The modifications to the study communities’ pandemic plans were made by the author (NAC) after each round of citizen input (i.e., semi-directed interviews, unstructured interviews, and community pandemic committee meetings) and the primary ones are highlighted below (Table ).
Summary of primary modifications made to community-level pandemic plans during the community engagement process
1st Generation pandemic plan
Each study community’s existing 1st
generation pandemic plan closely resembled the FNIHB-OR PIP, although some revisions were made prior to their response to pH1N1 [46
]. These revisions were made after some representatives from the Band Council and health center attended pandemic meetings and tabletop exercises. For instance, in some cases, community-based people were assigned specific roles during the pandemic response and appropriate locations in the community were identified (e.g., where to establish an alternate care site, where to store vaccines, etc.). However, more information in the plans was required, as one participant mentioned:
"… there was a template … we work[ed] on that, it was done back in 2006, I believe at first, but it was never followed up on, it was not finished thoroughly … then we made … additional recommendations here and there, we added some things that need be … but it was also a learning process for us, because … there were some things that didn’t work or we would just kind of improvise … (Participant # 13)."
In general, the communities’ pandemic plans were divided into three phases (e.g., pre-pandemic, pandemic, and post-pandemic). Each phase was further divided into the seven categories of preparedness and response (e.g., surveillance, vaccine, antivirals and antibiotics, health services, emergency response, public health measures, and communications). Each category included details of what tasks the community was responsible for, who was responsible to complete the tasks, and when the tasks were to be completed by.
2nd Generation pandemic plan
In general, the framework of the communities’ 2nd generation pandemic plans remained similar; however, ‘supplies’ was added as a category in each phase, consistent with it being an emerging code from the data. The primary modifications which resulted in the 2nd generation pandemic plans involved adding community-specific details. The ‘health services’ category included more details about influenza-like illness (ILI) screening at healthcare facilities, such as, identifying alternate entrances and waiting areas to isolate ILI cases from non-ILI cases, and guidelines to follow. Also, it was added that the community health nurses are responsible for providing basic personal protective equipment (PPE) training (e.g., how to wear masks, gowns, gloves, goggles, etc.) for staff at the health care facilities and community members when needed. Participants from the study communities reported that there was a lack of supplies for their pandemic response and ordered supplies did not arrive in a timely fashion. Thus, the new ‘supplies’ category included information about ordering, maintaining, and providing influenza pandemic supplies. Participants requested that additional information be included in some categories (e.g., vaccines, supplies, public health measures, and communications); therefore, it was later decided to include this information in an Appendix section in the 3rd generation pandemic plan (Table ).
List and description of appendices included in 3rdgeneration pandemic plans
3rd Generation pandemic plan
In general, after the unstructured interviews, more community-specific detail was incorporated into the communities’ pandemic plans. In the ‘surveillance’ category, it was added that the health staff are responsible to monitor absenteeism in schools and workplaces on a weekly basis during the regular influenza season and on a daily basis if ILI cases in the community increase by ten percent. Some participants reported that there was confusion about which health care facility was responsible for receiving and distributing antivirals. Thus, in the ‘antivirals and antibiotics’ category, specific detail of how antivirals are transported, received, stored, and who to contact when more medication is required was added. Furthermore, participants from all of the study communities stated that there was a general lack of community awareness during the pandemic response. As mentioned by one participant:
"…we didn’t really get all the education background … until the very last minute … they needed more awareness about it … especially in the school system, cause the kids don’t really understand … (Participant # 7)."
Thus, in the ‘health services’ category, it was recommended for the community health nurses to teach self-care training topics (e.g., general infection control measures and influenza education, etc.) at the school and workplaces and for all other community members. Also, details of the home support program, which would provide supplies and resources for ill families, were included. The main modification to highlight was the added Appendix section, which included sixteen appendices with detailed supplemental information to guide the community’s pandemic response (Table ).
4th Generation pandemic plan
After the community pandemic committee meetings, some noteworthy changes were made to the Appendix section, which were similar for all three communities. Information regarding the organizers, locations, and special considerations was added in the alternate care site plans. Furthermore, a participant had questioned:
"… the timing of this, the virus, if it happened like, in the spring, our springs are usually nice and warm, and where would we store the bodies? (Participant # 10)."
Thus, potential locations for a morgue in the community were chosen for summer and winter influenza pandemic scenarios and included in the corpse storage and temporary morgue plan. In Community C’s communication plan, it was added that, if necessary, practitioners of traditional First Nations medicine will provide health teachings.