Public health emergencies, such as an influenza pandemic, have the ability to cause high morbidity and mortality rates in humans . Research indicates that disadvantaged populations will be disproportionately affected by an influenza pandemic, thereby exacerbating previously established social and economic inequalities [2, 3]. For instance, some First Nations communities suffer from conditions of overcrowded housing and extreme poverty, in addition to inadequate access to many of the amenities of life (e.g., running water, health care, etc.) [4–6]. Geographically remote (i.e., nearest service center that provides access to Government of Canada’s programs and services with year-round road access is located over 350 kilometers away) and isolated (i.e., only accessible by planes year-round) First Nations communities typically face additional challenges, such as, limited transportation of required supplies and resources (especially during harsh weather situations) and continuous shortages of health care personnel [7–10]. Indeed, Canada’s First Nations, especially populations living in geographically remote communities, were severely impacted by the recent 2009 H1N1 influenza pandemic (pH1N1) [6, 11–13]. During the pH1N1 response, some remote and isolated First Nations communities reported problems, such as, confusion and lack of preparedness, owing to ill-defined roles and responsibilities of government bodies overseeing the delivery of health care and insufficient details in community-level pandemic plans .
Another public health emergency is inevitable ; therefore, countries worldwide are encouraged to have effective pandemic plans in place to minimize the associated social and economic disruption [2, 16]. Typically, national pandemic plans around the world have involved limited public consultation, and instead have been heavily guided by government and public health agencies, and panels of expert scientists [17–20]. However, it is important that recommended actions in pandemic plans are accepted by the public and can be realistically executed at the community level . Research has shown that public engagement in pandemic planning can aid in understanding community perspectives and local values [21, 22].
Furthermore, since all individuals are affected by an influenza pandemic, a societal approach to pandemic planning is recommended [2, 17, 22]. Unfortunately, various disadvantaged populations have not been sufficiently involved in the pandemic planning process [23–26]. For instance, Canada’s Assembly of First Nations noted that First Nations had not been sufficiently involved in the development of federal and provincial pandemic plans to date . Ethically addressing the needs of disadvantaged populations should be a cornerstone of pandemic planning . Disadvantaged populations best understand how they will be affected by a public health emergency and are able to identify barriers to current public health recommendations, placing them in a position to create innovative mitigation strategies . Thus, engaging the public, especially disadvantaged populations, can aid in providing pandemic policy planners with information about the unique, local issues they face, which may lead to more successful implementation of pandemic plans and potentially mitigate the inequity that may occur during an influenza pandemic [5, 22, 23].
Studies have shown that it is important for research findings to be promptly and optimally utilized to change current practice, thus enhancing the knowledge translation process of linking research to action [28–31]. In Canada, the Canadian Institutes of Health Research defines the term knowledge translation as, “a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically-sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system” . The present study is an example of knowledge translation where qualitative information was collected from participants residing in three remote and isolated First Nations communities of sub-arctic Ontario, Canada, and used to modify the existing community-level pandemic plans. A knowledge translation approach was appropriate for this study, as it aimed to bridge the knowledge-to-action gap regarding how to engage disadvantaged populations in the pandemic planning process [28, 30]. The purpose of this paper is to describe the community-based participatory approach and community engagement process used, and to highlight the resulting evolutionary stages of each community’s pandemic plan.