaccination uptake by comparing vaccination coverage, vaccine delays and doses administered in 2019 and 2020, in Quebec, Canada. Using a population-based vaccination registry, we compared vaccination coverage at 3, 5, 13 and 19 months of age between 2019 and 2020 cohorts each month from January to November. For vaccine delays, we measured the cumulative proportion vaccinated in each targeted cohort monthly. We also compared the measles-containing vaccines administered before 24 months of age between the same period in 2019 and 2020. A decline in vaccination coverage and children vaccinated on time was observed in all cohorts during the first months of the pandemic. The greatest impact was observed for the 18-month vaccination visit with a difference in vaccination coverage between both cohorts of 30.9% in May. Measles-containing doses administered during the first months of the pandemic were lower in 2020 compared with 2019: −21.1% in March (95%CI-21.6;-20.4), and −39.2% in April (95%CI-40.0;-38.2). After May, the coverage increased for all cohorts to reach pre-pandemic levels after a few months for most target ages. Routine childhood vaccinations were affected during the first months of the pandemic, but catch-up occurred thereafter and vaccination coverage in affected cohorts were very close to levels of 2019 after a few months of follow-up. Real-time monitoring of childhood vaccination is essential but also for other vaccination programs, severely affected by the pandemic.
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Affiliation(s)
- Marilou Kiely
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Quebec, Quebec City, Quebec, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Thowiba Mansour
- Centre de recherche du CHU de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Quebec, Quebec City, Quebec, Canada.,Département de Médecine Sociale et Préventive, Université Laval, Quebec City, Quebec, Canada.,Centre de recherche du CHU de Quebec, Université Laval, Quebec City, Quebec, Canada
| | | | - Yuba Raj Paudel
- School of Public Health, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lawrence W Svenson
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Alberta, Canada
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Arnaud Gagneur
- Département de Pédiatrie, Centre de Recherche du CHUS, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Humble RM, Sell H, Dubé E, MacDonald NE, Robinson J, Driedger SM, Sadarangani M, Meyer SB, Wilson S, Benzies KM, Lemaire-Paquette S, MacDonald SE. Canadian parents' perceptions of COVID-19 vaccination and intention to vaccinate their children: Results from a cross-sectional national survey. Vaccine 2021; 39:7669-7676. [PMID: 34688500 PMCID: PMC8500474 DOI: 10.1016/j.vaccine.2021.10.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022]
Abstract
Background Vaccinating children (≤17 years old)
is important for controlling the COVID-19 pandemic. As parents are
primary decision makers for their children, we aimed to assess parents’
perceptions and intentions regarding COVID-19 vaccination for their
children, including for some underserved populations (e.g., newcomers,
Indigenous peoples, and visible minority groups). Methods We conducted a cross-sectional
national survey of Canadian parents in December 2020, just as COVID-19
vaccines were approved for adults, to assess intention to vaccinate their
children (aged 0-17 years) against COVID-19, perceptions of COVID-19
disease and vaccines, previous uptake of influenza and routine vaccines,
and sociodemographic characteristics. Binomial logistic regression was
used to assess the association between parents' COVID-19 vaccination
intention for their children and exposure variables. Results Sixty-three percent of parents
(1074/1702) intended to vaccinate their children against COVID-19. Those
employed part-time (compared to full-time) had lower intention to
vaccinate their children (aOR=1.73, 95% CI: 1.06-2.84), while those who
spoke languages other than English, French, or Indigenous languages were
less likely to have low intention (aOR=0.55, 95% CI: 0.32-0.92). Low
vaccination intention was also associated with children not receiving
influenza vaccine pre-pandemic (aOR=1.51, 95% CI: 1.04-2.21), parents
having low intention to vaccinate themselves against COVID-19 (aOR=9.22,
95% CI: 6.43-13.34), believing COVID-19 vaccination is unnecessary
(aOR=2.59, 95% CI: 1.72-3.91) or unsafe (aOR=4.21, 95% CI: 2.96-5.99),
and opposing COVID-19 vaccine use in children without prior testing
(aOR=3.09, 95% CI: 1.87-5.24). Interpretation Parents’ COVID-19 vaccination
intentions for their children are better predicted by previous decisions
regarding influenza vaccination than routine childhood vaccines, and
other perceptions of COVID-19 vaccine-related factors. Public
communication should highlight the safety and necessity of COVID-19
vaccination in children to support a return to normal activities. Further
research should assess actual COVID-19 vaccination uptake in children,
particularly for underserved populations.
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Affiliation(s)
- Robin M Humble
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Hannah Sell
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Eve Dubé
- Department of Anthropology, Laval University, Quebec City, Quebec, Canada
| | - Noni E MacDonald
- Department of Paediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Ontario, Canada
| | - Sarah Wilson
- Public Health Ontario, ICES, Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Sell H, Assi A, Driedger SM, Dubé È, Gagneur A, Meyer SB, Robinson J, Sadarangani M, Tunis M, MacDonald SE. Continuity of routine immunization programs in Canada during the COVID-19 pandemic. Vaccine 2021; 39:5532-5537. [PMID: 34426028 PMCID: PMC8439618 DOI: 10.1016/j.vaccine.2021.08.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In Canada, the COVID-19 pandemic has interrupted many routine health services, placed additional strain on the health care system, and resulted in many Canadians being either unable or unwilling to attend routine immunization appointments. We sought to capture and synthesize information about changes to routine immunization programs in response to the pandemic and plans to catch-up any missed immunizations. METHODS Provincial/territorial (P/T) public health leaders were interviewed via teleconference between August-October 2020 to collect information on the following topics: how routine immunization delivery was affected during and after initial lockdown periods, plans to catch-up missed doses, and major challenges and achievements in continuing routine immunization programs. Data were coded and categorized according to common responses and descriptive analysis was performed. RESULTS Interviews occurred with participants from 11 of 13 P/Ts. School immunization programs were reported to be most negatively affected by the pandemic (n = 9). In the early pandemic period, infant, preschool, and maternal/prenatal programs were prioritized, with most P/Ts continuing these services with adaptations for COVID-19. After the initial lockdown period, all routine programs were continuing with adaptations in most P/Ts. Infant, preschool, and school programs were most often targeted for catch-up through measures such as appointment rebooking and making additional clinics and/or providers available. Major challenges included resource limitations (e.g., staff shortages, PPE shortages, limited infrastructure) (n = 11), public health restrictions (n = 8), and public hesitancy to attend appointments (n = 5). CONCLUSIONS Canadian routine immunization programs faced some disruptions due to the COVID-19 pandemic, particularly the school, adult, and older adult programs. Further research is needed to determine the measurable impact of the pandemic on routine vaccine coverage levels.
