title: Assessing the effectiveness and feasibility of implementing mitigation measures for an influenza pandemic in remote and isolated First Nations communities: a qualitative community-based participatory research approach.
abstract: BACKGROUND
  The next influenza pandemic is predicted to disproportionately impact marginalized populations, such as those living in geographically remote Aboriginal communities, and there remains a paucity of scientific literature regarding effective and feasible community mitigation strategies. In Canada, current pandemic plans may not have been developed with adequate First Nations consultation and recommended measures may not be effective in remote and isolated First Nations communities.
  
  
  METHODS
  This study employed a community-based participatory research approach. Retrospective opinions were elicited via interview questionnaires with adult key healthcare informants (n=9) regarding the effectiveness and feasibility of implementing 41 interventions to mitigate an influenza pandemic in remote and isolated First Nations communities of sub-Arctic Ontario, Canada. Qualitative data were manually transcribed and deductively coded following a template organizing approach.
  
  
  RESULTS
  The results indicated that most mitigation measures could potentially be effective if modified to address the unique characteristics of these communities. Participants also offered innovative alternatives to mitigation measures that were community-specific and culturally sensitive. Mitigation measures were generally considered to be effective if the measure could aid in decreasing virus transmission, protecting their immunocompromised population, and increasing community awareness about influenza pandemics. Participants reported that lack of resources (eg supplies, monies, trained personnel), poor community awareness, overcrowding in homes, and inadequate healthcare infrastructure presented barriers to the implementation of mitigation measures.
  
  
  CONCLUSIONS
  This study highlights the importance of engaging local key informants in pandemic planning in order to gain valuable community-specific insight regarding the design and implementation of more effective and feasible mitigation strategies. As it is ethically important to address the needs of marginalized populations, it is recommended that these findings be incorporated in future pandemic plans to improve the response capacity and health outcomes of remote and isolated First Nations communities during the next public health emergency.
authors.affiliation: University of Waterloo, Waterloo, Ontario, Canada. ncharani@uwaterloo.ca.
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Charania
authors.forename: Leonard Js
authors.initials: LJ
authors.lastname: Tsuji
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000191:economics / Q000379:methods; D055812:Community-Based Participatory Research / Q000379:methods*; D019317:Evidence-Based Medicine; D005240:Feasibility Studies; D006271:Health Facility Closure; D006801:Humans; D007198:Indians, North American; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000517:prevention & control*; D009864:Ontario; D058873:Pandemics / Q000517:prevention & control; D015397:Program Evaluation; D036301:Qualitative Research; D011790:Quarantine / Q000379:methods; D012189:Retrospective Studies; D012424:Rural Population; D011795:Surveys and Questionnaires