A Qualitative Study to Explore Environmental Health Concerns in Toronto’s Chinese Community through the Voices of the Chinese Environmental Ambassadors and Service Providers: Final Report

Research conducted for the Health Promotion & Environmental Protection Office, Toronto Public Health, with the support of Sustainable Toronto.

Principal Investigator:

Erin Gilgan

MHSc (Health Promotion) Candidate

Department of Public Health Sciences

University of Toronto

Co-investigators:

Carol Mee, Supervisor, Environmental Information & Education

Lorraine Fung, Health Promotion Consultant

Health Promotion & Environmental Protection Office

Toronto Public Health

Faculty Advisor:

Dr. Suzanne Jackson, Acting Director

Centre for Health Promotion

University of Toronto

February 2003

TABLE OF CONTENTS

ABSTRACT…………………………………………………………………………………………3SUMMARY OF RESULTS.……………………………………………………………………….4

1.0 BACKGROUND…………………………………………………………………………...5

2.0 STATEMENT OF THE ISSUE…...………………………………………………………5

2.1 RESEARCH OBJECTIVES………………………………………………………………...6

3.0 LITERATURE REVIEW…………………………………………………………………6

3.1 PERSPECTIVES ON HEALTH, CULTURE AND ETHNICITY…………………………7

3.2 ENVIRONMENTAL HEALTH AND DIVERSE ETHNO-CULTURAL

COMMUNITIES – THE ROLE OF FOR HEALTH PROMOTION……………………….8

3.3 DIVERSITY WITHIN THE TORONTO CHINESE COMMUNITY………………………9

4.0 CONCEPTUAL FRAMEWORK………………………………………………………...10

5.0 RESEARCH METHODS…………………………………………………………………12

5.1 FOCUS GROUP…………………………………………………………………………….12

5.2 KEY INFORMANT INTERVIEWS………………………………………………………..12

6.0 DATA ANALYSIS…………………………………………………………………………13

7.0 LIMITATIONS OF THE RESEARCH………………………………………………….14

8.0 RESULTS AND DISCUSSION…………………………………………………………...15

8.1 ENVIRONMENTAL HEALTH CONCERNS……………………………………………..15

8.2 EMPHASIZING THE CONNECTIONS: THE ENVIRONMENT AND HEALTH………16

8.3 PROVIDING A FORUM FOR COMMUNITY COLLABORATION IN

ENVIRONMENTAL HEALTH PROMOTION……………………………………………17

8.4 COMMUNICATING ENVIRONMENTAL HEALTH MESSAGES TO MEMBERS OF THE TORONTO CHINESE COMMUNITY …………………………………………...…18

8.5 COMMUNICATION METHODS………………………………………………………….18

8.6 COMMUNICATION STYLE AND CONTENT…………………………………………...20

8.6.1 LANGUAGE OF DELIVERY…………………………………………………….20

8.6.2 MESSENGER…………………………………………………...………………...21

8.6.3 MESSAGE CONTENT……………………………………………………………21

8.6.4 CHARACTERISTICS OF TARGET AUDIENCE……………………………….22

9.0 RECOMMENDATIONS AND DIRECTIONS FOR FUTURE RESEARCH

AND PRACTICE………………………………………………………………………….23

9.1 FOCUSING ON THE CONNECTIONS: LINKING HEALTH AND THE

ENVIRONMENT…………………………………………………………………………..23

9.2 FOSTERING PARTNERSHIPS IN ENVIRONMENTAL HEALTH PROMOTION:

WORKING WITH THE TORONTO CHINESE COMMUNITY…………………………24

9.3 COMMUNICATION RECOMMENDATIONS FOR ENVIRONMENTAL HEALTH

CAMPAIGNS AND PROGRAMS…………………………………………………………25

9.4 DIRECTIONS FOR FUTURE RESEARCH AND PRACTICE…………………………...26

10.0 APPENDICES……………………………………………………………………………..27

APPENDIX A: INTERVIEW GUIDE FOR CONDUCTING THE FOCUS GROUP………..28

APPENDIX B: INFORMATION LETTER FOR FOCUS GROUP PARTICIPANTS………29

APPENDIX C: CONSENT FORM FOR FOCUS GROUP PARTICIPANTS………………..31

APPENDIX D: INTERVIEW GUIDE FOR CONDUCTING KEY INFORMANT INTERVIEWS …………………………………………………………………………………….32

APPENDIX E: INFORMATION LETTER FOR KEY INFORMANTS……………………...33

APPENDIX F: CONSENT FORM FOR KEY INFORMANTS……………………………….35

11.0 REFERENCES……………………………………………………………………………36

ABSTRACT

In Ontario, the majority of environmental health promotion programs have targeted a homogeneous general population. The City of Toronto is incredibly diverse, and it is unknown to what extent environmental health concerns, such as air pollution, are shared across ethnic populations and cultural communities in the City, and how environmental health is perceived within different cultural contexts. This exploratory study aimed to identify and understand the environmental health concerns of importance to one part of the Toronto Chinese Community, as well to ascertain and investigate effective strategies to communicate environmental health messages to members of this Community. One focus group was conducted with members of the Chinese Environmental Ambassadors (volunteers from the Chinese Community who promote environmental awareness and protection within their communities). Also, three in-depth key informant interviews were conducted with individuals who provide community health or related services to members of the Chinese Community in Toronto (among others), and who self-identified as Chinese. Ideally, the research findings contributed to the development of a more comprehensive cultural understanding of the perceptions on environmental health issues of one part of the City’s Chinese Community. Additionally, several health promotion and communication recommendations were developed, in order to help meet the needs of some members of the Toronto Chinese Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office, Toronto Public Health.

SUMMARY OF RESULTS

According to the results of this research study:

· The most important environmental health concerns among some members of the Toronto Chinese Community include water quality, particularly drinking water; and outdoor air pollution, including smog.

· Awareness and interest in environmental issues often increases among members of this ethno-cultural community if the direct impacts on personal or family health are easily identifiable; that is, if the connections between health and the environment are emphasized.

· Involving members of the Toronto Chinese Community in the complete program planning and implementation process, particularly for targeted initiatives, is important to increase awareness and participation in environmental health promotion programming.

· The potential to pursue intersectoral collaboration, community development, and capacity building opportunities in environmental health with this ethno-cultural community is significant.

· Using the Chinese media (radio, television, and print) is a highly effective method for communicating environmental health messages and promoting programs to members of the City’s Chinese Community.

· Environmental health messages and programs should be delivered in the appropriate language, that is, Chinese (Cantonese and/or Mandarin dialects), or Chinese and English, depending upon the target audience.

· Environmental health messages delivered by messengers who represent significant expertise and recognizable qualifications would be better received and carry more strength within the Toronto Chinese Community.

· Messages on environmental health should be frequent, consistent, objective and non-threatening; messages should instil a need for personal action without instigating feelings of guilt or ill-will (e.g. victim-blaming).

· Knowledge of the target audience remains vital when promoting environmental health messages and programs among members of the Toronto Chinese Community; this requires a thorough understanding of the diversity of this ethno-cultural community.

