title: Government bodies and their influence on the 2009 H1N1 health sector pandemic response in remote and isolated First Nation communities of sub-Arctic Ontario, Canada.
abstract: BACKGROUND
  First Nation communities were highly impacted by the 2009 H1N1 influenza pandemic. Multiple government bodies (ie federal, provincial, and First Nations) in Canada share responsibility for the health sector pandemic response in remote and isolated First Nation communities and this may have resulted in a fragmented pandemic response. This study aimed to discover if and how the dichotomy (or trichotomy) of involved government bodies led to barriers faced and opportunities for improvement during the health sector response to the 2009 H1N1 pandemic in three remote and isolated sub-arctic First Nation communities of northern Ontario, Canada.
  
  
  METHODS
  A qualitative community-based participatory approach was employed. Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the two (or three) government bodies of each study community. Data were manually transcribed and coded using deductive and inductive thematic analysis to reveal positive aspects, barriers faced, and opportunities for improvement along with the similarities and differences regarding the pandemic responses of each government body.
  
  
  RESULTS
  Primary barriers faced by participants included receiving contradicting governmental guidelines and direction from many sources. In addition, there was a lack of human resources, information sharing, and specific details included in community-level pandemic plans. Recommended areas of improvement include developing a complementary communication plan, increasing human resources, and updating community-level pandemic plans.
  
  
  CONCLUSIONS
  Participants reported many issues that may be attributable to the dichotomy (or trichotomy) of government bodies responsible for healthcare delivery during a pandemic. Increasing formal communication and collaboration between responsible government bodies will assist in clarifying roles and responsibilities and improve the pandemic response in Canada's remote and isolated First Nation communities.
authors.affiliation: University of Waterloo, Waterloo, Ontario, Canada. ncharani@uwaterloo.ca
authors.forename: N A
authors.initials: NA
authors.lastname: Charania
authors.forename: L J S
authors.initials: LJ
authors.lastname: Tsuji
mesh_terms: D035082:Federal Government; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control; D033181:Information Dissemination; D007400:Interprofessional Relations; D007407:Interviews as Topic; D009864:Ontario / Q000453:epidemiology; D058873:Pandemics; D011635:Public Health Administration / Q000379:methods*; D015980:Public Health Practice; D019035:Rural Health Services / Q000458:organization & administration*