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Affiliation(s)
- Hannah Sell
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - S Michelle Driedger
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ève Dubé
- Faculty of Social Sciences, Université Laval, Quebec City, Quebec, Canada
| | - Arnaud Gagneur
- Département de pédiatrie, Université de Sherbrooke, Centre de Recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Joan Robinson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Matthew Tunis
- Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Dubé E, Gagnon D, Kaminsky K, Green CR, Ouakki M, Bettinger JA, Brousseau N, Castillo E, Crowcroft NS, Driedger SM, Greyson D, Fell D, Fisher W, Gagneur A, Guay M, Halperin D, Halperin SA, MacDonald S, Meyer SB, Waite NM, Wilson K, Witteman HO, Yudin M, Cook JL. Vaccination during pregnancy: Canadian maternity care providers' opinions and practices. Hum Vaccin Immunother 2020; 16:2789-2799. [PMID: 32271655 DOI: 10.1080/21645515.2020.1735225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A number of countries have implemented vaccination in pregnancy as a strategy to reduce the burden of influenza and pertussis. The aim of this study was to assess the involvement of Canadian maternity care providers in administration of vaccines to their pregnant patients. A cross-sectional web-based survey was sent to family physicians, obstetricians-gynecologists, midwives, pharmacists, and nurses. A multivariable logistic regression model was used to determine variables independently associated with offering vaccination services in pregnancy in providers' practice. A total of 1,135 participants participated. Overall, 64% (n = 724) of the participants reported offering vaccines in their practice and 56% (n = 632) reported offering vaccines to pregnant patients. The main reasons reported for not offering vaccination services in pregnancy were the belief that vaccination was outside of the scope of practice; logistical issues around access to vaccines; or lack of staff to administer vaccines. In multivariable analysis, the main factors associated with vaccination of pregnant patients in practices where vaccination services were offered were: providers' confidence in counseling pregnant patients about vaccines, seeing fewer than 11 pregnant patients on average each week, and being a nurse or a family physician. Although the majority of participants expressed strong support for vaccination during pregnancy, half were not offering vaccination services in their practice. Many were not equipped to offer vaccines in their practice or felt that it was not their role to do so. To enhance vaccine acceptance and uptake in pregnancy, it will be important to address the logistical barriers identified in this study.
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Affiliation(s)
- Eve Dubé
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Dominique Gagnon
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Kyla Kaminsky
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Courtney R Green
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
| | - Manale Ouakki
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Nicholas Brousseau
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada
| | - Eliana Castillo
- Cumming School of Medicine, University of Calgary , Calgary, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Institute for Clinical Evaluative Sciences and University of Toronto , Toronto, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba , Winnipeg, Canada
| | - Devon Greyson
- Vaccine Evaluation Center, University of British Columbia , Vancouver, Canada
| | - Deshayne Fell
- School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada.,Research Institute, Children's Hospital of Eastern Ontario , Ottawa, Canada
| | - William Fisher
- Department of Psychology, Western University , London, Canada
| | - Arnaud Gagneur
- Département des soins de santé communautaire, Université de Sherbrooke , Sherbrooke, Canada
| | - Maryse Guay
- Direction des risques biologiques et de la santé au travail, Institut National de Santé Publique du Québec , Québec, Canada.,Centre de recherche de l'hôpital Charles Le Moyne , Longueuil, Canada
| | - Donna Halperin
- School of Nursing, St. Francis Xavier University , Antigonish, Canada
| | - Scott A Halperin
- Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University and the IWK Health Centre , Halifax, Canada
| | - Shannon MacDonald
- Faculty of Nursing, School of Public Health, University of Alberta , Edmonton, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo , Waterloo, Canada
| | - Nancy M Waite
- Department of Pharmacy, University of Waterloo , Waterloo, Canada
| | | | - Holly O Witteman
- Département de médecine familiale et de médecine d'urgence, Université Laval , Québec, Canada
| | - Mark Yudin
- Department of Obstetrics and Gynecology, University of Toronto , Toronto, Canada
| | - Jocelynn L Cook
- Society of Obstetricians and Gynaecologists of Canada , Ottawa, Canada
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30
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Hakim H, Bettinger JA, Chambers CT, Driedger SM, Dubé E, Gavaruzzi T, Giguere AMC, Kavanagh É, Leask J, MacDonald SE, Orji R, Parent E, Paquette JS, Roberge J, Sander B, Scherer AM, Tremblay-Breault M, Wilson K, Reinharz D, Witteman HO. A Web Application About Herd Immunity Using Personalized Avatars: Development Study. J Med Internet Res 2020; 22:e20113. [PMID: 33124994 PMCID: PMC7665952 DOI: 10.2196/20113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/03/2020] [Accepted: 07/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Herd immunity or community immunity refers to the reduced risk of infection among susceptible individuals in a population through the presence and proximity of immune individuals. Recent studies suggest that improving the understanding of community immunity may increase intentions to get vaccinated. OBJECTIVE This study aims to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. METHODS Our multidisciplinary team developed a web application about community immunity to communicate epidemiological evidence in a personalized way. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. We predefined communication goals, created prototype visualizations, and tested four iterative versions of our visualization in a university-based human-computer interaction laboratory and community-based settings (a cafeteria, two shopping malls, and a public library). Data included psychophysiological measures (eye tracking, galvanic skin response, facial emotion recognition, and electroencephalogram) to assess participants' cognitive and affective responses to the visualization and verbal feedback to assess their interpretations of the visualization's content and messaging. RESULTS Among 110 participants across all four cycles, 68 (61.8%) were women and 38 (34.5%) were men (4/110, 3.6%; not reported), with a mean age of 38 (SD 17) years. More than half (65/110, 59.0%) of participants reported having a university-level education. Iterative changes across the cycles included adding the ability for users to create their own avatars, specific signals about who was represented by the different avatars, using color and movement to indicate protection or lack of protection from infectious disease, and changes to terminology to ensure clarity for people with varying educational backgrounds. Overall, we observed 3 generalizable findings. First, visualization does indeed appear to be a promising medium for conveying what community immunity is and how it works. Second, by involving multiple users in an iterative design process, it is possible to create a short and simple visualization that clearly conveys a complex topic. Finally, evaluating users' emotional responses during the design process, in addition to their cognitive responses, offers insights that help inform the final design of an intervention. CONCLUSIONS Visualization with personalized avatars may help people understand their individual roles in population health. Our app showed promise as a method of communicating the relationship between individual behavior and community health. The next steps will include assessing the effects of the application on risk perception, knowledge, and vaccination intentions in a randomized controlled trial. This study offers a potential road map for designing health communication materials for complex topics such as community immunity.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada, Winnipeg, MB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Institut national de santé publique du Québec, Quebec City, QC, Canada