1.0 BACKGROUND

This research study has been undertaken as a Year Three Sustainable Toronto (ST) Project in collaboration with the Health Promotion and Environmental Protection Office, Toronto Public Health. Sustainable Toronto represents a Community-University Research Alliance (CURA), sponsored by the Social Sciences and Humanities Research Council (SSHRC), and jointly co-ordinated by the University of Toronto and York University. The project title for the ST/TPH collaboration is “Promoting Education and Awareness of the Links between Health and the Environment"; its overall objective is to develop a strategic framework for Toronto Public Health related to effective environmental health program planning.
The research team consists of the principal investigator (graduate student in the MHSc Health Promotion program, Department of Public Health Sciences, University of Toronto and former practicum student at HP & EPO, TPH); the project director (Supervisor, Environmental Information and Education, HP & EPO, TPH); the academic advisor (Acting Director, Centre for Health Promotion, University of Toronto); and the practicum supervisor (Health Promotion Consultant, HP & EPO, TPH).

2.0 STATEMENT OF THE ISSUE

Environmental issues, such as air quality and contaminated water, noise pollution and pesticide use, can potentially affect the health of entire populations. Health promotion programs and policies strive to increase public awareness on environmental health risks, and encourage individual initiatives and community action in order to improve health and protect the environment.

In Ontario, the majority of environmental health promotion and related programs have been targeted at a homogeneous general population, with a few notable exceptions (Mitra & Bubelis, 2001). Yet the province’s population, particularly in the City of Toronto, is incredibly diverse, representing many ethnic groups and cultures, languages, and faiths/beliefs. This diversity may produce a variety of perspectives on the environment and its effects on health. Correspondingly, it is unknown to what extent environmental health concerns, such as air pollution, are shared across ethnic populations and cultural communities in the City, and how environmental health is perceived within different cultural contexts.

According to the literature, understanding the cultural norms and values of a target group towards the health issue or behaviour enables service providers to accurately conceptualize the issue (e.g. environmental health) and position health promotion and communication strategies accordingly (Kar, Alcalay & Alex, 2001). To improve the effectiveness and reach of environmental health programs, it is proposed that health promotion and communication strategies be tailored specifically to the needs and characteristics of the target population. This research attempts to identify and understand the environmental health concerns of importance to some members of the Chinese Community in the City of Toronto, as well as to ascertain and investigate effective strategies to communicate environmental health messages to this community. Additionally, this research aims to support Toronto Public Health’s goal to provide inclusive, accessible and equitable programs and services to the City’s diverse population(s).

2.1 RESEARCH OBJECTIVES

1. To identify the environmental health needs/concerns/interests of one part of Toronto’s Chinese Community.

2. To provide Toronto Public Health with some health promotion/health communication recommendations to help meet the needs of the City’s Chinese Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office.

3. To gain a more comprehensive understanding (culturally and linguistically) of the Chinese Community in the City of Toronto regarding environmental health promotion issues.

3.0 LITERATURE REVIEW

The following themes emerged through a review of the literature: perspectives on health, culture and ethnicity; environmental health and diverse ethno-cultural communities – the role of health promotion; and finally, diversity within the Toronto Chinese Community.

3.1 PERSPECTIVES ON HEALTH, CULTURE AND ETHNICITY

Cultures differ in the way they view the world, and in their beliefs about health, wellbeing and sickness. They develop models that attempt to explain, either implicitly or explicitly, to account for the phenomenon of health (or ill-health), and its place in human existence (Bowman & Hui, 2000; Raeburn & Rootman, 1998). The complex topic of health and ethnicity is becoming increasingly recognised as relevant in multicultural societies such as Canada. Concepts of health (or the absence of health) reflect the basic preoccupations of society, and the dominant views of society and the world. In this way, notions of health are culturally specific (Naidoo & Wills, 2000), and in Canada’s multicultural society various conceptions of health coexist (although the western biomedical tradition seems to dominate). It is important to recognise that the western biomedical model or view of health is a cultural phenomenon itself, and that concepts of health and wellbeing do not necessarily serve as a guide to the corresponding standards and concepts in other societies and ethno-cultural groups (Macbeth & Shetty, 2001).

Kar, Alcalay and Alex (2001) propose that an individual’s culturally conditioned beliefs, values, knowledge, attitudes and practices (BVKAP) influence his or her health-related behaviour in several ways, including beliefs about disease etiology; preferred modality of treatment; locus of decision/responsibility; communication and social relations; and accessibility of information and services.

The concept of ethnicity is difficult to define. Ethnicity is often maintained through culture and socialization and affects health-related factors in several ways. One view of ethnicity states that it might often be inextricable from what is considered socio-economic status or social class, and that in part ethnicity is a “…classification of others into a group by those outside that group” (Macbeth, 2001: 12). Ethnicity can also be defined as involving various factors including inheritance, language, beliefs, loyalties, change and context. This said, ethnicity is not necessarily static; rather it is complex and fluid in nature (Bhopal, 2001). Additionally, ethnicity should not necessarily imply homogeneity, and accurate descriptions of ethnic groups may be impossible due to the absence of meaningful boundaries of classification (Macbeth, 2001). The dynamics of cultural change, particularly following migration and degree of acculturation into a recipient society, contribute to the challenge of defining ethnicity. Bhopal (2001) defines ethnicity as the social group(s) that a person belongs to, or identifies with because of shared culture, that is, history, geographical origins, language, diet and other elements. In addition to this cultural component, ethnicity can also be viewed as involving a shared set of socio-political characteristics as well (Bhopal, 2001).

3.2 ENVIRONMENTAL HEALTH AND DIVERSE ETHNO-CULTURAL

COMMUNITIES – THE ROLE OF FOR HEALTH PROMOTION

There is limited literature available in regards to linking environmental health/health promotion and ethnicity/culture, particularly concerning the Chinese Community in Canada. The majority of existing literature focuses mainly on the socioeconomic and racial/ethnic disparities in health status attributed in part to environmental injustice and differential exposure to environmental hazards among low-income and/or ‘minority’ populations, particularly in the United States (Evans, Fullilove, Green & Levison, 2002; Williams & Florez, 2002; Preston, Warren & Stewart, 2000; Kleinberg, McKeever & Rothenbach, 1998). Limited information also exists on the risk perceptions of environmental hazards among the (Mainland) Chinese public; a study by Zhang (1994) concluded that this population generally had only limited knowledge of environmental hazards and consequently did not think or expect to be subject to environmental threats. The extent to which these conclusions are representative of environmental health perceptions of some members of the Toronto Chinese Community who have recently emigrated from Mainland China is unknown, and beyond the scope of this study, but may merit further investigation.

The Toronto and Region Conservation Authority (2002) has identified barriers that limit the participation of recent immigrants to Canada in environmental initiatives, which may theoretically be extended to include both environmental protection campaigns and environmental health programming. These barriers include language; access (logistics and communication); little or no access to environmental agencies and related organizations; settlement issues take priority; and a lack of resources (funding; educational and capacity building tools). Both Williams and Florez (2002) and Preston, Warren and Stewart (2000) noted that ethnicity can strongly influence participation in civic activities, and that ‘minority’ populations do not often have equitable access to various venues of public participation, thus in part limiting their ability to affect healthy public policy on the environment and environmental health.

