Introduction
Water related activities result in a large number of fatalities annually throughout Canada (Lifesaving Society 2005); unfortunately a disproportionate number of these fatalities occur within the country's aboriginal population (Canadian Red Cross 2005; Health Canada 2001). Although aboriginal people represent 3% to 5% of the Canadian population, they represent 9% of all boating related drowning, 10% of drowning fatalities during aquatic activities, 16% of drowning from falls into water, and 26% of snowmobile related drowning (Health Canada 2001). The problem is even more pronounced in Canada's north, which has a drowning rate that is up to ten times the national average, with aboriginal peoples accounting for a greater number of fatalities than their non-aboriginal counterparts (Health Canada 2001). According to Health Canada (2001), aboriginal people are more vulnerable to drowning due to their proximity to large bodies of water. Despite the fact that lifejackets have been found to reduce risks of drowning (Canadian Red Cross 2007), many northerners do not wear these potentially lifesaving devices. In this paper focus is placed on one community, Tuktoyaktuk, NWT, and we elucidate some of the reasons why residents of Tuktoyaktuk (who are primarily Inuvialuit) appear averse to wearing lifejackets and personal flotation devices, despite the substantial reduction in drowning that such behaviour could yield because of lifejackets’ ability to enable wearers to float when unexpectedly entering the water (Canadian Red Cross 2007).
Situating the community and its residents
Tuktoyaktuk, NWT, is a town of 870 residents located on the Beaufort Sea. The majority (84%) of residents identify themselves as aboriginal Canadians (that is Inuit, North American Indian or Métis) (Aboriginal population profile, 2006 census, 2008: 1). Residents of Tuktoyaktuk have had limited exposure to formal water safety instruction. In 1972, ‘Corky the barge’ a barge with a swimming pool on it, visited the community for several weeks and swimming instruction was offered. In 1990, a six week waterfront programme was offered in Tuktoyaktuk, which was repeated in 1992. In 1993, a small (12 × 3 m) shallow water pool was built in the community. This pool is housed in a ‘spring form’ structure, which looks much like a tent, and is operated on a seasonal basis during the warmer summer months due to the fact that the structure is not insulated. Swimming lessons, which include water safety education, are offered at the swimming pool. Pool staff typically consists of a swimming pool supervisor who is hired from southern Canada, along with several local community members who work as swimming pool assistants. Despite years of southern derived water safety education, drownings are still quite common in Tuktoyaktuk, and few community members wear lifejackets while participating in aquatic based activities.
While Tuktoyaktuk is the focus of this study, the community and its residents share many similarities with other northern communities: exposure to swimming lessons through the NWT aquatics programme (NWTAP). These similarities include a remote setting; high drowning rates; and low lifejacket use. As a result, the findings of this study may have relevance to other NWT and Nunavut communities and can be used to inform lifejacket use in these communities.
Review of literature
Drowning is the second leading cause of injury death in most aboriginal communities (Health Canada 2001; Saylor Reference Saylor2004) throughout Canada. In the NWT it is more pronounced, as drowning is a leading cause of injury death in every age group from 0 to 65 years of age (NWTHSS 2004). The NWTAP was designed to address this very issue, as well as to develop future northern, and particularly aboriginal, aquatics leaders. Despite the programme's 40 year presence in Canada's north, it has failed to meet its most fundamental objectives (Giles and others Reference Giles, Baker and Rousell2007).
The NWTAP has met with enormous popularity, reaching its height in 1997 with 41 aquatics programmes territory wide (Szabo Reference Szabo2002): nevertheless, the NWT has maintained an exceedingly high drowning rate, despite a substantial decrease across the rest of Canada. One of the key features of the NWTAP, which currently uses the Canadian Red Cross's ‘SwimKids’ and the Lifesaving Society of Canada's Swim for Life programmes, includes a focus on drowning prevention and the related use of lifejackets while in, on, or around bodies of water. Certainly, this approach is supported by Health Canada's (2001) Unintentional and intentional injury profile for aboriginal people in Canada, 1990–1999 report, which found that risks ‘associated with drowning in Aboriginal victims. . .include low use of flotation devices’ (Health Canada 2001: iii). The report further noted that only 6% of aboriginal drowning victims were found to be wearing lifejackets. These findings beg the question, ‘[w]hy do so few Aboriginal peoples wear lifejackets,’ especially in light of the fact that many communities have had exposure to drowning prevention programmes. Saylor (Reference Saylor2004) attempted to answer this question and found that unlike in the non-aboriginal world, cars, snowmobiles, etc. had arrived much more abruptly in aboriginal communities. Safety measures such as seat belts, car seats, helmets and other injury prevention interventions were not used at the time. Even today personal flotation devices are not commonly used (Saylor Reference Saylor2004: 313)
Although Saylor shed light on the issues at hand, there are many other personal, cultural and environmental factors that must be addressed fully to understand lifejacket use or lack thereof. Here, we have identified themes regarding why Tuktoyaktuk residents commonly fail to wear lifejackets and have chosen a well-supported health-behaviour theory, the theory of planned behaviour (TPB), to interpret these themes in order to elucidate the multiple factors that may influence lifejacket usage among residents of Tuktoyaktuk.