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy, Padova, Italy
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | - Éric Kavanagh
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Julie Leask
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, Australia
| | | | - Rita Orji
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Elizabeth Parent
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
| | | | - Jacynthe Roberge
- École de design, Édifice La Fabrique, Laval University, Quebec City, QC, Canada
| | - Beate Sander
- University Health Network, Toronto General Hospital, Eaton Building, Toronto, ON, Canada
| | - Aaron M Scherer
- Department of Internal Medicine, University of Iowa, Iowa, IA, United States
| | | | - Kumanan Wilson
- Department of Medicine, Bruyere Research Institute and Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, Quebec City, QC, Canada
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31
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Cooper E, Driedger SM, Lavoie J. Building on Strengths: Collaborative Intergenerational Health Research with Urban First Nations and Métis Women and Girls. IJIH 2019. [DOI: 10.32799/ijih.v14i1.31932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Little research has focused on how Indigenous girls and their familial female caregivers negotiate issues pertaining to wellbeing and decision-making practices. To address this gap, we employed a novel intergenerational Indigenous partnership methods using various decolonizing action and arts-based activities, to allow participants to guide and modify the direction of the research throughout data collection. We report on three separate activities: a physical game to address concepts of wellness, a memory game that focused on harm reduction and an art project that explored self-esteem. Within each of these activities, female family members and girls worked together to unpack issues of importance within their lives. We conclude that a flexible participatory research design within an intergenerational setting can meet not only the proposed research objectives, but participants’ ever-changing questions and concerns pertaining to health and wellbeing, while still producing rich data to answer important research questions.
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Abstract
It is important to recognize that experiences of racial and gendered violence are a sad legacy of colonialism. The experiences of historical trauma are on-going. These affect the mental and physical wellbeing of individuals, families and communities. Addressing historical trauma through community-informed practices is central to creating space for meaningful change. This paper outlines results from a seven-week activity-based research workshop conducted on three separate occasions with urban-based First Nations and Metis women and girls (aged 8-12). Using a decolonizing theoretical framework, this paper examines data collected within three specific arts-based activities: empowerment bracelets, "I'm proud of you" charm bracelets and "Who I am" pictures. Women were hesitant to discuss future plans, as many were not confident that their daughters would be in contact with their maternal families when they become teenagers. Girls observed and mimicked the thoughts and actions of their mothers, step-mothers, aunts, older sisters and grandmothers. They demonstrated the role they already play within the discourse of what it means to be female living within their communities. This paper concludes with the implicit harm reduction approach women and girls used when exploring the impacts of trauma while envisioning a healthier future.
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Affiliation(s)
- Elizabeth Cooper
- Faculty of Health Sciences, University of the Fraser Valley, Abbotsford, Canada.
| | - S Michelle Driedger
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josée G Lavoie
- Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Hakim H, Provencher T, Chambers CT, Driedger SM, Dube E, Gavaruzzi T, Giguere AMC, Ivers NM, MacDonald S, Paquette JS, Wilson K, Reinharz D, Witteman HO. Interventions to help people understand community immunity: A systematic review. Vaccine 2018; 37:235-247. [PMID: 30528593 DOI: 10.1016/j.vaccine.2018.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/05/2018] [Accepted: 11/01/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Herd immunity, or community immunity, occurs when susceptible people in a population are indirectly protected from infection thanks to the pervasiveness of immunity within the population. In this study, we aimed to systematically review interventions designed to communicate what community immunity is and how community immunity works to members of the general public. METHODS We searched PubMed, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and Web of Science for peer-reviewed articles describing interventions with or without evaluations. We then conducted web searches with Google to identify interventions lacking associated publications. We extracted data about the target population of the interventions, the interventions themselves (e.g., did they describe what community immunity is, and how it works), any effects of evaluated interventions, and synthesized data narratively. RESULTS We identified 32 interventions: 11 interventions described in peer-reviewed articles and 21 interventions without associated articles. Of the 32 interventions, 5 described what community immunity is, 6 described the mechanisms of how community immunity occurs and 21 described both. Fourteen of the 32 addressed infectious diseases in general while the other 13 addressed one or more specific diseases. Twelve of the 32 interventions used videos, 7 used interactive simulations and 6 used questionnaires. Ten of the 11 peer-reviewed articles described studies evaluating at least one effect of the interventions. Within these 10, 4/4 reported increased knowledge, 3/5 reported shifts of attitudes in favour of vaccination, 2/5 reported increased intentions to vaccinate. Of 3 studies evaluating interventions specifically about community immunity, 2 reported increased intentions to vaccinate. CONCLUSIONS A compelling benefit of vaccination exists at the population level in the form of community immunity. Identifying ways to optimally communicate about this benefit may be important, because some evidence suggests that effective communication about community immunity can increase vaccination intentions.