According to the World Health Organization, a safe and stable ecosystem, and sustainable resources are among the prerequisites for health (WHO, 1986). Health promotion represents action areas, strategies and values which may assist in meeting the environmental health needs of various ethno-cultural communities (Singh, 2003). In addition, health promotion practice can support the removal of barriers for these communities to enable collaboration and participation in environmental health programming initiatives. Significant relevant areas for action include the creation of supportive environments (physical and socio-cultural-economic environments), supporting community action, the development of personal skills, along with building healthy public policy (Naidoo & Wills, 2000; WHO, 1986). Health promotion theories, values (e.g. a positive and holistic view of health, participation, equity and social justice, and embracing diversity), and strategies (including health education and communication, empowerment, capacity building, intersectoral collaboration, and advocacy) have significant potential to develop, complement, and support these issues (Goodstadt & Kahan, 2001). Many of these health promotion principles and strategies are demonstrated in the mission, guiding principles and current practices of Toronto Public Health (TPH, 2002; TPH, 2001).

3.3 DIVERSITY WITHIN THE TORONTO CHINESE COMMUNITY

The Chinese population in Canada has often been incorrectly mistaken as one homogeneous ethnic group (Luk, 2000); yet recognizing the role of sub-ethnicity (intra-ethnic differences) is important because group level discussions can conceal or misrepresent important subgroup differences (Lo & Wang, 1997). As a cultural community, the Chinese population in Canada is a heterogeneous group with various regional backgrounds; and represents emigration patterns that have changed considerably over the last three decades (Lo & Wang, 1997). The substantial diversity of the Chinese Community in the City of Toronto exemplifies this phenomenon. Although members of the Toronto Chinese Community may share certain cultural commonalities, sub-ethnic/cultural differences exist among and between community members, based upon several factors including geographical origins, level of acculturation, linguistic factors, educational background, number of years or generations in Canada, and spiritual/religious beliefs (Bowman & Hui, 2000). For example, the level of acculturation can often differ depending on the length and type of exposure to, or interaction with, the values, beliefs and/or practices of the mainstream or dominant Canadian (Western) culture. Consequently, the attitudes, values, knowledge and behaviours of first generation Chinese immigrants in Canada versus subsequent generations of Chinese Canadians may likely vary significantly, and thus cannot be overlooked or generalized.

Chinese immigrants in Canada originated from different areas in the world, specifically Mainland China, Hong Kong and Taiwan. They also emigrated from South and Southeast Asia (particularly Vietnam), and to a lesser extent the West Indies, Central and South America, and Africa (Lo & Wang, 1997). Prior to the 1990s, the majority of Chinese immigrants came from Hong Kong and primarily spoke Cantonese, while over the last decade Mandarin-speaking immigrants from Taiwan and Mainland China have increased significantly in number (Wong, 2002; Bowman & Hui, 2000). Lo and Wang (1997) noted that the Hong Kong and Mainland Chinese subgroups are much larger and have been in the City the longest, and as a result, there may be more contact or networking opportunities within these subgroups.

In terms of settlement patterns within the City of Toronto and Greater Toronto Area (GTA), the Chinese Community has substantially decentralized, with more expansive ethnic suburban concentrations developing in areas including Scarborough and North York, along with Markham, Mississauga, and Richmond Hill. This said, the older ethnic enclaves in the downtown core continue to thrive (Central and East Chinatown) (Federation of Chinese Canadians in Scarborough, 2001; Lo & Wang, 1997). In reviewing 1991 Canada Census data, Lo and Wang (1997) also determined that the Chinese Community in the GTA represents an ethno-cultural community that is both socially and economically diverse.

4.0 CONCEPTUAL FRAMEWORK

This research proposes that culture and ethnicity produce a lens that influences an individual’s perceptions of, and perspectives on, environmental health. The lens may be composed of shared values, beliefs, worldviews, knowledge and practices. This research attempts an exploratory investigation of the composition of this ethno-cultural lens (specifically among members of the Toronto Chinese Community), and the development of an understanding of its influence related to environmental health issues in this specific community. Although it is recognized that there are several additional factors that contribute to the development of an individual’s environmental health concerns, these are not the focus of this research.

Culture and ethnicity may also affect how environmental health messages are received and processed by individuals and communities. This research strives to develop an initial understanding of this process, including the barriers and types of miscommunication that can occur, and attempts to determine how environmental health messages can be more effectively communicated, identifying issues for consideration and further research.

The selection of the Toronto Chinese Community as the focus of this research is based upon the following key demographic and related factors:

· Chinese is spoken as a first language with the greatest frequency in Toronto, second only to English (The available statistics do not provide a further breakdown into the Chinese languages, i.e. Cantonese, Mandarin, etc.) (Pendakur & Hennebry, 1998);

· Chinese is the most frequently reported home language in Ontario (Pendakur & Hennebry, 1998);

· Chinese is one of the most frequently reported ethnic origins in Toronto, other than British, French and Canadian, according to 1996 Census of Canada data (317, 205 Single response, 42,245 Multiple response, 359,450 Total response) (Pendakur & Hennebry, 1998);

· The People’s Republic of China was one of the top five most frequently reported places of birth for people living in Toronto, as was Hong Kong SAR, according to 1996 Census of Canada data (Pendakur & Hennebry, 1998); and finally,

Traditional Chinese cultural beliefs regarding health and wellbeing differ considerably from the dominant western (biomedical) perspectives on health and wellbeing that are represented in the majority of current public health practice in Canada. Potentially, these cultural values and beliefs may influence perceptions of environmental health issues among members of the Toronto Chinese Community, as well as affect their preferences or needs regarding the communication of environmental health messages.

In addition, members of the Toronto Chinese Community are currently working actively in the area of the environmental health promotion, through health education, community development and advocacy initiatives (e.g. Chinese Environmental Ambassadors). Finally, the HP&EPO, TPH had already worked in partnership with representatives of this ethno-cultural community before, and noted interest from this community to pursue further collaboration.

5.0 RESEARCH METHODS

As requested by the HP & EPO, qualitative methods were used in this research study, specifically in-depth interviews, and a focus group. Due to the limited timeframe and resources available for this study, one focus group and three in-depth key informant interviews were conducted. These were unstructured, with questions delivered in an open-ended format in order to avoid pre-judging or limiting responses, and were conducted by the principal investigator. Both the focus group and the in-depth interviews were audio-recorded, and the principal investigator also took detailed notes. Participation in the research study was voluntary, and the provision of informed consent in writing was required in order to participate. Participants were recruited using convenience sampling through existing HP & EPO contacts in the Chinese Community, as well as through snowball sampling beyond these initial contacts.

5.1 FOCUS GROUP

The participants in the focus group (n=6) were self-selected from members of the Chinese Environmental Ambassadors (CEA). CEA members are volunteers from Toronto’s Chinese Community who facilitate, and participate in activities that promote environmental awareness and protection within their communities (Hui, Ng, & Wong, 2002). Participants were asked to share their perceptions and attitudes, both in relation to their role as Environmental Ambassadors and in general, regarding the environmental health issues that are important to people in the Toronto Chinese Community. They were also asked to discuss their opinions on the most effective approaches to communicate environmental health messages to members of this cultural community.