Theoretical framework
The TPB (Ajzen Reference Ajzen1991) is a deliberative processing model (Connor and Sparks Reference Connor, Sparks, Connor and Norman2005) that attempts to explain human motivation and rational behaviour (Maddux Reference Maddux1993). This theory assumes that information or beliefs about a given behaviour and its consequences influence the likelihood of performing a specific behaviour. Although the TPB is mostly used in conjunction with quantitative research, here it is used as a heuristic framework to interpret themes that emerged through our qualitative study; indeed, employing a theoretical framework as a guide has been identified as an appropriate approach to conducting qualitative research (Creswell 1994). The TPB has been applied to the study of numerous health risk behaviours including drug and alcohol use (see Conner and Sparks Reference Connor, Sparks, Connor and Norman2005 for a review), sexual behaviours (see Godin and Kok, Reference Godin and Kok1996 for a review) as well as health promoting or protecting behaviours such as physical activity (see Hagger and others Reference Hagger, Chatzisarantis and Biddle2002 for a review), safe bicycle riding practices and health screening (see Conner and Sparks Reference Connor, Sparks, Connor and Norman2005 for a review). In a review of the use of the TPB in health behaviour research, Connor and Sparks (Reference Connor, Sparks, Connor and Norman2005) suggested that the TPB has been largely successful in explaining health behaviours. The TPB is thus an appropriate framework for the study of lifejacket use. In the TPB the most proximal determinant of behaviour is one's intention to do that behaviour. According to the theory, behavioural intention is determined by three determinants. The first is an individual's attitude(s) towards a particular behaviour, the second is the subjective norms associated with the behaviour, and the third is one's perceived behavioural control over the behaviour (Montano and others Reference Montano, Kasprzyk, Taplin, Glanz, Lewis and Rimer1997). Attitude is determined by behavioural beliefs which are individual beliefs about the outcomes associated with performing the behaviour. (for example ‘wearing a lifejacket may save my life,’ ‘wearing a lifejacket will be uncomfortable’) weighted by evaluations of those outcomes (‘I value safety,’ ‘I value comfort’). Subjective norm is determined by the perceptions of important referent individual(s)'s approval or disapproval of the individual performing the behaviour, known as ‘normative beliefs’ (for example ‘my friends do not think I should wear a lifejacket’; ‘my friends would look favourably upon me for wearing a lifejacket’), weighted by the individual's motivation to comply with the wishes or opinions of the referent individual(s) (for example ‘I want their approval so I will/will not wear a life-jacket’) (Montano and others Reference Montano, Kasprzyk, Taplin, Glanz, Lewis and Rimer1997). Finally, one's perceived behavioural control is determined by one's control beliefs concerning the presence or absence of resources for, and impediments to, performing the specified behaviour (for example ‘I have enough money to purchase a lifejacket’; ‘I do not have enough confidence to wear a lifejacket when no one else is’), weighted by the perceived impact of each resource and impediment to facilitate or inhibit that behaviour (for example ‘[b]ecause I can afford to buy a lifejacket, it will be easy for me to wear one’; ‘[i]f I am not confident in my ability to wear a lifejacket when no one else is, I likely will not wear one’) (Montano and others Reference Montano, Kasprzyk, Taplin, Glanz, Lewis and Rimer1997). While attitudes, subjective norms and perceived behavioural control are all seen as determinants of intention, perceived behavioural control is also viewed as a direct determinant of behaviour (Montano and others Reference Montano, Kasprzyk, Taplin, Glanz, Lewis and Rimer1997). Thus, while one's attitudes and subjective norms may support one's intention to wear a lifejacket, if one does not perceive one has control over wearing a lifejacket, then one will not wear one.
