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Int. J. Environ. Res. Public Health 2009, 6(9), 2481-2499; doi:10.3390/ijerph6092481

Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study

1,* , 2
1 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Rm 130, Toronto, ON M5T 1P8, Canada 2 School of Nursing, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, Canada 3 Resources, Research, Evaluation and Development Division, Sudbury & District Health Unit, 1300 Paris Street, Sudbury, ON P3E 3A3, Canada 4 Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada 5 Behavioural Cardiology Research Unit, University Health Network, NU 6N-618, 585 University Avenue, Toronto, ON M5G 2N2, Canada
* Author to whom correspondence should be addressed.
Received: 14 August 2009 / Accepted: 14 September 2009 / Published: 17 September 2009
(This article belongs to the Special Issue Cardiovascular Diseases and Public Health)
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Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who were aware of their high risk for CHD and had received information about cardiovascular risk modification while participating in a larger intervention study. Participants were drawn from two selected regions: Sudbury and District (northern Ontario) and the Greater Toronto Area (southern Ontario). Analysis drew on concepts of place and space to capture the complex interplay between geographic location, sociodemographic position, and people‟s efforts to understand and modify their risk for CHD. Three major sites of difference and ambiguity emerged: 1) place and access to health resources; 2) time and food culture; and 3) itineraries or travels through multiple locations. All participants reported difficulties in learning and adhering to new lifestyle patterns, but access to supportive health resources was different in the two regions. Even within regions, subgroups experienced different patterns of constraint and advantage. In each region, “fast” food and traditional foods were entrenched within different temporal and social meanings. Finally, different and shifting strategies for risk modification were required at various points during daily and seasonal travels through neighbourhoods, to workplaces, or on vacation. Thus health education for CHD risk modification should be place-specific and tailored to the needs and resources of specific communities.
Keywords: cardiovascular disease; place; cardiovascular risk modification; qualitative methods; health behaviour cardiovascular disease; place; cardiovascular risk modification; qualitative methods; health behaviour
This is an open access article distributed under the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Angus, J.E.; Rukholm, E.; Michel, I.; Larocque, S.; Seto, L.; Lapum, J.; Timmermans, K.; Chevrier-Lamoureux, R.; Nolan, R.P. Context and Cardiovascular Risk Modification in Two Regions of Ontario, Canada: A Photo Elicitation Study. Int. J. Environ. Res. Public Health 2009, 6, 2481-2499.

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