Helen Vallianatos

Community Health and the Built Environment: examining place in a Canadian chronic disease prevention project

The Community Health and the Built Environment (CHBE) project investigated the role of place in interventions for chronic disease prevention in order to identify contextual factors that may foster or inhibit intervention success. This paper presents a project model comprising objective-outsider and subjective-insider perspectives in a multi-method, community-based participatory research approach with an emphasis on knowledge exchange. The collaborative process generated valuable lessons concerning effective conduct of community-based research. The CHBE project model contributes a mechanism for investigating how place influences health behaviours and the outcomes of health promotion interventions.

Perceived community environmental influences on eating behaviors: A Photovoice analysis

People’s perceptions of local food environments influence their abilities to eat healthily. PhotoVoice participants from four communities in Alberta, Canada took pictures of barriers and opportunities for healthy eating and shared their stories in one-on-one semi-structured interviews. Using a socioecological framework, emergent themes were organized by type and size of environment. Findings show that, while availability and access to food outlets influence healthy eating practices, these factors may be eclipsed by other non-physical environmental considerations, such as food regulations and sociocultural preferences. This study identifies a set of meta-themes that summarize and illustrate the interrelationships between environmental attributes, people’s perceptions, and eating behaviors: a) availability and accessibility are interrelated and only part of the healthy eating equation; b) local food is synonymous with healthy eating; c) local food places for healthy eating help define community identity; d) communal dining (commensality) does not necessarily mean healthy eating; e) rewarding an achievement or celebrating special occasions with highly processed foods is socially accepted; f) food costs seemed to be driving forces in food decisions; g) macro-environmental influences are latent in food decisions. Recognizing the interrelationship among multiple environmental factors may help efforts to design effective community-based interventions and address knowledge gaps on how sociocultural, economic, and political environments intersect with physical worlds.

Food choices and practices during pregnancy of immigrant women with high-risk pregnancies in Canada: a pilot study

BackgroundImmigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.MethodsThis four-phase study employed a case study design allowing for multiple means of data collection and different units of analysis. Phase one consists of a scoping review of the literature. Phases two and three incorporate pictorial representations of food choices with semi-structured photo-elicited interviews. This study was undertaken at a Prenatal and Obstetric Clinic, in an urban Canadian city. In phase four, the research team will inform the development of culturally appropriate visual tools for health promotion.ResultsFive themes were identified: (a) Perceptions of Health, (b) Social Support (c) Antenatal Foods (d) Postnatal Foods and (e) Role of Health Education. These themes provide practitioners with an understanding of the cultural differences that affect women’s dietary choices during pregnancy. The project identified building collaborations between practitioners and families of pregnant immigrant women to be of utmost importance in supporting healthy pregnancies, along with facilitating social support for pregnant and breastfeeding mothers.ConclusionIn a multicultural society that contemporary Canada is, it is challenging for health practitioners to understand various ethnocultural dietary norms and practices. Practitioners need to be aware of customary practices of the ethnocultural groups that they work with, while simultaneously recognizing the variation within—not everyone follows customary practices, individuals may pick and choose which customary guidelines they follow. What women choose to eat is also influenced by their own experiences, access to particular foods, socioeconomic status, family context, and so on.The pilot study demonstrated the efficacy of the employed research strategies and we subsequently acquired funding for a national study.

Food choices and practices during pregnancy of immigrant and Aboriginal women in Canada: a study protocol