Notably, ‘all other factors including demographics and environment operate through the model constructs and do not independently contribute to explaining the likelihood of a person's performing a behaviour’ (Montano and others Reference Montano, Kasprzyk, Taplin, Glanz, Lewis and Rimer1997: 85). This characteristic of the TPB makes it a favourable theory for interpreting the present data, as it is not known why the aboriginal residents of Tuktoyaktuk, NWT do not typically wear lifejackets. It is thus important that the model used to analyse the data is broad and as such may capture several of the factors important to this population. For example, though socioeconomic status, race and ethnicity often have been used in a simplistic manner in the health literature (Pasick Reference Pasick, Glanz, Lewis and Rimer1997), the TPB may be able to account for the impact of cultural norms and socioeconomic status to a reasonable degree through the subjective norm, attitude, and perceived behavioural control variables. Importantly, the TPB was not used in the initial question formulations, but was applied after initial data analysis revealed its utility to the project at hand.
Methodology and methods
The research presented in this paper was gathered through a two month community based initiative in Tuktoyaktuk after acquiring ethics approval from the University of Ottawa and a NWT research licence from the Government of the NWT. All NWT research licences stipulate that research teams must work with the community throughout the research design and implementation processes in order to remain sensitive to cultural practices and to ensure that the project meets with community approval. The study used participant observation, semi-structured interviews and archival research as data collection techniques. Participant observation is at the core of ethnographic fieldwork (Emerson and others Reference Emerson, Fretz, Shaw and Atkinson2001). Researchers ‘establish a place in [a] natural setting. . .to investigate, experience and represent the social life and social processes that occur in that setting’ (Emerson and others Reference Emerson, Fretz, Shaw and Atkinson2001: 352) through participant observation, while striving to maintain a professional distance (Fetterman Reference Fetterman1998). This technique yields rich qualitative data that can be used to provide supporting evidence to participants’ statements about their own behaviours. However, there are limitations associated with this method, such as access and the impact of observation (Flick Reference Flick2007). Thus, semi-structured interviews were also conducted with 20 Tuktoyaktuk residents. The 20 interviewees were selected through snowball sampling, which ‘involves the selection of samples utilizing insider knowledge and referral chains among subjects who possess common traits that are of research interest’ (Kaplan and others Reference Kaplan, Korf and Sterk1987: 566). Archival research of government documents and northern newspapers further supplemented the data.
Semi-structured interviews were conducted with 20 mostly Inuvialuit residents of Tuktoyaktuk ranging in age from their teens to their late sixties. Questions that were asked pertained to activities performed in aquatic settings, safety precautions and perceptions of susceptibility to drowning. Many of the questions had a specific focus on the use of lifejackets. An example of a question that was asked that tapped into the attitudinal component of the TPB was ‘[d]o you think that any of the activities in which you participate on the water are dangerous?’ Questions that measured subjective norms included, ‘[h]as an elder ever told you what to do around the water?’ Finally an example of a question that measured behavioural control was, [d]o you believe that lifejackets are affordable?’ All interviews were transcribed verbatim and verified by the interviewees, at which point they had the opportunity to make changes. The interviewees were also given a copy of their transcript for their own records. Names that appear in full in the account below are individuals’ real names. Names that appear as only first names and in italics are pseudonyms.
The data were manually coded for reoccurring themes, which are explored in the results section. The fourth author, who collected the data, returned to Tuktoyaktuk to verify research findings prior to this article being written.
Results
Three themes surrounding lifejacket use by residents in Tuktoyaktuk, NWT emerged through comprehensive data analysis. Firstly, residents largely perceive lifejackets to be inaccessible in Tuktoyaktuk. Secondly, wearing a lifejacket is not perceived to prevent drowning; therefore, it is not perceived to be essential to have when riding in or on a watercraft. Lastly, because lifejackets are deemed as non-essential safety equipment and are not perceived to prevent drowning, they are not encouraged by referent individuals in Tuktoyaktuk.
