Factors Affecting the Communication and Understanding of Known and Potential/Theoretical Risks to Health in Northern Aboriginal Communities

Investigator Name: Cynthia G. Jardine, Ph.D.

Project Completion Date: February 2007

Research Category: Research

Institution: University of Alberta

Project Number: 6795-15-2003/5750004

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Summary

In recent years, communication about risks to human health has commanded increasing public attention and reaction. Establishing a productive dialogue on health risks has become more challenging as issues and the related scientific information have become more complex and multi-faceted. This research study sought to develop better insight into the factors affecting the communication and understanding of both known and potential or theoretical risks to health in two similar, but unique northern Aboriginal communities B the Yellowknives Dene First Nation communities of N'Dilo and Dettah in the Northwest Territories and the Inuit communities of Nain and Hopedale in Nunatsiavut (Labrador).

The study was conducted as a collaborative effort between the researchers and the communities, using a participatory approach that included community members as partners. The first phase of the research involved collecting information on demographics, health status, lifestyle, risk perspectives and communication using a questionnaire administered by local trained community fieldworkers. A total of 50 people participated in the Northwest Territories - 29 in N'Dilo (8 men and 21 women) and 21 in Dettah (9 men and 12 women). In Nunatsiavut, 57 people participated B 28 in Nain (14 men and 14 women) and 29 in Hopedale (17 men and 12 women). The surveys were conducted in the local language (Dogrib in the Northwest Territories and Inuktitut in Nunatsiavut) when appropriate. In N'Dilo and Dettah answers to the open-ended questions were digitally recorded and transcribed verbatim. In Nain and Hopedale, the answers were recorded by the interviewers. The results of each questionnaire were entered into the computer program SPSS v.13.5 (later upgraded to v. 14.0). Common codes for the open-ended responses were developed and agreed upon by the investigators in both communities.

The second phase of the data collection was conducted using a relatively new and innovative research technique called PhotoVoice. Participants were asked to take pictures in their environment (using disposable cameras provided for them by the research team) that they felt posed a risk to themselves, their families and/or their community. They were then asked to discuss the pictures with the researchers in an informal interview. Participants were requested to pick four pictures to discuss, but were allowed to discuss all their pictures if desired. As in the previous stage of data collection, interviews were tape recorded, transcribed verbatim and translated into English, if necessary. Particip ants were provided with copies of their pictures. The data was coded separately by two or more members of each study team, and codes compared and coordinated, providing cross-coder validity. Categories reflect the major themes of the PhotoVoice pictures in each region.

The specific instruments and/or questions in both stages of the data collection were chosen to better understand: (1) the characteristics of the communities and the people within them (in terms of demographics, lifestyle, and traditional activities); (2) the risks of concerns to the people in these communities; (3) people's knowledge and understanding of various risks, and their current risk behaviours; and (5) people's current sources of information about risk, and their degree of trust in these sources.

It is becoming increasingly understood that perspectives of risk must be understood within the context of the interconnected social, economic and cultural milieus that define different communities. It is also known that people's responses to various risks (especially those associated with external threats) are strongly associated with 'place-identity'. The individuals interviewed in this study are long time residents of their respective communities. Most have lived in the same location for 20 years or more and thus have a strong attachment (cultural, social, and physical) to their local surroundings. These individuals represent distinct northern Aboriginal cultural groups. In addition, their responses to the lifestyle related questions posed in this research indicate a high level of activity in their local environment. These factors are indicative of the importance of their physical surroundings as a determinant of individual and community health and well-being. Whether it is through the provision of traditional/country foods (known as 'wild foods' in Nunatsiavut communities) or medicines, or the ability to get out on the land and practice traditional pursuits such as hunting and fishing, the environment is paramount in the health of individuals in each of these four communities.

In general, participants rate their h ealth as relatively good although there is some variation in this rating between regions and between communities in Nunatsiavut. They also indicated that they care deeply for their families and communities. Across all four communities, representatives expressed concern for the health of their community and future of their children. The social and economic environment in which many of the representatives live is reported to be having a negative impact on their health. Unemployment is high and formal education levels relatively low compared to other populations in the country. In nearly all cases, the level of activity of participants on the land B an important factor in their health and well-being - has decreased in recent years.