BackgroundFacilitating the provision of appropriate health care for immigrant and Aboriginal populations in Canada is critical for maximizing health potential and well-being. Numerous reports describe heightened risks of poor maternal and birth outcomes for immigrant and Aboriginal women. Many of these outcomes may relate to food consumption/practices and thus may be obviated through provision of resources which suit the womens ethnocultural preferences. This project aims to understand ethnocultural food and health practices of Aboriginal and immigrant women, and how these intersect with respect to the legacy of Aboriginal colonialism and to the social contexts of cultural adaptation and adjustment of immigrants. The findings will inform the development of visual tools for health promotion by practitioners.Methods/DesignThis four-phase study employs a case study design allowing for multiple means of data collection and different units of analysis. Phase 1 consists of a scoping review of the literature. Phases 2 and 3 incorporate pictorial representations of food choices (photovoice in Phase 2) with semi-structured photo-elicited interviews (in Phase 3). The findings from Phases 1-3 and consultations with key stakeholders will generate key understandings for Phase 4, the production of culturally appropriate visual tools. For the scoping review, an emerging methodological framework will be utilized in addition to systematic review guidelines. A research librarian will assist with the search strategy and retrieval of literature. For Phases 2 and 3, recruitment of 20-24 women will be facilitated by team member affiliations at perinatal clinics in one of the citys most diverse neighbourhoods. The interviews will reveal culturally normative practices surrounding maternal food choices and consumption, including how women negotiate these practices within their own worldview and experiences. A structured and comprehensive integrated knowledge translation plan has been formulated.DiscussionThe findings of this study will provide practitioners with an understanding of the cultural differences that affect womens dietary choices during maternity. We expect that the developed resources will be of immediate use within the womens units and will enhance counseling efforts. Wide dissemination of outputs may have a greater long term impact in the primary and secondary prevention of these high risk conditions.

Understanding South Asian Immigrant Women's Food Choices in the Perinatal Period

Background: Food practices throughout the perinatal period have a profound influence on the health and wellbeing of a mother and her child. Following migration, pregnant immigrant women bring with them culturally-situated beliefs about appropriate eating behaviours, while simultaneously encountering new socio-cultural environments that can negatively affect their food choices. Research is needed to inform and improve the provision of culturally appropriate maternal health and nutritional care. Methods: We employed a focused ethnography, photo-voice methods, and photo-assisted interviews to explore and understand South Asian immigrant women’s food choices and practices during the perinatal period and to investigate the intersectionality of these factors in a social context of cultural adaptation and adjustment. Findings: The key themes constructed from the data included (a) general health beliefs, (b) antenatal and postnatal food choices including Ayurvedic medical beliefs, (c) social advice and socio-economic factors.

Immigrant women’s food choices in pregnancy: perspectives from women of Chinese origin in Canada

ABSTRACT Objective: Following migration, pregnant immigrant women may encounter social, cultural, and economic challenges that negatively affect their food choices and subsequent health outcomes. Culturally appropriate health care is crucial during the perinatal period to ensure the health of immigrant mothers and their children. This project aims to explore and understand how the health beliefs and practices of Chinese immigrant women affect their food choices during the perinatal period. Design: This qualitative study used the methodology of focused ethnography. Women participated in one semi-structured interview, followed by a second photo-assisted, semi-structured interview which incorporated photographs taken by the women themselves. Results: The food choices and health behaviors of immigrant women were influenced by their general health beliefs, cultural knowledge concerning particular types of foods, traditional Chinese medical beliefs, social advice and information, and socio-economic factors. Conclusion: The provision of culturally appropriate health care is crucial during the perinatal period, as it is not only a vulnerable life stage for women and their children but also a sensitive period of interaction with the Canadian health-care system. Understanding these intersecting factors can help to ensure culturally appropriate care and optimized health outcomes for Chinese immigrant women during the perinatal period.

Reintegration of Women Post Obstetric Fistula Repair: Experience of Family Caregivers:

In northern Ghana, families traditionally function as the main provider of care. The role of family, however, is becoming increasingly challenged with the social shifts in Ghanaian culture moving from extended kinship to nuclear households. This has implications for the care of women post obstetric fistula (OF) repair and their family members who assist them to integrate back into their lives prior to developing the condition. This research is part of a larger critical ethnographic study which explores a culture of reintegration. For this article, we draw attention to the findings related to the experience of family caregivers who care for women post OF repair in northern Ghana. It is suggested that although family caregivers are pleased to have their family member return home, there are many unanticipated physical, emotional, and economic challenges. Findings lead to recommendations for enhancing the reintegration process and the need for adequate caregiving support.