Theme one: inaccessible lifejackets
Lifejackets are perceived to be inaccessible to the residents of Tuktoyaktuk due to the costs and available stock found within the hamlet. Although not one interviewee specified a precise lifejacket price in the interview, Stanley Felix hypothesised that one would be very expensive and would probably cost anywhere from $150 to $180 (personal communication, 8 July 2007). Joe Nasogaluak repeated this sentiment. ‘Maybe they can't afford it,’ he commented when responding to a question about why most residents of Tuktoyaktuk do not wear a lifejacket when they enter a boat (personal communication, 10 July 2007). Teenaged resident Becky Steen also offered price as a deterrent for lifejacket use and the primary reason why she believes that people use more safety equipment in the south than in the north (personal communication, July 25, 2007).
Beyond inaccessibility due to perceived cost, Tuktoyaktuk residents felt that lifejackets were literally inaccessible. As the community is small and relatively isolated, residents only had access to two stores, the Northern and Stanton's, and neither store carries lifejackets in their regular stock. Kelly stated that it is hard for residents to access lifejackets in Tuktoyaktuk, ‘[because] they can't find them. We're in a small community and it's hard to get stuff like that. I don't even think they have any at Northern and that's, like, our main store’ (personal communication, 12 July 2007). Other residents said that if they ever needed something like a lifejacket that they would order it from the catalogue (Lionel, personal communication, 20 July 2007) or have someone in a bigger city like Edmonton buy one on their behalf (Maureen Pokiak, personal communication, 13 July 2007). Nevertheless, Becky Steen reported that her parents owned a store in Tuktoyaktuk years ago that ‘had like [. . .] lifejackets galore. But they kind of sat there every year. Nobody bought some’ (personal communication, 25 July 2007).
Theme two: drownings are attributed to factors other than failing to wear lifejackets
The majority of the Tuktoyaktuk residents interviewed knew someone who had drowned. Nevertheless, this personal connection with drowning has not motivated many Tuktoyaktuk residents to wear a lifejacket when boating. Most of the interviewees believed that there were factors other than the failure to wear a lifejacket that make larger contributions to drowning, such as failing to properly prepare for a trip on the ice or water or snowmobiling on thin ice.
According to many Tuktoyaktuk residents, drowning is attributed directly to one's carelessness in preparation for activities in aquatic settings. Tuktoyaktuk elder David Noksana Sr. stated that he believed that it was the careless that are most likely to drown: ‘[people] that don't take precautions. They don't take. . .whatever they need to survive out there in case something go wrong. They're the ones that going to drown’ (personal communication, 10 July 2007). Fellow elder Emily confirmed this attitude: ‘[take] your time, take three, four days to be ready. Make sure you got everything, whatever safety in the boat. But them [the careless], they rush and rush, that's not right to rush and rush, by the time you rush and rush, you forget something’ (personal communication, 18 July 2007). Les Raddi provided insight into this perspective when sharing memories about his childhood in Tuktoyaktuk. He stated that at that time there were no lifejackets, but everyone who was careful survived, because they did not rush (personal communication, 14 July 2007). Thus, according to Tuktoyaktuk residents a careful attitude approach towards water-based activities is necessary for safety, but it such an approach does not necessarily include lifejacket usage.
Though some community members reported that they believed that lifejacket use was important when going out on the water, they perceive lifejacket use as an ‘option’ and not necessary for safety. Stanley Felix stated that lifejackets were important; however, he reported that if a lifejacket were not readily available, he would still ride in the boat, thus it is an optional safety precaution. Similarly, according to hunter Joe Nasogaluak, most people in Tuktoyaktuk ‘have [lifejackets] in their boat, but they don't wear them’ (personal communication, 10 July 2007) Instead of wearing them:
they sit on them. Most boats up here don't have padded seats, so most people use them for a cushion on their seats. I hardly ever see anybody wearing their lifejackets. . .someone like me, I use it for a cushion. . .[because lifejackets are inconvenient], uncomfortable, stiff, some of them smell (Stanley Felix, personal communication, 8 July 2007)
Elder David Noksana Sr. agreed with this statement, noting that while he does not wear his lifejacket when in his boat, he has it right there, ‘it's handy’, for when the water gets rough and he feels the need to wear it (personal communication, 10 July 2007). Though some community members might keep a lifejacket handy, others stated that they did not believe that they would save one's life if one fell into the frigid arctic waters. For example, Joe Nasogaluak stated that he did not believe that a floater suit would save his life if he fell into the water, noting, ‘[i]f I fell in with a Mustang [floater suit] on, I would be frozen. I would float, maybe, but I would be frozen. . .the Mustang is so expensive, and it will fill [up with water on the inside]’ (Joe Nasogaluak, personal communication, 10 July 2007).