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Affiliation(s)
- Hina Hakim
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | | | - Christine T Chambers
- Department of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Eve Dube
- Institut national de santé publique du Québec, Quebec City, QC, Canada.
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
| | - Anik M C Giguere
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital - University of Toronto, Toronto, ON, Canada.
| | | | - Jean-Sebastien Paquette
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
| | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Daniel Reinharz
- Department of Social and Preventive Medicine, Laval University, Quebec City, QC, Canada.
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Quebec City, QC G1V 0A6, Canada.
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34
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Dubé E, Gagnon D, Kaminsky K, Green CR, Ouakki M, Bettinger JA, Brousseau N, Castillo E, Crowcroft NS, Driedger SM, Greyson D, Fell D, Fisher W, Gagneur A, Guay M, Halperin D, Halperin SA, MacDonald S, Meyer SB, Waite NM, Wilson K, Witteman HO, Yudin M, Cook JL. Vaccination Against Influenza in Pregnancy: A Survey of Canadian Maternity Care Providers. J Obstet Gynaecol Can 2018; 41:479-488. [PMID: 30409569 DOI: 10.1016/j.jogc.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/06/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Influenza vaccine uptake among Canadian pregnant individuals is suboptimal. Failure to incorporate vaccination into routine prenatal care and a lack of recommendations from healthcare providers are recognized as barriers to vaccination. The aim of this study was to assess Canadian maternity care providers' knowledge, attitudes, and practices regarding influenza vaccination in pregnancy. METHODS A cross-sectional Web-based questionnaire was sent during July and August 2017 to family physicians, obstetricians-gynaecologists, midwives, pharmacists, and nurses who care for pregnant individuals. A multivariable logistic regression model was used to determine variables independently associated with providers' recommendation of the influenza vaccine in pregnancy. RESULTS The analysis included 1061 providers. Most participants (85%) reported being vaccinated against influenza themselves, and 72% reported recommending the influenza vaccine to all of their pregnant patients during the previous influenza season. Participants' attitudes regarding influenza vaccination during pregnancy were generally positive: 64% strongly agreed that pregnant individuals are at an increased risk of complications from influenza, and 69% strongly agreed that it is safe to vaccinate pregnant individuals against influenza. The main determinants of participants' recommendations for influenza vaccination to all pregnant patients were following official recommendations on influenza vaccination, discussing vaccines with most or all pregnant individuals seen in their practice, and being vaccinated themselves during the previous influenza season. CONCLUSION Enhancing influenza vaccine uptake in pregnancy is largely dependent on maternity care providers' recommendations. This study provides valuable insight on providers' knowledge, attitudes, and practices.
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Affiliation(s)
- Eve Dubé
- Institut national de santé publique du Québec, Québec, QC.
| | | | - Kyla Kaminsky
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Courtney R Green
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
| | - Manale Ouakki
- Institut national de santé publique du Québec, Québec, QC
| | - Julie A Bettinger
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC
| | | | - Eliana Castillo
- Cumming School of Medicine, University of Alberta, Edmonton, AB
| | | | - S Michelle Driedger
- Department of Community Health Science, University of Manitoba, Winnipeg, MB
| | - Devon Greyson
- Vaccine Evaluation Center, University of British Columbia, Vancouver, BC
| | - Deshayne Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - William Fisher
- Department of Psychology, Western University, London, ON
| | - Arnaud Gagneur
- Department of Community Health Medicine, Université de Sherbrooke, Sherbrooke, QC
| | - Maryse Guay
- Department of Community Health Medicine, Université de Sherbrooke, Sherbrooke, QC
| | | | | | | | | | - Nancy M Waite
- School of Pharmacy, University of Waterloo, Waterloo, ON
| | | | | | | | - Jocelynn L Cook
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON
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Kelly LE, Dyson MP, Butcher NJ, Balshaw R, London AJ, Neilson CJ, Junker A, Mahmud SM, Driedger SM, Wang X. Considerations for adaptive design in pediatric clinical trials: study protocol for a systematic review, mixed-methods study, and integrated knowledge translation plan. Trials 2018; 19:572. [PMID: 30340624 PMCID: PMC6194696 DOI: 10.1186/s13063-018-2934-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022] Open
Abstract
Background Although children have historically been excluded from clinical trials (CTs), many require medicines tested and approved in CTs, forcing health care providers to treat their pediatric patients based on extrapolated data. Unfortunately, traditional randomized CTs can be slow and resource-intensive, and they often require multi-center collaboration. However, an adaptive design (AD) framework for CTs could be used to increase the efficiency of pediatric CTs by incorporating prospectively planned modifications to CT methods without undermining the integrity or validity of the study. There are many possible adaptations, but each will have ethical, logistical, and statistical implications. It remains unclear which adaptations (or combinations thereof) will lead to real-world improvements in pediatric CT efficiency. This study will identify, evaluate, and synthesize the various regulatory, ethical, logistical, and statistical considerations and emerging issues of AD in CTs that could be used to evaluate the use of drugs in children. Methods/design Following the development of a peer-reviewed search strategy, a systematic review on AD in CTs will be conducted. Data on regulatory, ethical, logistic, and statistical considerations as well as population and trial design characteristics will be synthesized. A mixed-methods study including surveys and focus groups with regulators, research ethics board members, biostatisticians, clinicians, and scientists, as well as representatives from patient groups and the public will evaluate the opportunities and challenges in applying AD in trials enrolling children and propose recommendations on best practices. Discussion This study will deliver practical recommendations on the use of AD in pediatric CTs. Collaboration and consultation with national and global partners will ensure that our results meet the needs of researchers, regulators, and patients, both locally and globally, and that they remain current and relevant by engaging a wide variety of stakeholders. Overall, this research will enrich the knowledge base regarding if, how, and when AD can be used to answer research questions with fewer resources while still meeting the highest ethical standards and regulatory requirements for CTs. In turn, this will result in increased high-quality clinical research needed by health care providers so they have access to appropriate, population-specific evidence regarding the safe and effective use of medicines in children.