5.2 KEY INFORMANT INTERVIEWS

The participants in the in-depth key informant interviews (n=3) were individuals who provide community health or related services to members of the Chinese Community in Toronto (among others). These service providers all identified as Chinese themselves, although this was not a strict requirement for participation in the study. Participants were asked to share their feelings and observations, in relation to their role as service providers, on the environmental concerns of their Chinese clients, and how and to what extent Chinese culture contributes to perceptions of environmental health among members of this community. The service providers were also asked to discuss their opinions on effective communication strategies for this heterogeneous cultural community, particularly pertaining to messages on environmental health and related health promotion initiatives.

6.0 DATA ANALYSIS

Transcription of the audio tapes began immediately after the initiation of data collection, which supplemented field notes taken during the sessions. Transcripts were reviewed several times to identify emerging themes, e.g. environmental concerns, motivation, communication style. Each transcript statement was then categorized under a specific theme(s). Reviewing each theme during its development enabled the establishment of higher-order categories, e.g. developing the connections between health and the environment. The transcript statements that remained after categorization were again reviewed for relevance and to account for contrasting opinions.

In order to establish trustworthiness, meetings with a member of the Research Team were conducted to review the themes identified from the data, along with the higher-order categories of findings. The research findings were subsequently compiled into a draft summary for the purpose of peer debriefing with the Research Team, and were distributed among the participants for member checking (interpretation review and feedback).

Many valid issues and ideas were communicated during the focus group and interviews. Toronto Public Health identified specific objectives for this research study. Participants were informed in a letter that accompanied the draft summary of findings that consequently, in order to pursue the focus of the research so that it met the particular objectives of TPH, some of the issues and ideas raised were excluded from the summary.

The findings in Tables 1.0 (environmental health concerns) and 2.0 (communication methods) have been listed in order of how frequently they were discussed in the sessions, in addition to their level of importance (Table 1.0) and relevance/effectiveness (Table 2.0) as perceived by the participants. The principal investigator reviewed the transcripts in order to generate these lists and their order. The findings from the data analysis were then reviewed with respect to the relevant available literature, in order to generate recommendations for practice, and directions for future research and/or action.

7.0 LIMITATIONS OF THE RESEARCH

It is important to identify that this research study has several specific limitations, which are noted below.

It is understood that by selecting one specific ethno-cultural community in Toronto, i.e. the Chinese Community, that this study in effect excludes all other ethno-cultural communities in the City. The nature of this research study was exploratory, and consequently inferences to other ethno-cultural communities in the City thus cannot be made from any resulting recommendations.
As stated previously, the Chinese Community in Toronto is heterogeneous, and it is realized that the findings and recommendations resulting from the research study are not representative of, nor generalizable to the Toronto Chinese Community as a whole. The use of convenience sampling contributed to significant selection bias, and also limits the study’s generalizability to the greater Toronto Chinese Community. Notably, these findings represent the opinions and experiences of a very small group of participants, who represent (in their own acknowledgement as well as that of the principal investigator) a limited cross-section of the Toronto Chinese Community. All participants were born in Hong Kong, and were Cantonese speakers. This said, the participants represent a range of educational backgrounds, age groups, and number of years living in Canada. Among the total number of participants (n=9), there were 5 females and 4 males. Nonetheless, the results of the study may potentially provide a starting point for the creation of more culturally-relevant and culturally-accessible environmental health communication campaigns, and health promotion programming in HP & EPO.

· When working with specific communities that may be viewed as under-serviced, or about whom little research-specific information is known, it is often important to work through existing networks or representatives to gain access and facilitate relationships with the larger community. Due to the limited timeline and resources (both human and financial) available for this study, participants in the focus groups and interviews were entirely drawn from existing external contacts of HP & EPO and the faculty advisor, in spite of attempts of the principal investigator to broaden participant recruitment. It is thus acknowledged that the extent to which the opinions, values and knowledge of the research participants are representative of the Toronto Chinese Community as a whole, is unknown.

It is important to acknowledge that although the principal investigator has some expertise that enables this study to be conducted, this research study also constituted the major component of her practicum placement at TPH (and thus was an experiential learning exercise as well).
Due in part to the labour disruption at the City of Toronto, among other factors, the timeline for data collection, analysis and reporting/dissemination has been affected, and the amount of time available for these activities has been condensed considerably. This affected the number of interviews that could be completed, and the level of detailed analysis that was achieved.

8.0 RESULTS AND DISCUSSION

Many issues and ideas of interest were raised by the participants during the data collection process. The following is summary of the results and discussion of the findings from the focus group and in-depth interviews of this research study.

8.1 ENVIRONMENTAL HEALTH CONCERNS

According to the research participants, the most important environmental health issues among some members of the Toronto Chinese Community include water quality, particularly drinking water; and outdoor air pollution, including smog. Indoor air quality, and exposure to hazardous materials in the workplace, are additional environmental health issues of concern, although some participants were unsure if these issues fell under the mandate of Toronto Public Health. Table 1.0 outlines the responses of the research participants regarding environmental health issues of importance among some members of Toronto’s Chinese Community. The responses are separated into four categories; these categories represent the frequency of responses, and their level of importance as perceived by the participants, beginning with the most frequently discussed and important issues/concerns.

Table 1.0 - Environmental Health Issues/Concerns of Some Members of Toronto’s Chinese Community as Identified by Research Participants

· Water quality (drinking water)

· Outdoor air pollution (including smog)

· Garbage; recycling practices

· Climate change and the Greenhouse Effect

· Pesticide use

· Soil contamination

· Exposure to hazardous materials or conditions in the workplace

· Food safety (e.g. chemicals in freshwater fish)

· Loss of green space

· Indoor air quality

· Sun safety and UV protection

8.2 EMPHASIZING THE CONNECTIONS: THE ENVIRONMENT AND HEALTH

When asked about the connections that some members of the Chinese Community in Toronto are making regarding the environment and their health, the participants outlined several issues. If an environmental issue has direct impacts or consequences on their personal or familial health status, the conscious awareness and interest in this issue often increases, e.g. poor air quality on a smog day aggravating a respiratory condition, or requiring their children to play inside. If this direct relationship between the environment and health is identifiable through their own personal experience, the participants believed that some community members may be more likely, for example, to attend an information session on the health effects of air pollution or reducing energy consumption in the home or workplace.

Water quality, particularly related to drinking water, was identified by some participants as a significant environmental health issue among members of the Chinese Community; some members of this Community boil their drinking water or purchase water filters, in order to ensure that the water is safe to drink. Potential explanations for these precautionary behaviours include that boiling water is a continuation of a pre-immigration household practice that may be still deemed a necessity due to concerns about local water quality; and the recent media attention surrounding related environmental health threats in other communities, e.g. contaminated water supply in Walkerton. Here again, some Community members are recognizing the connections between the environment and their health, and are taking action within their households to minimize any adverse health-related outcomes.