Theme three: referent individuals do not support lifejacket use
Within Tuktoyaktuk lifejackets are not perceived to prevent drowning in cold water and thus are deemed unnecessary by many residents. This belief is perpetuated by referent individuals within Tuktoyaktuk through their actions and words. Resident Mallory likes to wear a lifejacket, as it makes her feel safer on the water, but the other residents with whom she associates think she is ‘crazy’ for wearing one. She reported that friends constantly tell her, ‘[don't] be scared, you don't have to wear your lifejacket’ (personal communication, 14 July 2007). Mallory maintained that she does not let these comments affect her choice to wear a lifejacket, but it is possible that such beliefs and comments have drastically affected other residents’ lifejacket use.
According to many residents, Inuvialuit peoples traditionally listen to their elders and mirror their behaviour (Bert Kimisana, personal communication, 6 July 2007; Becky Steen, personal communication, 25 July 2007; Henry, personal communication, 7 July 2007). Mirroring can have both positive and negative effects, depending on the message that referent persons are communicating. Becky Steen reported that ‘when [she's] been in a boat with an elder, they're like, “You can't do that, that's too dangerous”’ (personal communication, 25 July 2007) and because ‘elders are kind of the boss, in the north’ (personal communication, 25 July 2007), she listened to their advice. However, when elders do not wear lifejackets in their boats, they may communicate that lifejackets are not necessary to be safe on the water, and thus do not need to be worn at all times. James Pokiak commented on the elders’ influence:
[First] of all you're going to have to teach these elders to start doing some of these [water safety] things. It's good to listen to the elders, and if you have an elder who knows a lot of ways of being safe in the water, you have to maybe get those people to let the public know. But, I don't think I know of any elders right now in the community [who know a lot about water safety] (personal communication, 26 June 2007)
Indeed, Treser and others (Reference Treser, Trusty and Yang1997) found that children were more likely to wear lifejackets when adults who were on board were wearing lifejackets, though the inverse was not found to be true. Because elders hold places of authority in their communities it is important that they model safe aquatics behaviour in order for such behaviour to be modelled by other community members.
Discussion
The three identified themes map onto determinants of intention and behaviour in the TPB. Lifejackets are perceived to be inaccessible and this is consistent with the perceived behavioural control component. Further, participants do not perceive lifejackets as necessarily preventing people from drowning, but believe that a careful attitude does, which fits with the attitude component. Finally, referent individuals do not encourage lifejacket use in Tuktoyaktuk, which links to the subjective norm component of the theory. Together, these three themes can be used to understand many Tuktoyaktuk residents’ reluctance to wear lifejackets.
Inaccessible lifejackets
A significant deterrent to lifejacket accessibility in Tuktoyaktuk is the literal inaccessibility of lifejackets at the local stores. Neither of the local stores carry lifejackets in their regular stock because they are not in demand. As a result, interested patrons must have lifejackets shipped to the community from alternate suppliers. The complications associated with acquiring a lifejacket make it difficult for Tuktoyaktuk residents ultimately to wear lifejackets; however, this has not always been the case. As noted above by Becky Steen, there was a time in the community's history where literal lifejacket accessibility was not a deterrent, but many residents did not take advantage of this opportunity. This finding suggests that the financial deterrent acknowledged by many residents, as well as other components in the TPB, directly may also affect the resultant behaviour (wearing a lifejacket).
Residents’ perceptions that lifejackets are inaccessible both financially and literally may affect their control beliefs regarding the performance of the behaviour. These beliefs regarding lack of control over lifejacket use combined with beliefs regarding the ineffectiveness of lifejackets at preventing drowning may result in perceptions of perceived behaviour control that do not facilitate lifejacket use. According to the TPB, when control beliefs and beliefs about the perceived impact of the behaviour are not in place, perceptions of perceived behavioural control should, in turn, fail to lead to intentions for or engagement in the resultant behaviour (that is lifejacket use).