The importance of socio-cultural variables and place are evident in the risks of concern to these communities. Many of the health concerns reported by individuals in all communities are related to aspects of their social environment and personal behaviours. The most important concerns or health risks identified through responses to various questions include activities involving alcohol, drugs and smoking. This observation was confirmed through various forms of questions in the administered questionnaire, and independently validated in the PhotoVoice research. Those activities associated with these addictive behaviours were ranked in all communities as being the most dangerous (e.g. drinking alcohol while pregnant). In describing their assessment of these risks, participants spoke of the 'lack of control' or 'choice' in relation to these addictive behaviours. These risks are also of concern to people for the future of their children.

Participants in this study also expressed concern regarding contamination to their land from anthropogenic sources, although to a lesser extent than lifestyle related risks. Understanding of these risks was variable. In general, participants understood and recognized visible changes in their local environment but had difficulties reporting clear understanding of more 'invisible' phenomena, such as arsenic and PCB contamination of the land, water and animals.

Participants in the study appear to understand the nature and magnitude of the risks to their health associated with lifestyle and basic physical and environmental risks. They show indication of having received, comprehended and accepted information on these risks. However, in many instances, they have not modified their engagement in risky behaviours as one might expect were behavioural change to be the goal of this health messaging. Potential reasons for this lack of positive behavioural change may include such things as the influence of social norms which still consider some of these 'risky behaviours' as acceptable; the lack of options or the perception of the lack of options for positive behavioural change (e.g. changes in diet to minimize contaminant exposure through the consumption of country food species higher in some organochlorine and metal contaminants); or the lack of acceptance and potentially ineffective nature of the current messaging strategy (e.g. fear based health messaging).

Many of the main sources of health risk information listed by study participants are not well trusted. For example, in N'Dilo and Dettah friend/relatives and television were among the top four sources of information cited most frequently by respondents, yet had relatively low trust ratings. Conversely, elders were not listed as a main source of information, but had the highest trust rating. This divergence between who is used as a source of information and who is trusted as a source of information may also be contributing to discrepancies in reported risk perceptions and risk responses in these communities

The majority of participants in the four communities reported high levels of trust in elders and local representatives as sources of health information. However, elders are often not sufficiently informed to be able to provide this information in communities today. The advent of new technological risks to health is making this knowledge gap even more acute. This situation is similarly found with local health professionals, although often for different reasons related to individual time and capacity. In all communities, federal government agencies were not identified as being a key source of health infor mation, and were rated 'low' in terms of trust.

Recommendations:

• For known lifestyle risks, the solution to designing more effective risk communication and public health education campaigns is not simply 'more education' or 'better messages'. The fundamental need is to better understand the underlying factors influencing existing behaviours and to work with communities to find relevant and appropriate local solutions.
• Agencies responsible for communicating about risk need to pay greater attention to the emotional or affective reasoning portion of the risk message and the risk response.
• Messages that work towards arousing positive, rather than negative, emotional responses (such as those emphasizing the individual and community benefits associated with behaviour changes) might be more effective in changing risk behaviours.
• Agencies need to look to the effect of social systems and social acceptability on risk behaviours and incorporate these into local risk dialogues. Direct and meaningful community participation in risk issues and solutions is required.
• Agencies need to look for better ways to communicate with people in Indigenous communities about uncertain and frightening risks, such as those posed by environmental contamination. Effective risk communication requires committing the time and resources necessary to building a relationship and constructive dialogue with the people affected by the risk.
• Building the trust of an already distrustful public will also be an uphill challenge for government agencies. Perhaps government should at the very least strive for accountability and consistency of their actions in the short term, in the hope that this will lead to a fragile establishment of a trust relationship in the future. Incorporation of a fair, open process of public participation and dialogue is one important means of increasing public trust.

The views expressed herein do not necessarily represent the views of Health Canada