title: Lived experience of acute gastrointestinal illness in Rigolet, Nunatsiavut: "just suffer through it".
abstract: Enteric illness associated with foodborne and waterborne disease is thought to be common in some Canadian Indigenous communities. This study aimed to understand the lived experience of acute gastrointestinal illness (AGI), including symptoms and severity, perceived causes, and healthcare seeking behaviors of AGI in the small Inuit community of Rigolet, Canada. A concurrent mixed quantitative and qualitative methods design was used. Two cross-sectional retrospective surveys provided quantitative data to examine self-reported AGI symptoms and the distribution of potential risk factors in the community. Qualitative data from in-depth interviews with one-third of AGI cases were analyzed using a constant-comparative method to describe symptoms and severity, identify perceived risk factors, and explore health seeking behavior of AGI in Rigolet. Of the survey respondents reporting AGI, most reported symptoms of diarrhea without vomiting, followed by diarrhea with vomiting, and vomiting without diarrhea. The most common secondary symptoms included stomach cramps and abdominal pain, nausea, and extreme tiredness. Community members identified potential risk factors for AGI that reflect the epidemiology triad (host, agent, and environmental factors), including hygiene, retail food, tap water, boil water advisories, and personal stress. Risk aversion and healthcare seeking behaviors reflected the core constructs of the Health Belief Model (perceived susceptibility, severity, and benefits and barriers to action). Understanding community experience, perspectives, and beliefs related to AGI is useful for public health practitioners and health care providers. This information is important especially considering the relatively high estimated burden of AGI and the relatively low healthcare seeking behaviors in some Indigenous communities compared to national estimates. Moreover, the mixed-methods approach used to understand the burden of AGI could be extended to other health research in Indigenous contexts.
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada. Electronic address: harpers@uoguelph.ca.
authors.forename: Sherilee L
authors.initials: SL
authors.lastname: Harper
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada; Public Health Agency of Canada, Guelph, Ontario, Canada.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Edge
authors.affiliation: Department of Geography, McGill University, Montreal, Quebec, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Ford
authors.affiliation: Centre for Food-borne, Environmental & Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada.
authors.forename: M Kate
authors.initials: MK
authors.lastname: Thomas
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.
authors.forename: Scott A
authors.initials: SA
authors.lastname: McEwen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005517:Foodborne Diseases / Q000150:complications / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000628:therapy; D006306:Health Surveys; D006801:Humans; D004930:Inuit; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013315:Stress, Psychological; D014881:Water Supply / Q000592:standards; D055815:Young Adult
keywords: Aboriginal health; Acute gastrointestinal illness; Burden of illness; Canada; Foodborne disease; Inuit; Lived experience; Nunatsiavut; Waterborne disease