Global warming was identified by one participant as a prominent environmental issue among members of the Toronto Chinese Community. Yet other participants disagreed, stating that they found it difficult to raise awareness about climate change and the Greenhouse Effect among some Community members who use their services. Some of the associated concepts were deemed to be too abstract; since the implications of climate change on their health and wellbeing would not necessarily be immediate, this macro-level issue may be viewed as less of a priority in their daily lives.

8.3 PROVIDING A FORUM FOR COMMUNITY COLLABORATION IN

ENVIRONMENTAL HEALTH PROMOTION

The majority of participants stressed the importance of directly involving the Chinese Community in the conceptualization, design, implementation and evaluation of environmental health initiatives, particularly when specifically targeting messages to members of this ethno-cultural community, or when facilitating active or passive participation in health promotion programming. Collaboration with representatives of appropriate social service and community health agencies, community groups, and the private sector could be an effective way to accomplish this goal, as these organizations possess a level of expertise (e.g. language) and knowledge of their Chinese clientele that would prove beneficial to the process.

Several participants also expressed interest to foster or maintain co-operation and/or consultation with Toronto Public Health, particularly for assistance with their own organization’s or group’s grassroots activities and community-level programming, as related to environmental health promotion. They placed importance on Toronto Public Health’s level of expertise, access to resources, and status in the community. According to the participants, the potential to pursue community development and capacity building opportunities related to environmental health promotion with some members of the Toronto Chinese Community is significant, and should be explored further with Community representatives.

8.4 COMMUNICATING ENVIRONMENTAL HEALTH MESSAGES TO

MEMBERS OF THE TORONTO CHINESE COMMUNITY

The participants identified several key communication methods and style-related issues for successful implementation of environmental health promotion campaigns or programs for members of the City’s Chinese Community. Table 2.0 outlines the responses of the research participants regarding methods for communicating environmental health issues of importance among members of Toronto’s Chinese Community.

8.4 COMMUNICATION METHODS

Table 2.0 outlines the responses of the research participants regarding methods for communicating environmental health messages to members of Toronto’s Chinese Community. The responses are separated into five categories; these categories represent the frequency of responses, and their level of relevance/effectiveness as perceived by the participants, beginning with the most frequently discussed and effective communication methods.

Table 2.0 - Methods for Communicating Environmental Health Messages to

Members of Toronto’s Chinese Community

· Chinese radio, television and print media

· Workshops and health fairs

· Community programming e.g. environmental tours, tree planting projects

· Brochures, posters, other printed materials

· Integrated environmental education initiatives, e.g. ESL classes, day camps

· Training of trainers initiative/Peer education

· Word of mouth

· Websites

· Mainstream mass media sources

The communication method identified as particularly effective for reaching members of Toronto’s Chinese Community was the Chinese media, including radio, television and print. This includes both Chinese-focused media sources, e.g. Fairchild Television, Sing Tao newspaper, along with multicultural media sources used by the Chinese Community, e.g. OMNI 2. Some media sources may have specific sections, such as reports on health issues or community event listings, which can be used to promote environmental health issues or publicize opportunities for community development among members of this Community. Several participants emphasized that for many members of Toronto’s Chinese Community, culture-specific media was their main source of news and other information. This said, not all members of this ethno-cultural community use the same Chinese media sources, e.g. radio stations or newspapers. If an environmental health message or health promotion program aims to target a specific group within this diverse ethno- cultural community by using the media, the media sources used by this particular subgroup must be determined in advance.

The view of some participants was that mainstream media were less effective means of message delivery; they viewed that these sources were already well-established, with a specific agenda, and less inclined to publicize Community-related programs or other events.

Workshops were also identified as a useful technique; along with other educational programming initiatives, workshops offer flexibility, opportunities for capacity building, and can often be adapted to meet the needs of different audiences with relative ease. This is key, as it was noted by both the research participants and in the literature that Chinese Community in Toronto is diverse. Consequently, different types of environmental health promotion programming are needed depending upon, for example:

· the content of the health message;

· the age group;

· the level of education, or socio-economic status of the target audience;

· the level of acculturation of the target audience;

· along with their existing level of awareness or interest in the issue.

Peer education, through models such as the training of trainers (TOT), was identified by several participants as another effective method of communicating on environmental health information and practices. By training these types of volunteers, it was felt that environmental health promotion outreach among many different age groups within the Toronto Chinese Community, and to appropriate neighbourhoods within the City, could be accomplished. One participant stated that this method was particularly effective for working with members of the City’s Chinese Community because the Chinese culture encourages harmony among human relationships, so using peer education models to share positive health messages could be both influential and supportive.

Some participants stated that Toronto Public Health is influential and respected; this reputation would be useful in negotiations with the Chinese media for program exposure, particularly if TPH representatives spoke the Chinese language and/or were members of the cultural community themselves. One participant suggested that if senior program staff from TPH’s ‘20/20 The Way to Clean Air’ initiative did a promotional interview with the Chinese media, then the program would be “a hit in the Chinese Community”.

8.6 COMMUNICATION STYLE AND CONTENT

In addition to distinguishing several useful methods for communicating environmental health messages to members of Toronto’s Chinese Community, including both the channels and vehicles of communication, the participants identified several style and content elements of importance when working with this cultural community, outlined in Table 3.0.

Table 3.0 – Disseminating Environmental Health Messages in the Toronto Chinese Community: Communication Style and Content Factors Identified by Research Participants
Language of Delivery	Chinese Dialects (Cantonese, Mandarin) Written Communication (Traditional versus Simplified Chinese)
Messenger	Credible Source Expert with Recognizable Qualifications (e.g. Physician)
Message Content	Frequent and Consistent Objective and Non-threatening No Fear Appeals or Victim-blaming Presentation of Multiple Options Provision of Estimated Outcomes of Each Option Direct Connections Between Health & the Environment
Characteristics of Target Audience	· Scope: Broad or Focused · Potential Target Groups (Older Adults; Men)

8.6.1 LANGUAGE OF DELIVERY

It is essential to deliver environmental health promotion messages and programming to many members of this ethno-cultural community in the Chinese language, according to the participants. This can be done either directly in the Chinese language, or in both English and Chinese, depending upon the demographic characteristics of the group being targeted (e.g. comfort and proficiency with the English language; education and income levels). Some neighbourhoods in Toronto consist primarily of either Cantonese or Mandarin speakers (dialects of the Chinese language), while in other neighbourhoods, there is a broad mix of speakers of these two dominant dialects. One participant noted that although the written language of both dialects is the same, depending upon the education levels of the target audience, either the traditional or the simplified version of the Chinese written language should be used. Many members of the Chinese Community in Toronto understand the traditional version; Chinese people residing in Toronto have immigrated from all over the world, and many have learned this version, according to one participant.

