Charania N A, Tsuji L J S
University of Waterloo, Waterloo, Ontario, Canada.
Rural Remote Health. 2011;11(3):1781. Epub 2011 Aug 15.
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.
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.
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.
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.
原住民社区受到2009年甲型H1N1流感大流行的严重影响。加拿大的多个政府机构（即联邦、省和原住民机构）共同负责偏远和孤立的原住民社区卫生部门的大流行应对工作，这可能导致了大流行应对工作的碎片化。本研究旨在探究在加拿大安大略省北部三个偏远和孤立的亚北极原住民社区应对2009年甲型H1N1流感大流行期间，相关政府机构的二元（或三元）划分是否以及如何导致了所面临的障碍和改进机会。
采用基于社区的定性参与式方法。通过目的抽样选取代表每个研究社区两个（或三个）政府机构的成年关键信息提供者（n = 13）进行半结构化访谈。数据通过手动转录，并使用演绎和归纳主题分析进行编码，以揭示积极方面、所面临的障碍和改进机会，以及每个政府机构在大流行应对方面的异同。
参与者面临的主要障碍包括从多个来源收到相互矛盾的政府指导方针和指示。此外，社区层面的大流行计划缺乏人力资源、信息共享和具体细节。建议改进的方面包括制定补充沟通计划、增加人力资源以及更新社区层面的大流行计划。
参与者报告了许多可能归因于在大流行期间负责医疗服务的政府机构二元（或三元）划分的问题。加强负责政府机构之间的正式沟通与合作将有助于明确角色和责任，并改善加拿大偏远和孤立的原住民社区的大流行应对工作。
