Harper Sherilee L, Edge Victoria L, Ford James, Thomas M Kate, McEwen Scott A
Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.
Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada; Public Health Agency of Canada, Guelph, Ontario, Canada.
Soc Sci Med. 2015 Feb;126:86-98. doi: 10.1016/j.socscimed.2014.12.011. Epub 2014 Dec 8.
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.
在加拿大一些原住民社区，与食源性和水源性疾病相关的肠道疾病被认为很常见。本研究旨在了解加拿大里戈莱特因纽特人小社区中急性胃肠疾病（AGI）的实际经历，包括症状和严重程度、感知到的病因以及AGI患者的就医行为。研究采用了定量与定性相结合的同步混合方法设计。两项横断面回顾性调查提供了定量数据，以检查自我报告的AGI症状以及社区中潜在风险因素的分布情况。对三分之一的AGI病例进行深入访谈所获得的定性数据，采用持续比较法进行分析，以描述症状和严重程度、确定感知到的风险因素，并探索里戈莱特AGI患者的就医行为。在报告患有AGI的调查受访者中，大多数人报告有腹泻但无呕吐症状，其次是腹泻伴呕吐，以及呕吐但无腹泻。最常见的次要症状包括胃痉挛、腹痛、恶心和极度疲劳。社区成员确定了AGI的潜在风险因素，这些因素反映了流行病学三角模型（宿主、病原体和环境因素），包括卫生状况、零售食品、自来水、开水饮用建议以及个人压力。风险规避和就医行为反映了健康信念模型的核心要素（感知易感性、严重性以及行动的益处和障碍）。了解与AGI相关的社区经历、观点和信念，对公共卫生从业者和医疗服务提供者很有帮助。考虑到AGI估计负担相对较高，且与全国估计数相比，一些原住民社区的就医行为相对较低，这些信息尤为重要。此外，用于了解AGI负担的混合方法可扩展到原住民背景下的其他健康研究。