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Affiliation(s)
- Lauren E Kelly
- Department of Pediatrics and Child Health, The University of Manitoba, 405 Chown, 753 McDermot Ave., Winnipeg, MB, R3E0T6, Canada. .,Clinical Trials Platform, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada. .,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Michele P Dyson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Robert Balshaw
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Data Science Platform, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Alex John London
- Center for Ethics and Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Christine J Neilson
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Junker
- Department of Allergy and Immunology, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Salaheddin M Mahmud
- Clinical Trials Platform, George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Vaccine and Drug Evaluation Centre, University of Manitoba, Winnipeg, MB, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Xikui Wang
- Department of Statistics, University of Manitoba, Winnipeg, MB, Canada
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Driedger SM, Cooper E, Annable G, Brouwers M. "There is always a better way": Managing uncertainty in decision making about new cancer drugs in Canada. Int J Health Plann Manage 2018; 33:e485-e499. [PMID: 29417619 DOI: 10.1002/hpm.2492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/07/2018] [Indexed: 11/10/2022] Open
Abstract
Policy decisions about the approval and funding of new cancer drugs must often be made in an environment of complex uncertainty about clinical and cost-effectiveness data. The focus of this article is on the results from qualitative interviews with senior officials (n = 16) who make decisions about or influence cancer drug policy in various organizations in the Canadian cancer control system. Most participants identified the use of a limited number of informal approaches to address uncertainty, such as grounding decisions in evidence and advice from expert groups. People tended to focus on evidence informed decisions including price negotiations, the ability to implement policy changes, and stakeholder values. Lessons from the Canadian context related to continuing efforts to build a public culture of understanding into how policy decisions like cancer drug funding are made may result in greater acceptance and increased confidence in health policy decision-making processes across multiple sectors internationally.
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Affiliation(s)
- S Michelle Driedger
- Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Cooper
- Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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Patey AM, Curran JA, Sprague AE, Francis JJ, Driedger SM, Légaré F, Lemyre L, Pomey MPA, Grimshaw JM. Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses' fetal surveillance practice using theoretical domains framework. BMC Pregnancy Childbirth 2017; 17:320. [PMID: 28946843 PMCID: PMC5613395 DOI: 10.1186/s12884-017-1517-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/18/2017] [Indexed: 11/30/2022] Open
Abstract
Background Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Methods Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. Results We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses’ behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social influences; Behavioural regulation). Conclusion We identified potential influences on birthing unit nurses’ use of IA as their primary method of fetal surveillance. These beliefs suggest potential targets for behaviour change interventions to promote IA use. Electronic supplementary material The online version of this article (10.1186/s12884-017-1517-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea M Patey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute - General Campus, Ottawa, Canada. .,School of Health Sciences, City, University of London, London, UK.
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, Canada
| | - Ann E Sprague
- Better Outcomes Registry and Network Ontario, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jill J Francis
- School of Health Sciences, City, University of London, London, UK
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - France Légaré
- Département de Médecine Sociale et Préventive, Faculté de médecine, Université Laval, Québec, Canada.,Axe Santé des Populations et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec, Québec, Canada
| | - Louise Lemyre
- School of Psychology, University of Ottawa, Ottawa, Canada
| | | | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute - General Campus, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Driedger SM, Annable G, Brouwers M, Turner D, Maier R. Can you un-ring the bell? A qualitative study of how affect influences cancer screening decisions. BMC Cancer 2017; 17:647. [PMID: 28903742 PMCID: PMC5598010 DOI: 10.1186/s12885-017-3596-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/23/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The belief that early detection is the best protection against cancer underlies cancer screening. Emerging research now suggests harms associated with early detection may sometimes outweigh the benefits. Governments, cancer agencies, and organizations that publish screening guidelines have found it is difficult to "un-ring the bell" on the message that "early detection is your best protection" because of its widespread communication and enduring resonance. This study explores affective factors-and their interplay with relevant analytical factors-in public/laypersons' decision making about cancer screening. METHODS A total of 93 people (47 men, 46 women) attended focus groups about, respectively, prostate cancer screening and breast cancer screening in two Canadian cities. RESULTS Affective factors were a major influence on many focus group participants' decision making about cancer screening, including fear of cancer and a generalized enthusiasm for prevention/screening, and they were often inspired by anecdotes about the cancer experiences of family and friends. Affect also existed alongside more analytical factors including assessments of reduced risk in the management of any cancer diagnosis if caught early, and, for men, the belief that an unreliable test is "better than nothing," and that men deserve prostate cancer screening because women have breast and cervical cancer screening. Affective factors were particularly noticeable in the sub-groups most supportive of screening and the "early detection" message: older women who felt that mammogram screening should begin at age 40 rather than 50, and older men who felt that prostate cancer screening should be expanded beyond its current unorganized, opportunistic usage. In contrast, younger participants displayed less affective attachments to "early detection" messages and had greater concerns about harms of screening and were more receptive to nuanced messages informed by evidence. CONCLUSION Policymakers attempting to communicate more nuanced versions of the "early detection" message need to understand the role of affect alongside other judgments brought into laypersons' decision making processes and anticipate how affective responses to their messages will be shaped, transformed, and potentially subverted by external forces beyond their control. Particularly overt external factors are campaigns by cancer advocacy organizations actively promoting breast and prostate cancer awareness and screening to younger women and men using affectively-charged messages.
