Submitted to Health Canada
Contract Number: HT372-192583/001/CY
Prepared By: Leger Marketing Inc.
Ce rapport est également disponible en français.
Contract value: $54,446.23
Award date: 18/06/2019
Delivery date: 09/12/2019
Registration number: POR027-19
For more information on this report, please contact hc.cpab.por-rop.dgcap.sc@canada.ca
Leger Marketing Inc.
507 Place d'Armes, Suite 700
Montréal, Quebec
H2Y 2W8
Telephone: 514-982-2464
Fax.: 514-987-1960
Prepared for Health Canada
Supplier Name: Leger Marketing Inc.
December 2019
This public opinion research report presents the methodology and the results of a series of focus groups conducted by Leger Marketing Inc. on behalf of Health Canada. The research was conducted with health professionals between July 18 and August 20, 2019.
Cette publication est aussi disponible en français sous le titre: ÉTUDE SUR LA NOTORIÉTÉ ET LES PERCEPTIONS DES PROFESSIONNELS DE LA SANTÉ À L'ÉGARD DES QUESTIONS DE SANTÉ ENVIRONNEMENTALE (PRODUITS CHIMIQUES ET SANTÉ)
This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at hc.cpab.por-rop.dgcap.sc@canada.ca or at:
Health Canada, CPAB
200 Eglantine Driveway, Tunney's Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9
Catalogue Number: H14-343/2020E-PDF
International Standard Book Number (ISBN): 978-0-660-33755-5
Related publications (registration number: POR 027-19): 978-0-660-33756-2
Catalogue Number: H14-343/2020F-PDF
© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health Canada 2020
Leger is pleased to present Health Canada with these findings from a series of focus groups on the awareness and perceptions of environmental health issues and Health Canada Materials on the subject. This report was prepared by Leger, the research firm contracted by the Department of Health (contract number: HT372-192583/001/CY, awarded June 16, 2019).
Family physicians are a front-line health resource for many Canadians, particularly among vulnerable populations. They are a reliable and credible resource, and as such, they are important partners for Health Canada in disseminating and strengthening the federal department's messages.
There is some evidence to suggest that environmental health, in particular related to chemicals and pollutants in Canadians' living environments, is not a key component of family physician visits.
As such, Health Canada wants to ensure that it is effectively engaging family physicians in Canada on this issue in the coming years.
It is in this context that this study explored physicians' awareness and perceptions of environment health, with an emphasis on chemicals of concern and pollutants in an around the home, to ultimately allow Health Canada to more effectively tailor materials for, and build relationships with physicians.
The qualitative research objectives were to assess:
1. The perceptions and awareness of health risks of chemicals and pollutants found in and around the home, and Government of Canada's Chemicals Management Plan
2. The concerns regarding the impact of household chemicals of concern and pollutants on the health of their patients, with a focus on vulnerable populations
3. The sources of information on environmental health and barriers/challenges/ suggestions for discussing with patients
4. The preferences for tools/materials from Health Canada and information content
5. The recommendations for health professional organizations that Health Canada could partner with on environmental health and the CMP
A total of eight (8) "mini" groups were planned in four (4) different provinces: Nova Scotia, Quebec, Ontario and British Columbia. Two separate groups were planned in each location, for a total of eight (8) groups.
A first series of groups (4) were conducted with physicians working mainly in urban areas in their respective provinces. These physicians were located in the Census Metropolitan Area (CMAs) of the following cities: Halifax (NS), Montreal (QC), Toronto (ON) and Vancouver (BC). A second series of groups (4) were planned with physicians working mainly in rural areas : Ontario, Quebec, Nova Scotia and British Columbia. Due to recruitment problems, the group of rural physicians in Quebec was cancelled. Given the difficulty in obtaining lists of physicians who accept to participate in opinion research in rural Quebec, recruitment had to be done through direct calls to medical clinics from numbers available in the telephone directory. Since recruitment took place in the middle of the summer vacation period, it has not been feasible to meet the quota set for this group. It should be noted that "rural" recruitment has been difficult in every region, not only in Quebec. A total of 7 groups were therefore carried out under the mandate.
Groups were comprised of family physicians reflecting as much as possible, a good mix of age and gender. Groups were held online via the Itracks Video Chat platform.
Leger was responsible for participant recruitment. Leger recruited six (6) physicians in each group to ensure that at least four (4) or five (5) would show up for the group discussion. Recruitment was done over the phone using lists of family physicians. Recruiters work from lists of physicians who have already participated in opinion research in the past and who volunteer to participate in such research. When these lists become insufficient, cold calls were made directly to clinics. Groups were held in evenings as daytime events make recruitment more difficult with physicians. The screener guide was developed by Leger in collaboration with the project authority, so the profiles of physicians clearly matched the research objectives.
The recruitment screener informed physicians of their rights under Canada's Privacy legislation and the Standards for the Conduct of Government of Canada Public Opinion Research. More specifically, that their confidentiality was guaranteed, and that participation was voluntary. They were also informed that the results of the research were going to be made available to the public through Library and Archives Canada.
Physicians received an honorarium of $425 for their participation in the discussion.