Drownings are attributed to factors other than failing to wear a lifejacket
Because residents appear to believe that lifejacket use is ineffective in preventing drowning deaths in cold water and that careful attitudes are more important than lifejacket usage in preventing drowning, they may lack the necessary positive attitude for engaging in the behaviour. Due to the fact that many Tuktoyaktuk residents are living at or below the national poverty line, any extra expense above and beyond the necessities (for example a lifejacket) will certainly stretch the budget (Stanley Felix, personal communication, 8 July 2007). Such a purchase must yield a noticeable benefit to the consumer to justify the financial sacrifice. The problem with lifejackets is that they are a long term investment in personal health, and thus do not produce a noticeable benefit immediately, as is the case with milk and bread. To relate this to Tuktoyaktuk residents’ attitudes, they may not deem the expense of a lifejacket worthwhile because in order for lifejackets to yield a favourable benefit they must save someone's life. While most of the interviewees have known a drowning victim, they do not attribute the drowning to a lack of lifejacket use, but rather to other factors such as carelessness and the ineffectiveness of lifejackets in saving lives in cold water, thus they do not connect lifejacket use with drowning prevention. A shortcoming with this reasoning, however, is that lifejackets must be worn in order to save lives. The fact that few people wear lifejackets prevents Tuktoyaktuk residents from seeing the potential benefits of consistent lifejacket use for themselves and other community members.
The findings in theme two can be linked to the attitude component in the TPB. One's attitude is determined by beliefs about the outcomes or attributes of performing the behaviour (the behavioural beliefs that wearing a lifejacket when in, on or around water will prevent drowning), weighted by the evaluations of those outcomes or attributes (the individual values the outcome of drowning prevention). In this case, participants’ behavioural beliefs surrounding lifejacket use are not directly attributed to a positive outcome, such as preventing drowning, and are in fact sometime contributed to negative outcomes, such as having to wear a smelly or uncomfortable lifejacket.
Referent individuals do not support lifejacket use
Many of the elders interviewed stated that they believe that taking care when in, on or around the water is essential for water safety; however, they do not necessarily communicate this belief or extend this belief to consistent lifejacket use. As a result, many individuals throughout the community appear to view lifejackets as non-essential when travelling by boat. This view may be due to the messages that elders communicate through the behaviour they exhibit surrounding lifejacket use, that is they do not wear them or suggest that others wear them.
Referent individuals’ approval or disapproval regarding lifejacket use in Tuktoyaktuk may impact behaviour through the subjective norm component of the TPB. Because elders’ (who are important referent individuals) normative beliefs do not appear to support lifejacket use as normative, it is not surprising that residents also fail to wear lifejackets. Though most residents subscribe to the subjective norm of not wearing lifejackets, there are some exceptions. Tuktoyaktuk residents Mallory and Becky Steen are strong young women who reported consistent lifejacket use, despite the comments and pressure to conform to norm of not wearing lifejackets. The fact that individuals like Mallory and Becky Steen are taking the initiative to wear lifejackets despite the normative beliefs of referent individuals is promising; however, more research is needed to understand what enabled them to engage in this behaviour and how to equip others within communities like Tuktoyaktuk to do the same.
Conclusion
The fact that many northern aboriginal residents do not adhere to recommendations outlining lifejacket use for drowning prevention cannot be overcome through simple means. The practice of not wearing lifejackets may be understood in part by considering variables in the TPB, namely attitudes, subjective norms and perceived behavioural control. As a result, intervention programmes addressing this issue would benefit from taking all of these factors into account.
Saylor (Reference Saylor2004) proposed a variety of solutions to address the aboriginal children's high injury rate in Canada, such as advocating for accessible bicycle helmets in first nations communities, many of pertained to the perceived behavioural control component of the TPB. Although Saylor is correct to address this issue, as accessibility to factors facilitating health is imperative to healthy behavioural choices, the present research suggests that it is also important that intervention programmes addressing the issue of lifejacket use in aboriginal populations also focus on changing attitudes and subjective norms in the target population. Such a multi-pronged focus is essential for any degree of success to be attained.