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Affiliation(s)
- S. Michelle Driedger
- Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Gary Annable
- Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Juravinski Site, 60 (G) Wing, 711 Concession Street, Hamilton, ON L8V 1C3 Canada
| | - Donna Turner
- Population Oncology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, MB R3E 0V9 Canada
| | - Ryan Maier
- Community Health Sciences, College of Medicine, Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
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Driedger SM, Maier R, Marrie RA, Brouwers M. Caught in a no-win situation: discussions about CCSVI between persons with multiple sclerosis and their neurologists - a qualitative study. BMC Neurol 2017; 17:176. [PMID: 28882115 PMCID: PMC5590111 DOI: 10.1186/s12883-017-0954-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/27/2017] [Indexed: 12/05/2022] Open
Abstract
Background In recent years, shared decision making (SDM) has been promoted as a model to guide interactions between persons with MS and their neurologists to reach mutually satisfying decisions about disease management – generally about deciding treatment courses of prevailing disease modifying therapies. In 2009, Dr. Paolo Zamboni introduced the world to his hypothesis of Chronic Cerebrospinal Venous Insufficiency (CCSVI) as a cause of MS and proposed venous angioplasty (‘liberation therapy’) as a potential therapy. This study explores the discussions that took place between persons with MS (PwMS) and their neurologists about CCSVI against the backdrop of the recent calls for the use of SDM to guide clinical conversations. Methods In 2012, study researchers conducted focus groups with PwMS (n = 69) in Winnipeg, Canada. Interviews with key informants were also carried out with 15 participants across Canada who were stakeholders in the MS community: advocacy organizations, MS clinicians (i.e. neurologists, nurses), clinical researchers, and government health policy makers. Results PwMS reported a variety of experiences when attempting to discuss CCSVI with their neurologist. Some found that there was little effort to engage in desired discussions or were dissatisfied with critical or cautious stances of their neurologist. This led to communication breakdowns, broken relationships, and decisions to autonomously access alternative opinions or liberation therapy. Other participants were appreciative when clinicians engaged them in discussions and were more receptive to more critical appraisals of the evidence. Key informants reported that they too had heard of neurologists who refused to discuss CCSVI with patients and that neurology as a whole had been particularly vilified for their response to the hypothesis. Clinicians indicated that they had shared information as best they could but recommended against seeking liberation therapy. They noted that being respectful of patient emotions, values, and hope were also key to maintaining good relationships. Conclusions While CCSVI proved a challenging context to carry out patient-physician discussions and brought numerous tensions to the surface, following the approach of SDM can minimize the potential for unfortunate outcomes as much as possible because it is based on principles of respect and more two-way communication. Electronic supplementary material The online version of this article (10.1186/s12883-017-0954-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ryan Maier
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, ON, Canada
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Driedger SM, Eyles J. Charting Uncertainty in Science-Policy Discourses: The Construction of the Chlorinated Drinking-Water Issue and Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.1068/c007r] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Drinking-water guidelines remain an ongoing issue within Canada, as elsewhere. Given recent epidemiological evidence concerning chlorinated disinfection byproducts in drinking water and cancer outcomes, some branches within Health Canada have been undertaking an extensive review of the issue. This paper examines what impact contested scientific authorities, as filtered through a regulatory agency, may have on the policymaking process in the setting of Canadian drinking-water guidelines. Using an agenda-setting framework, we rely on a textual analysis of a Health Canada expert panel report and a position paper written to accompany the panel report; Canadian print media translations of scientific evidence; and in-depth interviews with scientists (from the academy, industry, and government) and other interested stakeholders [for example, chlorine and water industry, and environmental nongovernmental organizations]. Through this analysis we reconstruct a discourse which suggests government-science in policy, rather than policymakers, is primarily and presently driving the issue. The issue itself appears to remain a debate which is largely over the strength of the scientific evidence from regulatory and public-health scientists (for example, in Health Canada), and their colleague research scientists (for example, leading researchers in the field). Although we argue that it is primarily cancer that drives the science-policy agenda, with respect to chlorinated drinking water, it is possible that reproductive effects are likely to be central to the debate for controlling chlorine use in the future.
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Affiliation(s)
- S Michelle Driedger
- Department of Geography, Simard Hall, University of Ottawa, 60 University Private, Ottawa, Ontario K1N 6N5, Canada
| | - John Eyles
- School of Geography and Geology, McMaster Institute for Environment and Health, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
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Dubé E, Gagnon D, Ouakki M, Bettinger JA, Guay M, Halperin S, Wilson K, Graham J, Witteman HO, MacDonald S, Fisher W, Monnais L, Tran D, Gagneur A, Guichon J, Saini V, Heffernan JM, Meyer S, Driedger SM, Greenberg J, MacDougall H. Understanding Vaccine Hesitancy in Canada: Results of a Consultation Study by the Canadian Immunization Research Network. PLoS One 2016; 11:e0156118. [PMID: 27257809 PMCID: PMC4892544 DOI: 10.1371/journal.pone.0156118] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/08/2016] [Indexed: 11/18/2022] Open
Abstract
"Vaccine hesitancy" is a concept now frequently used in vaccination discourse. The increased popularity of this concept in both academic and public health circles is challenging previously held perspectives that individual vaccination attitudes and behaviours are a simple dichotomy of accept or reject. A consultation study was designed to assess the opinions of experts and health professionals concerning the definition, scope, and causes of vaccine hesitancy in Canada. We sent online surveys to two panels (1- vaccination experts and 2- front-line vaccine providers). Two questionnaires were completed by each panel, with data from the first questionnaire informing the development of questions for the second. Our participants defined vaccine hesitancy as an attitude (doubts, concerns) as well as a behaviour (refusing some / many vaccines, delaying vaccination). Our findings also indicate that both vaccine experts and front-line vaccine providers have the perception that vaccine rates have been declining and consider vaccine hesitancy an important issue to address in Canada. Diffusion of negative information online and lack of knowledge about vaccines were identified as the key causes of vaccine hesitancy by the participants. A common understanding of vaccine hesitancy among researchers, public health experts, policymakers and health care providers will better guide interventions that can more effectively address vaccine hesitancy within Canada.