8.6.2 MESSENGER

The person delivering the message is also very important to members of the Toronto Chinese Community, according to several participants. The messenger is the model appearing in the message that delivers information or demonstrates behaviour. Some participants stated that an environmental health message delivered by a physician or other expert with significant recognizable qualifications would be better received and carry more strength within the Community. The reason cited for this by some participants was that there exists a strong belief in authority among some Chinese people, along with considerable respect for those viewed as qualified experts. As a result, it is these individuals who tend to be more successful in attracting attention to environmental health issues, soliciting awareness and behaviour change, and promoting capacity building and community involvement on these issues.

8.6.3 MESSAGE CONTENT

The participants identified that using fear appeals, or other scare tactics in communication campaigns on environmental health issues would not be an effective way to promote awareness, behaviour change, or community development among some members of the Toronto Chinese Community. Instead messages should be frequent, consistent, objective and non-threatening; messages should instil a need for personal action without instigating feelings of guilt or ill-will (e.g. victim-blaming). One participant stated that some members of this cultural community appreciate being presented with several options and the estimated outcomes of each option by service providers. As opposed to service providers adopting an omnipotent or paternalistic role, they should instead act in the role of facilitator and guide as feasibility permits. This could enable some members of the City’s Chinese Community to decide the option best suited for their needs, and to pursue behaviour change accordingly as a result.

The consensus among participants was that in order to increase the effectiveness and appropriateness for some members of Toronto’s Chinese Community, environmental health messages needed to present direct connections to the relationship between the environment and one’s health. If the issues are presented as directly affecting their immediate health and the health of their families, it will be of real interest to some members of this cultural community. For example, a workshop on outdoor or indoor air quality would be viewed as more beneficial, and of greater interest, if combined with a discussion on asthma. Also, some participants noted that options to improve environmental health that may also help to save money by reducing household expenses (e.g. energy saving activities) would be popular among some community members. In addition, some participants suggested that the use of various incentives could be useful when promoting environmentally healthy practices among members of this cultural community (if financially feasible), at least until the linkages between environmental wellbeing and their health are recognized. Finally, appropriate behaviour change should be initially promoted at the level of the individual, according to one participant, before being broadened to a community-level focus.

8.6.4 CHARACTERISTICS OF TARGET AUDIENCE

It was the consensus among the participants that knowledge of the target audience remains vital when promoting environmental health messages and programs among members of the Toronto Chinese Community. This corresponds with the defined goals and objectives of a potential program or campaign – is the program aimed at the Toronto Chinese Community in a broad sense, or is it focusing on a specific group within this diverse cultural community? For example, some participants suggested that elderly members of Chinese families could potentially represent an effective target group for program planning and outreach. It was felt that the elderly were well-respected, and were influential within their families, and that subsequently messages that targeted their age group would then ‘trickle down’ among other family members, due to strong family ties and appreciation of the knowledge, experience and opinions of older generations. Some participants also reported that seniors attended workshops on environmental health issues more frequently than younger people. They also found that promoting environmental health issues among the middle aged individuals to be the most difficult. This age group was viewed as the most resistant to change, and most often too busy with the activities of daily life to change their practices, even when they were aware that such change would be beneficial.

One participant also suggested that it would potentially be beneficial to target selected environmental health messages to men in the Toronto Chinese Community (particularly the head of the household). It was the experience of this participant that many of these men were interested in environmental issues, and as major decision-makers in their families, had the potential to influence household practices and motivate for behaviour change.

9.0 RECOMMENDATIONS AND DIRECTIONS FOR FUTURE RESEARCH

AND PRACTICE

The findings of this research study have contributed to the development of the following recommendations, intended to help meet some of the needs of members of the Toronto Chinese Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office, Toronto Public Health.

9.1 FOCUSING ON THE CONNECTIONS: LINKING HEALTH AND THE ENVIRONMENT

This investigation of the environmental health concerns of some members of the Toronto Chinese Community has suggested some initial issues with which the Health Promotion and Environmental Protection Office may pursue health promotion campaigns and programming. Singh (2003) proposed that health promotion practitioners should capitalize on both the health and environmental arguments when working with communities on environmental health promotion. This approach can be more effective and relevant in communicating these messages to individuals and groups who would otherwise not necessarily attend to an environmental message. This reasoning is shared by the research participants as pertaining to some members of the Toronto Chinese Community.

Reviewing the research results has produced the following recommendations:

· Focus health promotion information and action initially on environmental health issues related to water quality (particularly drinking water), and outdoor air pollution (including smog).

· Emphasize clearly the direct impacts or consequences of environmental issues on personal and family health in communication campaigns and health promotion programming; relating these connections to the context of their daily lives could be particularly effective.

9.2 FOSTERING PARTNERSHIPS IN ENVIRONMENTAL HEALTH PROMOTION: WORKING WITH THE TORONTO CHINESE COMMUNITY

It is evident from the research findings that the need to pursue further collaboration with the Toronto Chinese Community is key in order to foster lasting partnerships in environmental health with members of this ethno-cultural community. It is also apparent that working effectively together requires a health promotion approach, employing several of the strategies that the HP & EPO currently strives to practice, among others. This means:

· Fostering intersectoral collaboration with representatives of appropriate social service and community health agencies, community groups, and the private sector, which serve or work with the Toronto Chinese Community, building upon the experience of any existing collaborations with Community members, e.g. the Chinese Environmental Ambassadors.

· Directly involving representatives of the Toronto Chinese Community during the campaign or program planning process, including the conceptualization, design, implementation and evaluation of environmental health initiatives. This is particularly necessary when specifically targeting environmental health messages to members of this ethno-cultural community, or when facilitating active or passive participation in health promotion programming.

· Working with Community representatives to reduce barriers to the participation of members of this ethno-cultural community in environmental health promotion campaigns and programming.

· Building Community capacity in the areas of advocacy and self-help skills related to environmental health issues, in active collaboration with Community representatives.

As a potential result of these recommendations, progress may be made in increasing the participation of Community members in civic activities, e.g. community consultations, contributing to their ability to affect healthy public policy on environmental health issues.

9.3 COMMUNICATION RECOMMENDATIONS FOR ENVIRONMENTAL HEALTH CAMPAIGNS AND PROGRAMS

Reviewing the results, it is clear that there are key communication method and style elements that need to be considered when striving to implement effective environmental health promotion and campaigns or programs for members of the Toronto Chinese Community.

In terms of communication methods:

· Focus on using the Chinese media, including radio, television and print to promote environmental health issues, and to publicize opportunities for community development and participation among members of this Community. Note that since different cultural subgroups of the Community use different media sources, these must be determined in advance if a specific subgroup is being targeted in a particular initiative.

· Continue the collaborative development of workshop resources and peer education opportunities e.g. training of trainers (TOT) on environmental health promotion issues and strategies. Ensure that these resources and programming are flexible, and can be adapted to meet the diverse needs of the City’s heterogeneous Chinese Community, depending upon the target audience.

Regarding communication style and content:

· Deliver environmental health promotion messages and programming to members of this ethno-cultural community in the Chinese language, or in both Chinese and English, depending upon the demographic characteristics of the target group.

· When using personal figures to present environmental health campaigns and programs to members of the Toronto Chinese Community, utilize messengers who represent significant expertise and recognizable qualifications whenever possible.