Reflection/Commentary on a Past Article: “Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment”: http://journals.sagepub.com/doi/full/10.1177/160940691101000201

We are honored and delighted to be part of the International Journal of Qualitative Methods’ special issue featuring updates on the top 20 papers from the past 20 years. Here, we offer current reflections on our 2011 paper, Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment (Nykiforuk, Vallianatos, & Nieuwendyk, 2011). This article reported on one of the methodologies used in our mixed-methods design for a community-based participatory research (CBPR) project that examined ecological and individual facilitators and barriers to physical activity and healthy eating as experienced by four communities in Alberta, Canada (see Nykiforuk et al., 2012). We published our photovoice paper at a time when the public health research community’s interest in “built environment and health” was at an unprecedented high. Yet, at that time, the available methodological literature informing this critical area of inquiry was predominantly quantitative and often concerned with objective measurement of built environment features such as walkability, access to public transit, or proximity to green space. Our full study was among the first to integrate these “objective” quantitative measures of community with nuanced “subjective” knowledge of communities offered by residents, with the intention of using the integrated findings from those pieces to inform the collaborative, community-led development of local interventions to promote the health of residents. Thus, the so-called subjective knowledge of community residents was of paramount importance to the success of the full study, and the “subjective” substudy among the first in the built environment area to employ photovoice as the means for engaging residents to share their knowledge and perceptions of their communities. Our paper offered a detailed report on our application of C. Wang and Burris’ (1994, 1997) photovoice methods, tailored to the purposes of community (built and social) environment research, with the purpose of communicating this method for capturing and appropriately representing participants’ voices in research about their lives and communities. We contributed a critique of photovoice as a method for revealing community residents’ perceptions of community as a health resource and for health promotion research more broadly. We also included a detailed accounting of our own successes and challenges of using photovoice in a CBPR research project focused on community-based chronic disease prevention. Thinking back on this publication, we were asked to speak to how it fit into our career paths, how it impacted our work since, how it impacted the field, and our thoughts on one thing that has changed the most in this area since we published our manuscript. We collaborated on the key points that follow, while also reflecting on how our individual work has developed. We identified how our work has benefited from interdisciplinary partnerships, and how incorporation of visual methods is particularly useful for participatory, communitybased research endeavors moving forward.

Transnationalism, parenting, and child disciplinary practices of African immigrants in Alberta, Canada

Child discipline remains a topic of public health interest across the globe. Despite this enduring interest, very little is known about the child disciplinary practices of African immigrants in Canada. This paper explores the disciplinary practices of African immigrant parents in Alberta, a Canadian province with a recent surge in the population of African immigrants. Employing a critical ethnographic methodology, informed by transnational theory, we collected data through in-depth qualitative interviews with a purposive sample of African community leaders (n = 14), African immigrant parents (n = 32), policymakers (n = 2), and health and immigrant settlement workers (n = 10). As members of the African immigrant community, we were deeply immersed in the research settings, which afforded us the opportunity to collect pertinent observational data in the form of reflexive notes. Thematic analysis of the data revealed child disciplinary approaches that incorporate Canadian and African parenting practices, as well as practices that appear somewhat unique to this demographic. We found that African immigrant parents used corporal discipline, persuasive discipline, and a hybrid of the two, as well as emerging practices involving transnational fostering and emotional isolation of children who persistently misbehaved. These practices, in their totality, appeared to be influenced by the transnational experiences of parents and precepts that are traceable to Canadas legal and educational systems. We present theoretical, policy, and service implications of our findings, including a recommendation to incorporate sociocultural dimensions of child discipline into Canadian child welfare policies and practices.

Women’s Experiences of Food Insecurity and Coping Strategies in the Chittagong Hill Tracts, Bangladesh

ABSTRACT Despite advances in food production and distribution technologies, global food insecurity continues throughout parts of South Asia. Using ethnographic data collected from the Chittagong Hill Tracts (CHT) in Bangladesh, this article reports on gendered and ethnocultural variations in experiences of food insecurity. Three key findings are that (1) regardless of ethnicity, the majority of the households in this study suffered moderate food insecurity; (2) food insecurity was higher among female-headed households; and (3) women’s means of coping strategies varied depending on household structure and ethnic identity. It is argued that indigenous women’s coping strategies were protective in comparison with Bengali women’s experiences.