The following table shows the dates and locations of physicians for all focus groups.
City |
Language |
Recruit |
Participate |
Date |
|---|---|---|---|---|
Toronto (urban) |
EN |
6 |
5 |
July 18 |
Ontario (rural) |
EN |
6 |
4 |
August 20 |
Montréal (urban) |
FR |
6 |
6 |
July 18 |
Québec (rural) |
FR |
6 |
0 |
CANCELLED |
Halifax (urban) |
EN |
6 |
3 |
July 22 |
Nova Scotia (rural) |
EN |
6 |
4 |
July 25 |
Vancouver (urban) |
EN |
6 |
6 |
July 22 |
British Columbia (rural) |
EN |
6 |
5 |
August 20 |
Total |
48 |
33 |
Groups lasted approximately 90 minutes, and were conducted in English (except in Montreal, where the groups were conducted in French). The moderation of the groups was carried out by a senior researcher from Leger.
Participating physicians were aware of health issues related to the environment. They were all able to define what it was and give examples of it. The majority of participants felt that the environment, both water and air quality as well as the living and working environment, is an important determinant of the health of Canadians.
However, the majority of them considered their level of knowledge in this regard to be quite limited beyond general awareness. They did not consider themselves to be overly well informed on the subject. Few physicians participating in the focus groups had to treat patients with environmental health problems, except for cases of allergies or other problems caused by a pre-existing health condition.
Very few participants recalled seeing or reading environmental health information published by Health Canada. In fact, very few recalled specific initiatives. At best, some vaguely recalled information on radon, carbon monoxide, Zika, Lyme disease and mould.
Although considered an important issue to physicians, environmental health does not translate to a priority in their practice. Unless a patient presents particular risks due to a specific condition where the patient directly raises the environmental aspect of a problem or if there is doubt about the cause of symptoms, environmental health is not included in the regular topics covered during routine patient visits. Physicians consider that the time spent with each patient is too short and does not necessarily allow the environmental dimension of health to be addressed each time. Only if a patient addresses the subject directly, will it be part of the discussion.
According to physicians, access to health knowledge and information is more difficult for immigrant populations in some parts of the country. They felt it was important for Health Canada to disseminate information in languages other than English and French to make the information accessible to as many people as possible. In addition to the language barriers posed by immigration, the low health literacy of many Canadians is also an issue that can hinder the dissemination of vital information. Health Canada must take these factors into account in its efforts to communicate with the public.
Physicians do not feel it is their role to inform Canadians on potential risk factors, viewing environmental health rather as a public health issue, mainly important at a preventative stage. They also consider that they lack the necessary expertise to discuss environmental health issues with patients. Indeed, physicians consider that their role is less to inform the public about environmental health than to treat the potential direct impacts of environmental factors on the health of their patients. Informing and educating the public, fighting myths, beliefs, misinformation and raising public awareness is seen as falling under Health Canada's role and responsibilities. Physicians consider it is important that Health Canada provides verified and reliable information to Canadians. As such, physicians consider that Health Canada's reputation can be reassuring to Canadians.
Most of the physicians who participated in the focus groups have a good opinion of Health Canada. Physicians interviewed in the focus groups considered Health Canada to be a credible source of information. However, most of them almost never use Health Canada resources and information in their work. They prefer sources provided by Canadian health associations (e.g., Canadian Lung Association, etc.) or peer-reviewed sources.
For now, if necessary, physicians will search the Internet (Google) for credible and useful information on environmental health issues. A few physicians reported having a hard time finding information on the Health Canada website. They considered the website difficult to navigate. There is a clear need expressed by physicians to have a site that archives and stores information on the most common environmental health issues in Canada, such as a credible searchable repository. This was reflected in the review of the Healthy Home website which was well received as a centralized resource for their patients.
Physicians expressed a preference for material resources that are simple, clear, direct, accurate, colourful, evidence-based and that provide up-to-date information. Documents must be short enough to be used, read and understood quickly by both physicians and patients. If the resource is seen as too big or too deep, physicians doubt that Canadians will bother to search for and read this type of material.
The views and observations expressed in this document do not reflect those of Health Canada/PHAC. This report was compiled by Leger and based on the research conducted specifically for this project. The analysis presented represents what Leger believes were the most salient points during the focus group sessions. All words and sentences in quotation marks are actual verbatim comments from physicians, selected by Leger for their capacity to directly convey the views and opinions of physicians, in their own words.
Findings from these the focus groups should be considered directional only, and results should not be projected as representative of all general physicians in Canada. It is intended to provide deeper insight into the underlying reasons for opinions or lack thereof.
I hereby certify, as chief agent of Leger, that the deliverables are in full compliance with the neutrality requirements of the Policy on Communications and Federal Identity and the Directive on the Management of Communications—Appendix C (Appendix C: Mandatory Procedures for Public Opinion Research). Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, party positions, or the assessment of the performance of a political party or its leaders.
Signed by:
Christian Bourque
Executive Vice President and Associate
Leger Marketing Inc.
507 Place d'Armes, Suite 700
Montréal, Quebec
H2Y 2W8
cbourque@leger360.com