It is, of course, important to note that part of the disconnect between lifejacket use and drowning prevention might be due to the fact that lifejackets will not always save lives. Certainly, if a person were to fall into the Beaufort Sea's freezing waters, a lifejacket might not save the person's life, as although s/he might not die of drowning, death by hypothermia is a very real possibility. Nevertheless, while lifejackets will not necessarily save lives in all situations (O'Connor and O'Connor Reference O'Connor and O'Connor2006), they do increase the chances for survival (O'Connor and O'Connor Reference O'Connor and O'Connor2005).
A lifejacket lending programme, which was suggested by several residents, and/or ‘float coat’ programme (Zaloshnja and others Reference Zaloshnja, Miller, Galbraith, Lawrence, DeBruyn, Bill, Hicks, Keiffer and Perkins2003) have the potential to contribute in positive ways to lifejacket use in aboriginal populations in Canada's north. Such initiatives, however, will be successful only if the attitudes of the target population regarding lifejacket use are effectively changed so that residents come to value lifejackets and other personal flotation devices for their drowning prevention characteristics. It is also imperative that any behavioural intervention that occurs within an aboriginal population ‘identify and understand the wider set of social meanings attached to specific risk behaviours and to develop with indigenous and minority communities health strategies that take into account the everyday realities of their lives’ (Thompson and others Reference Thompson, Gifford and Thorpe2000: 726). The involvement of elders in water safety training through the NWTAP at the local pool could strengthen the effectiveness of water safety messages, as elders are powerful referent individuals to many Tuktoyaktuk residents. Therefore, their opinions and words carry greater weight than those of the southerners typically hired to run northern pools. It is only by working with local residents that we can understand the diverse factors that influence drowning prevention and thus create water safety programmes that will meet aboriginal northerners’ unique needs.
The TPB provides a framework that is useful in illustrating the ways in which complex factors need to be addressed in order to facilitate health behaviour change. One of the strengths of the TPB is its perceived behavioural control component, which can explain the relationship between behavioural intention and actual behaviour, that is when a person does not have complete control over a behaviour, behaviour intention cannot be the only factor that determines an individual's behaviour. Indeed, Glanz and others (Reference Glanz, Lewis and Rimer1997) have noted that the TPB allows us systematically and empirically to identify factors that may be important in interventions, such as social norms.
While the TPB claims that ‘all other factors including demographics and environment operate through the model constructs and do not independently contribute to explaining the likelihood of a person's performing a behavior’ (Montano and others Reference Montano, Kasprzyk, Taplin, Glanz, Lewis and Rimer1997: 85), there is the possibility that the model may actually miss some variables that are not channelled through the chosen predictors of behaviour and intention (Glanz and others Reference Glanz, Lewis and Rimer1997). For example, French and others (Reference French, Sutton, Hennings, Mitchell, Wareham, Griffin, Hardeman and Kinmouth2005) have suggested that the TPB may not capture affect, which may play important roles of predicting behaviour.
Another limitation to the TPB is that, as with other deliberative processing theories, this theory assumes that people hold the goal of keeping themselves safe. Nevertheless, one might question the importance of this goal in a hierarchy of goals when other more basic goals, such as the daily stress of making ends meet, are not being met. The suicide rate for Inuvialuit peoples (18/100,000) is much higher than the Canadian average (13/100,000) (Inuit Tapiriit Kanatami 2002). As such, it is important to be cognisant of the fact that safety promoting behaviour, such as wearing a lifejacket, may be met with heightened resistance. Despite the selected theory's limitations and its a posteriori application, the present study presents a first step in identifying specific aspects of the TPB that may be relevant to understanding lifejacket use in northern communities and, as such, may inform future research efforts.
Inspiring residents of Tuktoyaktuk, and other communities for that matter, to wear lifejackets is clearly more complicated than having a swimming instructor demonstrate how to select and wear a lifejacket or to have these safety items given away free of charge. Instead, lifejacket promotion campaigns must seek to engage with all of the TPB's components if they are to meet with success and have a significant impact on reducing the high number of water related fatalities in Canada's north.
Acknowledgements
This research project was supported by a Social Sciences and Humanities Research Council of Canada grant to the first author (Standard Research Grant #410 200 0204), a Northern Scientific Training Program grant to the fourth author, and assistance from the Northwest Territories Recreation and Parks Association and the Department of Municipal and Community Affairs at the Government of the Northwest Territories. We would like to thank research assistant Stacey Cockney for her assistance as well as the people of the Hamlet of Tuktoyaktuk for its support.