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Affiliation(s)
- Eve Dubé
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
- Maladies infectieuses et immunitaires, Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Dominique Gagnon
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Manale Ouakki
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Julie A. Bettinger
- Vaccine Evaluation Center, BC Children’s Hospital, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Maryse Guay
- Maladies infectieuses, Institut national de santé publique du Québec, Québec, Québec, Canada
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Scott Halperin
- Department of Microbiology & Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Janice Graham
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly O. Witteman
- Département de médecine familiale et de médecine d’urgence, Université Laval, Québec, Québec, Canada
- Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec–Université Laval, Québec, Québec, Canada
| | - Shannon MacDonald
- Nursing Faculty, University of Alberta, Edmonton, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - William Fisher
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - Laurence Monnais
- Département d'Histoire, Université de Montréal, Montréal, Québec, Canada
| | - Dat Tran
- Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Arnaud Gagneur
- Département de pédiatrie, Service de néonatologie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Juliet Guichon
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Vineet Saini
- Department of Production Animal Health, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Jane M. Heffernan
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - S. Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joshua Greenberg
- School of Journalism and Communication, Carleton University, Ottawa, Ontario, Canada
| | - Heather MacDougall
- Department of History, University of Waterloo, Waterloo, Ontario, Canada
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Dhar-Chowdhury P, Haque CE, Driedger SM. Dengue Disease Risk Mental Models in the City of Dhaka, Bangladesh: Juxtapositions and Gaps Between the Public and Experts. Risk Anal 2016; 36:874-891. [PMID: 26387980 DOI: 10.1111/risa.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Worldwide, more than 50 million cases of dengue fever are reported every year in at least 124 countries, and it is estimated that approximately 2.5 billion people are at risk for dengue infection. In Bangladesh, the recurrence of dengue has become a growing public health threat. Notably, knowledge and perceptions of dengue disease risk, particularly among the public, are not well understood. Recognizing the importance of assessing risk perception, we adopted a comparative approach to examine a generic methodology to assess diverse sets of beliefs related to dengue disease risk. Our study mapped existing knowledge structures regarding the risk associated with dengue virus, its vector (Aedes mosquitoes), water container use, and human activities in the city of Dhaka, Bangladesh. "Public mental models" were developed from interviews and focus group discussions with diverse community groups; "expert mental models" were formulated based on open-ended discussions with experts in the pertinent fields. A comparative assessment of the public's and experts' knowledge and perception of dengue disease risk has revealed significant gaps in the perception of: (a) disease risk indicators and measurements; (b) disease severity; (c) control of disease spread; and (d) the institutions responsible for intervention. This assessment further identifies misconceptions in public perception regarding: (a) causes of dengue disease; (b) dengue disease symptoms; (c) dengue disease severity; (d) dengue vector ecology; and (e) dengue disease transmission. Based on these results, recommendations are put forward for improving communication of dengue risk and practicing local community engagement and knowledge enhancement in Bangladesh.
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Affiliation(s)
- Parnali Dhar-Chowdhury
- Natural Resources Institute, University of Manitoba, Winnipeg, MB, Canada, R3T 2N2
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada, R3E 3R2
| | - C Emdad Haque
- Natural Resources Institute, University of Manitoba, Winnipeg, MB, Canada, R3T 2N2
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada, R3E 0W3
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Jardine CG, Boerner FU, Boyd AD, Driedger SM. The More the Better? A Comparison of the Information Sources Used by the Public during Two Infectious Disease Outbreaks. PLoS One 2015; 10:e0140028. [PMID: 26485302 PMCID: PMC4618063 DOI: 10.1371/journal.pone.0140028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 09/21/2015] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Cynthia G. Jardine
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Franziska U. Boerner
- Institute for Technology Assessment and Systems Analysis, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Amanda D. Boyd
- The Edward R. Murrow College of Communication, Washington State University, Pullman, Washington, United States of America
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Abstract
Purpose
– Scholars rely on electronic databases to conduct searches and locate relevant citations. The purpose of this paper is to compare the retrieval results on the same topic (multiple sclerosis and liberation therapy) of two commonly used databases for searching print news media: ProQuest’s Canadian Newsstand Major Dailies and Dow Jones’ Factiva.
Design/methodology/approach
– A case study comparing two electronic searchable databases using the same keywords, date range, and newspaper-specific search parameters across three Canadian university institutions.
Findings
– Considerable differences were found between institutional searches using Factiva. Factiva allows all individual users the capacity to establish systems-wide “administrator” privileges, thereby controlling the output for subsequent users if these preferences are not changed. The capacity for individual users to tailor searches within Canadian Newsstand Major Dailies was more in line with standard protocols for institutions paying for single user accounts with access to multiple sessions within that same institution: any user-specific searching/retrieval preferences are individually contained within a search and do not influence the searches of a different user.
Research limitations/implications
– What began as a comparative analysis of two commonly used databases for searching print news media turned into an examination of larger systemic problems. The findings call into question several factors: the integrity of a researcher-generated data set; the quality of results published in peer-reviewed journals based on researcher-generated data sets derived from established e-resource databases; the reliability of the same e-resource database across multiple institutions; and the quality of e-resource databases for scholarly research when developed to serve primarily non-academic clients.
Originality/value
– No comparison of this kind for these particular e-resource databases has been documented in the literature. In fact, the scholarly publications that address questions of functionality and reliability of either Factiva or Proquest have not brought this issue into the discussion. Therefore, this study furthers academic discourse on the nature and reliability of database use at any academic institution and illustrates that researchers, in a variety of academic fields, cannot depend on the reliability of their search results without thoroughly consulting the various settings of their database.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Dhar-Chowdhury P, Emdad Haque C, Michelle Driedger S, Hossain S. Community perspectives on dengue transmission in the city of Dhaka, Bangladesh. Int Health 2014; 6:306-16. [PMID: 24981443 DOI: 10.1093/inthealth/ihu032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The recurrence of dengue has become a growing public health threat. This research examines the knowledge, beliefs, attitudes and practice of local community members regarding dengue transmission in the city of Dhaka, Bangladesh. It also investigates explanatory demographic and socioeconomic factors that affect community knowledge, beliefs and practices. METHODS In July-August 2011, a random sample of household heads or alternatives (n=300) was surveyed in 12 wards of Dhaka. This survey was supplemented by 12 focus group discussions (n=107) and 18 key informant interviews in three selected wards. RESULTS Most community members had heard about dengue (91.3%; 274/300) and knew (93.7%; 281/300) that mosquitoes act as the primary vector of its transmission. In contrast, most (87.3%; 262/300) was unaware that Aedes mosquitoes prefer to lay their eggs in water containers. Multivariate logistic regression modeling revealed that the respondents in age group 45-60 years were 2.83 times more likely to have positive attitudes towards undertaking precautionary measures to prevent dengue than the respondents aged <25 years. CONCLUSIONS These findings confirm the presence in local communities of misconceptions and considerable knowledge gaps about dengue transmission that could be improved by formulating interventions targeting specific subgroups of the population.
