Factors influencing health care and service providers’ and their respective “at risk” populations’ adoption of the Air Quality Health Index (AQHI): a qualitative study

Abstract

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.

An evaluation of the Air Quality Health Index Program on respiratory diseases in Hong Kong: an interrupted time series analysis

“…Similar to other cities in the world (UK, Canada, U.S.A); Hong Kong’s AQHI policy alerts the public to risk and thereby promotes behavioral changes for “at risk populations” (Radisic and Newbold 2016). As such, health effects of the policy only occur if the population at risk changes its behavior in response to the information as well as the associated lower exposure reducing disease.…”

“…A qualitative study done by Radisic and Newbold in 2016 concluded that proper adaption to the AQHI depended on knowledge about the AQHI and characteristics of the policy; and perception about air quality and health. People less educated about the AQHI were less likely to adopt the behavioral changes suggested by the policy, which may include the elderly (Radisic and Newbold 2016). Older people are most vulnerable to COPD and pneumonia but they may not respond immediately to new information (Radisic and Newbold 2016).…”

“…People less educated about the AQHI were less likely to adopt the behavioral changes suggested by the policy, which may include the elderly (Radisic and Newbold 2016). Older people are most vulnerable to COPD and pneumonia but they may not respond immediately to new information (Radisic and Newbold 2016). This consideration may be particularly relevant in Hong Kong where a substantial proportion of older people are illiterate, and so may find it harder to access the AQHI.…”

Taking a Stand Against Air Pollution—The Impact on Cardiovascular Disease

“…Communication tools such as various air quality indices focused on short-term variation in air quality can help patients adjust activities when air quality is poor ( 19 ). Detailed air pollution maps that provide information on long-term exposures and their impacts at neighborhood scales can also be used to target CVD treatment ( 20 ), exposure reduction, and efforts to address other behavioral risks contributing to CVD in those living in locations with highest exposures ( 21 ). Finally, the health sector as a whole, which bears the impact of air pollution, can provide much-needed support for ministries of environment, energy, and transportation, which are traditionally responsible for mitigation efforts.…”

Taking a Stand Against Air Pollution – The Impact on Cardiovascular Disease

“…Communication tools such as various air quality indices focused on short-term variation in air quality can help patients adjust activities when air quality is poor [ 19 ]. Detailed air pollution maps that provide information on long-term exposures and their impacts at neighborhood scales can also be used to target CVD treatment [ 20 ], exposure reduction, and efforts to address other behavioural risks contributing to CVD in those living in locations with highest exposures [ 21 ]. Finally, the health sector as a whole, which bears the impact of air pollution, can provide much-needed support for ministries of environment, energy, and transportation, which are traditionally responsible for mitigation efforts.…”