· Present environmental health messages in a frequent, consistent, objective and non-threatening manner; include multiple options and facilitating devices for behaviour change, and if possible, provide the estimated outcomes of each option, e.g. reducing household expenses. These messages should instil a need for personal action without ‘blaming the victim’.

· Insure that the relationships between health and the environment are prominent in the message content.

· Recognize the diversity of the Toronto Chinese Community; acquire knowledge of the specific target audience through collaboration with Community representatives and service providers, and through reviewing appropriate local demographic indicators, e.g. census data.

9.4 DIRECTIONS FOR FUTURE RESEARCH AND PRACTICE

As stated by Lo and Wang (1997), treating the Chinese Community in Toronto as a homogeneous group conceals internal differences. Since the generalizability of this research study is limited due to the very small sample size, and the similar demographic characteristics of the participants, further research on these issues, using a broader sample, is encouraged. This should ideally include a greater cross-section of the Toronto Chinese Community, for example:

· Speakers of different Chinese dialects (Mandarin, Cantonese, or other dialects)

· Different geographical origins;

· Different number of years or generations in Canada;

· Various educational backgrounds;

· Living in particular neighbourhoods in the City.

Using qualitative research methods was particularly effective in this exploratory research study, and allowed for the collection of data that was rich and comprehensive. This said, in order to include a larger sample population in this type of research, it may be more feasible to use mixed methods (qualitative and quantitative), such as initial focus groups, followed by a survey.

In reviewing findings of this research study, it seems that there is significant potential to pursue community development and capacity building opportunities related to environmental health with some members of the Toronto Chinese Community. These opportunities in particular, along with intersectoral collaboration, health education, and health communication, represent important health promotion strategies for working on environmental health issues with this ethno-cultural community. Since many of these strategies are already reflected in current TPH expertise and practice, there is potential to expand and build upon them in order to work with Toronto Chinese Community to help meet the needs of its members in relation to environmental health. Ideally, the recommendations from this research study will assist with this process.

10.0 APPENDICES

APPENDIX A: INTERVIEW GUIDE FOR CONDUCTING THE FOCUS GROUP

APPENDIX B: INFORMATION LETTER FOR FOCUS GROUP PARTICIPANTS

APPENDIX C: CONSENT FORM FOR FOCUS GROUP PARTICIPANTS

APPENDIX D: INTERVIEW GUIDE FOR CONDUCTING KEY INFORMANT

INTERVIEWS

APPENDIX E: INFORMATION LETTER FOR KEY INFORMANTS

APPENDIX F: CONSENT FORM FOR KEY INFORMANTS

APPENDIX A: INTERVIEW GUIDE FOR CONDUCTING THE FOCUS GROUP

Questions for the Focus Group Interview

Thank you for agreeing to participate in this focus group. The Health Promotion and Environmental Protection Office, Toronto Public Health has expressed an interest in identifying and understanding which environmental health issues are important, to the Chinese Community in the City of Toronto. In addition, we would like to investigate effective ways to communicate environmental health messages to members of your community.

This consultation process is intended to obtain opinions from members of Toronto’s Chinese Environmental Ambassadors. This session will be tape-recorded, and I will also take detailed notes. Any personal information you provide will remain confidential and your name will not appear in any report of the study. The final report of this research will be submitted to the Health Promotion and Environmental Protection Office, Toronto Public Health. The results of this research will assist with the development of some health promotion and communication recommendations for Toronto Public Health to help meet the needs of the Chinese Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office. The research will be presented at the Sustainable Toronto Research Dissemination Day, in fulfilment of the sponsoring organization’s requirements. I will also discuss the research as part of a larger presentation on my practicum experience at Toronto Public Health to faculty and fellow students in the Master of Health Sciences (Health Promotion) Program (Department of Public Health Sciences, University of Toronto).

(The interviewer will begin the discussion by asking each focus group participant to introduce themselves. This will be followed by the following general question in order put people more at ease with one another and encourage dialogue to begin).

1. What are the top three environmental issues we face in Toronto?

2. When we think about how our environment affects our health, what environmental health issues are important right now and why?

3. In your role as an Environmental Ambassador, do you feel that the environmental health concerns that you identify are typical of those Toronto’s Chinese Community? How and why?

4. We can also talk about the communication of health messages:

In your role as an Environmental Ambassador, how do you communicate environmental health messages to your community?

Possible Probes:

What materials, words, images, and style do you use?

What works and what does not work?

5. If you were responsible for creating environmental health messages for Toronto’s Chinese Community, what factors would you need to consider for the messages to “reach” your community?

6. Is there anything else you would like to mention? THANK YOU!

APPENDIX B: INFORMATION LETTER FOR FOCUS GROUP PARTICIPANTS

A Qualitative Study to Explore Environmental Health Concerns in

Toronto’s Chinese Community Through the Voices of the

Chinese Environmental Ambassadors and Service Providers

Research conducted for the Health Promotion and Environmental Protection Office, Toronto Public Health, with the support of Sustainable Toronto.

Information Letter for Focus Group Participants

According to a recent report, the majority of environmental health promotion programs in Ontario have targeted a homogeneous general population. The City of Toronto is incredibly diverse, and it is unknown to what extent environmental health concerns, such as air pollution, are shared across ethnic populations and cultural communities in the City, and how environmental health is understood within these different communities.

As a graduate student completing a practicum at the Health Promotion and Environmental Protection Office, Toronto Public Health, I have been asked to conduct research in order to identify and understand which environmental health issues are important to the Chinese Community in the City of Toronto. In addition, Toronto Public Health would like to investigate effective ways to communicate environmental health messages to members of this diverse cultural community.

In this study, Toronto Public Health would like to explore two main issues:

1. The environmental health issues that are important to the Chinese Community in Toronto; and,

2. The best ways to communicate environmental health messages to people in the Chinese Community.

If you agree to participate in the study you will be asked to talk about these questions in a group setting of about 8-10 people. If you agree to participate, a group interview will be arranged at a convenient time and place. It should take about two hours. Participation is voluntary, and you are free to end the interview at any time. You do not have to answer any questions. The interviewer will make detailed notes during the session and the interview will be tape-recorded, but no comments will be associated to you and your name will not appear in any report. All focus group participants will be asked to keep the conversation confidential and not disclose what was said and who said it.

Findings from the research will contribute to the development of a more comprehensive cultural understanding of how the Chinese Community in Toronto perceives environmental health issues. This information will also assist with the development of some health promotion and communication recommendations for Toronto Public Health to help meet the needs of the Chinese Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office.

The research will also be presented at the Sustainable Toronto Research Dissemination Day, in fulfilment of the sponsoring organization’s requirements. I will also discuss the research as part of a larger presentation on my practicum experience at Toronto Public Health to faculty and fellow students in the Master of Health Sciences (Health Promotion) Program (Department of Public Health Sciences, University of Toronto).

/…con’t

We will provide you with a summary of the final report upon request. To obtain this summary, please contact the Health Promotion and Environmental Protection Office, Toronto Public Health at (416) 392-6788.

If you have any questions please contact me at (416) 338-8099, e-mail: egilgan@city.toronto.on.ca

Thank you for considering this request.