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Affiliation(s)
- Parnali Dhar-Chowdhury
- Natural Resources Institute, University of Manitoba, 70 Dysart Road, Winnipeg, MB, Canada R3T 2N2 National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada R3E 3R2
| | - C Emdad Haque
- Natural Resources Institute, University of Manitoba, 70 Dysart Road, Winnipeg, MB, Canada R3T 2N2
| | - S Michelle Driedger
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada R3E 0W3
| | - Shakhawat Hossain
- Department of Mathematics and Statistics, University of Winnipeg, Winnipeg, MB, Canada R3B 2E9
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Driedger SM, Cooper EJ, Moghadas SM. Developing model-based public health policy through knowledge translation: the need for a 'Communities of Practice'. Public Health 2014; 128:561-7. [PMID: 24461909 DOI: 10.1016/j.puhe.2013.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The 2009 influenza A (H1N1) pandemic prompted public health agencies worldwide to respond in a context of substantial uncertainty. While many lessons around successful management strategies were learned during the influenza A (H1N1) pandemic, the usefulness and impact of mathematical models to optimize policy decisions in protecting public health were poorly realized. The authors explored the experiences of modellers and public health practitioners in trying to develop model-based public health policies in the management of the 2009 influenza A (H1N1) pandemic in Canada. STUDY DESIGN A qualitative case study design based on interviews and other textual data was used. METHODS Individual interviews were conducted with mathematical modellers and public health professionals from academia and government health departments during the second wave of the 2009 influenza A (H1N1) pandemic (both prior to and following the vaccine roll-out), using a convergent interviewing process. Interviews were supplemented with discussions held during three separate workshops involving representatives from these groups on the role of modelling in pandemic preparedness and responses. NVivo9™ was used to analyse interview data and associated notes. RESULTS Mathematical models were underutilized during the response phase of the 2009 influenza A (H1N1) pandemic, largely because many public health professionals were unaware of modelling infrastructure in Canada. Challenges were reflected in three ways: 1) the relevance of models to public health priorities; 2) the need for clear communication and plain language around modelling and its contributions and limitations; and 3) the need for increased trust and collaboration to develop strong working relationships. CONCLUSIONS Developing a 'Communities of Practice' between public health professionals and mathematical modellers during inter-pandemic periods based on common targeted goals, using plain language, and where relationships between individuals and organizations are developed early, could be an effective strategy to assist the process of public health policy decision-making, particularly when characterized by high levels of uncertainty.
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Affiliation(s)
- S M Driedger
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, Manitoba R3E 0W3, Canada.
| | - E J Cooper
- Department of Community Health Sciences, University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, Manitoba R3E 0W3, Canada.
| | - S M Moghadas
- Centre for Disease Modelling, York Institute for Health Research, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada.
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Driedger SM, Cooper E, Jardine C, Furgal C, Bartlett J. Communicating risk to aboriginal peoples: first nations and Metis responses to H1N1 risk messages. PLoS One 2013; 8:e71106. [PMID: 23940697 PMCID: PMC3737099 DOI: 10.1371/journal.pone.0071106] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 06/25/2013] [Indexed: 12/26/2022] Open
Abstract
Developing appropriate risk messages during challenging situations like public health outbreaks is complicated. The focus of this paper is on how First Nations and Metis people in Manitoba, Canada, responded to the public health management of pandemic H1N1, using a focus group methodology (n = 23 focus groups). Focus group conversations explored participant reactions to messaging regarding the identification of H1N1 virus risk groups, the H1N1 vaccine and how priority groups to receive the vaccine were established. To better contextualize the intentions of public health professionals, key informant interviews (n = 20) were conducted with different health decision makers (e.g., public health officials, people responsible for communications, representatives from some First Nations and Metis self-governing organizations). While risk communication practice has improved, ‘one size’ messaging campaigns do not work effectively, particularly when communicating about who is most ‘at-risk’. Public health agencies need to pay more attention to the specific socio-economic, historical and cultural contexts of First Nations and Metis citizens when planning for, communicating and managing responses associated with pandemic outbreaks to better tailor both the messages and delivery. More attention is needed to directly engage First Nations and Metis communities in the development and dissemination of risk messaging.
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Affiliation(s)
- S Michelle Driedger
- Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
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Jardine CG, Banfield L, Driedger SM, Furgal CM. Risk communication and trust in decision-maker action: a case study of the Giant Mine Remediation Plan. Int J Circumpolar Health 2013; 72:21184. [PMID: 23984297 PMCID: PMC3753156 DOI: 10.3402/ijch.v72i0.21184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Cynthia G Jardine
- Centre for Health Promotion Studies, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Boerner F, Keelan J, Winton L, Jardine C, Driedger SM. Understanding the interplay of factors informing vaccination behavior in three Canadian provinces. Hum Vaccin Immunother 2013; 9:1477-84. [PMID: 23571169 DOI: 10.4161/hv.24427] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Arguably, the two most critical components in any response to a pandemic are effective risk communication and the rapid development of a vaccine. Despite the roll-out of a publicly-funded H1N1 vaccine program across the country, less than half of all Canadians were vaccinated during the 2009-10 pandemic. Using focus group data, this study examined vaccinating behaviors, the impact of public health messaging, and the public's attitudes toward H1N1 and the H1N1 vaccine in three Canadian provinces. Drawing on vaccine risk communication literature, a framework was devised to identify and analyze the factors related to vaccine uptake and vaccine refusal. The most predictive factor for H1N1 vaccine uptake was a prior history of vaccinating against seasonal influenza. Other important factors included barriers to immunizing (access issues) and an individual's perception of serious risk from contracting H1N1. Although critical gaps in the public's understanding of influenza infections were identified, together with misinformation about vaccination effectiveness and safety, these factors were less frequently reported to be the core factors influencing an individual's decision to vaccinate.
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