Research associating adverse health effects with air pollution exposure is robust. Public health authorities recognize the need to implement population health strategies that protect public health from air pollution exposure. The Air Quality Health Index (AQHI) is a public health initiative that is intended to protect the public's health from exposure to air pollution. The aim of this research was to identify and explain factors influencing AQHI adoption at the individual level and to establish intervention strategies. A cross-sectional survey with both quantitative and qualitative questions was administered in Hamilton, Ontario, Canada, during the months of June to October 2012. Logistic regression and the Health Belief Model are used to explore the data. Demographics (gender, age, education, and area of residence), knowledge/understanding, and individual risk perceptions (neighbourhood air effects on health) were found to be significant predictors of AQHI adoption. The perceived benefits of AQHI adoption included protection of health for self and those cared for via familial and (or) occupational duties, whereas the perceived barriers of AQHI adoption included lack of knowledge about where to check and lack of time required to check and follow AQHI health messages. Also, self-efficacy was uncovered as a factor influencing AQHI adoption. Accordingly, increases in AQHI adoption could be achieved via increasing AQHI knowledge among low socioeconomic status females, communicating the benefits of AQHI adoption to “at-risk” populations and implementing supports for males to follow AQHI health messages.

BackgroundThe Air Quality Health Index (AQHI) provides air quality and health information such that the public can implement health protective behaviours (reducing and/or rescheduling outdoor activity) and decrease exposure to outdoor air pollution. The AQHI’s health messages account for increased risk associated with “at risk” populations (i.e. young children, elderly and those with pre-existing respiratory and/or cardiovascular conditions) who rely on health care and service providers for guidance. Using Rogers’ Diffusion of Innovations theory, our objective with respect to health care and service providers and their respective “at risk” populations was to explore: 1) level of AQHI knowledge; 2) factors influencing AQHI adoption and; 3) strategies that may increase uptake of AQHI, according to city divisions and socioeconomic status (SES).MethodsSemi-structured face-to-face interviews with health care (Registered Nurses and Certified Respiratory Educators) and service providers (Registered Early Childhood Educators) and focus groups with their respective “at risk” populations explored barriers and facilitators to AQHI adoption. Participants were selected using purposive sampling. Each transcript was analyzed using an Interpretive Description approach to identify themes. Analyses were informed by Rogers’ Diffusion of Innovations theory.ResultsFifty participants (6 health care and service providers, 16 parents, 13 elderly, 15 people with existing respiratory conditions) contributed to this study. AQHI knowledge, AQHI characteristics and perceptions of air quality and health influenced AQHI adoption. AQHI knowledge centred on numerical reliance and health protective intent but varied with SES. More emphasis on AQHI relevance with respect to health benefits was required to stress relative advantage over other indices and reduce index confusion. AQHI reporting at a neighbourhood scale was recognized as addressing geographic variability and uncertainty in perceived versus measured air quality impacting health. Participants predominantly expressed that they relied on sensory cues (i.e. feel, sight, taste) to determine when to implement health protective behaviours. Time constraints were identified as barriers; whereas local media reporting and wearable devices were identified as facilitators to AQHI adoption.ConclusionIncreasing knowledge, emphasizing relevance, and reporting AQHI information at a neighbourhood scale via local media sources and wearable devices may facilitate AQHI adoption while accounting for SES differences.

Air pollution exposure is detrimental to population health and particularly to older adults (]65 years of age) who are considered part of the ''at-risk'' population. The Air Quality Health Index (AQHI) provides air quality and health information such that the public can implement health protective behaviour and decrease exposure to outdoor air pollution. The AQHI education session for older adults aims to increase knowledge, encourage use of the AQHI, and gain a better understanding of how at-risk populations self-identify. An AQHI education session was delivered face-to-face to older adults living independently in Hamilton, Canada. A pre-and post-test questionnaire with both quantitative and qualitative questions was administered to measure knowledge and intention to use AQHI. A total of 62 participants attended the education session and completed the pre-and post-test questionnaire. Results of a paired t test indicated a statistically significant difference in preand post-test knowledge (p B0.05). After the education session, 82% of participants indicated their intention to use AQHI. The benefit of using AQHI included health protection while the most relevant barrier was the inability to self-identify as belonging to the elderly at-risk population. An AQHI education session was effective in increasing AQHI knowledge and encouraging use of the AQHI. Consideration must be given to replacing the current terminology ''elderly'' with the use of chronological age (]65 years) to describe the at-risk population and foster greater ability to self-identify and use AQHI. Extra attention must be given to engage older adults living in lower socioeconomic areas to address health disparities.