Sincerely,

Erin Gilgan

Health Promotion and Environmental Protection, Toronto Public Health, 277 Victoria St., 7^th Floor

APPENDIX C: CONSENT FORM FOR FOCUS GROUP PARTICIPANTS

A Qualitative Study to Explore Environmental Health Concerns in

Toronto’s Chinese Community Through the Voices of the

Chinese Environmental Ambassadors and Service Providers

Research conducted for the Health Promotion and Environmental Protection Office, Toronto Public Health, with the support of the Sustainable Toronto.

Consent Form for Focus Group Participants

I understand that Toronto Public Health is carrying out a study to identify and understand which environmental health issues are important to the Chinese Community in the City of Toronto. In addition, Toronto Public Health would like to investigate effective ways to communicate environmental health messages to members of this community.

I understand that I will be asked my opinions about this in a group setting of about 8 to 10 participants. I understand that my participation is voluntary and I am free to end my participation in the focus group at any time. I also do not have to answer any questions. I understand that the interviewer will take detailed notes during the session and that the session will be tape-recorded, but that no comments will be directly associated to me and my name will not appear in any report. I understand that the investigator cannot guarantee that other focus group members will not disclose my opinions from the session. I have received an explanation of the study and my questions of clarification have been answered.

I understand that findings from the research will contribute to the development of a more comprehensive cultural understanding of how the Chinese Community in Toronto perceives environmental health issues. I also understand that the information I provide will assist with the development of some health promotion and communication recommendations for Toronto Public Health to help meet the needs of the Chinese Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office.

I understand that the research will be presented at the Sustainable Toronto Research Dissemination Day, in fulfilment of the sponsoring organization’s requirements. Additionally, I understand that the research will be discussed as part of a larger presentation on the investigator’s practicum experience at Toronto Public Health to faculty and fellow students in the Master of Health Sciences (Health Promotion) Program (Department of Public Health Sciences, University of Toronto).

I understand that if I agree to participate in this study I can request a summary of the findings of the study by contacting the Health Promotion and Environmental Protection Office, Toronto Public Health.

I __________________ (please print your name) consent to participate in this study.

_______________________ _______________________

Signature of Participant Signature of Witness

_______________________

Date

If I have any questions I can contact Erin Gilgan at the Health Promotion and Environmental Protection Office, Toronto Public Health at (416) 338-8099; email: egilgan@city.toronto.on.ca

APPENDIX D: INTERVIEW GUIDE FOR CONDUCTING KEY INFORMANT INTERNVIEWS

Questions for the Key Informant Interview

Thank you for agreeing to participate in this key informant interview. The Health Promotion and Environmental Protection Office, Toronto Public Health has expressed an interest in identifying and understanding which environmental health issues are important, or are of concern, to the Chinese community in the City of Toronto. In addition, we would like to investigate effective ways to communicate environmental health messages to members of this diverse cultural community.

This consultation process is intended to obtain opinions from individuals who provide community health or related services to members of the Chinese Community in Toronto (among others). This session will be tape-recorded, and I will also take detailed notes. Any personal information you provide will remain confidential and your name will not appear in any report of the study. The final report of this research will be submitted to the Health Promotion and Environmental Protection Office, Toronto Public Health. The results of this research will assist with the development of some health promotion and communication recommendations for Toronto Public Health to help meet the needs of the Chinese Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office. The research will also be presented at the Sustainable Toronto Research Dissemination Day, in fulfilment of the sponsoring organization’s requirements. I will also discuss the research as part of a larger presentation on my practicum experience at Toronto Public Health to faculty and fellow students in the Master of Health Sciences (Health Promotion) Program (Department of Public Health Sciences, University of Toronto).

1. What are the environmental concerns of your Chinese clients?

2. Specifically, what connections are your Chinese clients making between the environment and their health and why?

3. As a service provider to members of Toronto’s Chinese Community, do you feel that the environmental health concerns of these particular clients are different or similar than those of other communities in the City? How and why?

4. Through your experience working with Chinese clients (and/or through your personal experience as a member of the Toronto Chinese Community yourself), how and to what extent does Chinese culture contribute to perceptions of environmental health among members of this community?

5. In your experience working with Chinese clients which communication strategies (including methods, mediums, messages, language, and context) work best?

6. Given what you just said, what would you recommend that Toronto Public Health do to effectively communicate environmental health messages to members of Toronto’s Chinese Community?

7. Is there anything else you would like to mention?

THANK YOU!

APPENDIX E: INFORMATION LETTER FOR KEY INFORMANTS

A Qualitative Study to Explore Environmental Health Concerns in

Toronto’s Chinese Community Through the Voices of the

Chinese Environmental Ambassadors, and Service Providers

Research conducted for the Health Promotion and Environmental Protection Office, Toronto Public Health, with the support of Sustainable Toronto.

Information Letter for Service Providers

In this study, Toronto Public Health would like to ask you the following questions:

1. What are the environmental concerns of your Chinese clients?

2. Specifically, what connections are your Chinese clients making between the environment and their health and why?

5. In your experience working with Chinese clients which communication strategies (including methods, mediums, messages, language, and context) work best?

6. Given what you just said, what would you recommend that Toronto Public Health do to effectively communicate environmental health messages to members of Toronto’s Chinese Community?

7. Is there anything else you would like to mention?

You will be asked to talk about these questions in an interview. If you agree to participate, an interview will be arranged at a convenient time and place, and it should take about an hour. Participation is voluntary, and you are free to end the interview at any time. You do not have to answer any questions. The interviewer will make detailed notes during the session and the interview will be tape-recorded. Any personal information that you provide will be confidential and your name will not appear in any report.

/…con’t

Community, particularly as these relate to the mandate of the Health Promotion and Environmental Protection Office.

If you have any questions please contact me at (416) 338-8099, e-mail: egilgan@city.toronto.on.ca

Thank you for considering this request.

Sincerely,

Erin Gilgan

Health Promotion and Environmental Protection, Toronto Public Health, 277 Victoria Street, 7^th Floor

APPENDIX F: CONSENT FORM FOR KEY INFORMANTS

A Qualitative Study to Explore Environmental Health Concerns in

Toronto’s Chinese Community Through the Voices of the

Chinese Environmental Ambassadors and Service Providers

Research conducted for the Health Promotion and Environmental Protection Office, Toronto Public Health, with the support of Sustainable Toronto.

Consent Form for Key Informants

I understand that I will be asked my opinions about this in an interview. I have been provided with the questions beforehand. I understand that my participation is voluntary and that I am free to end the interview at any time. I do not have to answer any questions. I understand that the interviewer will make detailed notes during the session and that the interview will be tape-recorded, but any personal information that I provide will be confidential and my name will not appear in any report. I have received an explanation of the study and my questions of clarification have been answered.

I _________________ (please print your name) consent to participate in this study.

_______________________ _______________________

Signature of Participant Signature of Witness

_______________________

Date

If I have any questions I can contact Erin Gilgan at the Health Promotion and Environmental Protection Office, Toronto Public Health at (416) 338-8099; email: egilgan@city.toronto.on.ca

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