Introduction
In most arctic and subarctic indigenous Canadian communities, dogs occupy a central place. Such is the case in the Northern Village of Kuujjuaq, an Inuit community of nearly 3,000 inhabitants and the largest of Nunavik, the Québec region north of the 55th parallel (Lévesque, Reference Lévesque2018; Aenishaenslin et al., Reference Aenishaenslin, Brunet, Lévesque, Gouin, Simon, Saint-Charles, Leighton, Bastian and Ravel2019). Indeed, as historical auxiliaries to the Inuit, dogs contribute to a sense of cultural continuity, an important dimension of indigenous health (Auger, Reference Auger2016). In other populations, dogs have been associated with multiple benefits for human emotional, physical and social health (Pinello et al., Reference Pinello, Palmieri, Ruiz, Zaidan Dagli, Niza-Ribeiro, Prata, Ribeiro and Rocha-Santos2022).
However, the village and the other northern communities also face numerous public health problems related to dogs. Dog bites occurrence tend to be higher in these localities than in other Canadian indigenous communities and non-indigenous populations (Daigle et al., Reference Daigle, Delesalle, Ravel, Ford and Aenishaenslin2022). As in the general population, children are especially exposed due to their size and behavior toward dogs, and at a higher risk of fatal wounds from dog attacks (Mediouni et al., Reference Mediouni, Brisson and Ravel2020; Daigle et al., Reference Daigle, Delesalle, Ravel, Ford and Aenishaenslin2022). Additionally, the proximity to wildlife (e.g., wolves and foxes) increases the risk of transmission of zoonotic pathogens to dogs and then humans (Schurer et al., Reference Schurer, Bouchard, Bryant, Revell, Chavis, Lichtenwalner and Jenkins2018; Aenishaenslin et al., Reference Aenishaenslin, Brunet, Lévesque, Gouin, Simon, Saint-Charles, Leighton, Bastian and Ravel2019). Among these, arctic foxes are a reservoir for an arctic variant of the rabies virus, which poses a significant threat as it is mainly transmitted by bites (Aenishaenslin et al., Reference Aenishaenslin, Simon, Forde, Ravel, Proulx, Fehlner-Gardiner, Picard and Bélanger2014). The cumulative annual incidence of potential human exposure to rabies in Kuujjuaq reported between 2008 and 2017 was 3.68/1,000 inhabitants, 92% of which were caused by dog bites. This rate is five to forty times higher than the annual incidence of dog bites reported in the southern regions of Québec in 2016 (0.1 to 0.7/1,000) (Mediouni et al., Reference Mediouni, Brisson and Ravel2020). Dog attacks can also lead to psychological issues such as anxiety and posttraumatic stress and contribute to social tensions among community members (Dhillon et al., Reference Dhillon, Hoopes and Epp2019).
Several intertwined factors are deemed to exacerbate dogs-related risks to human health in Nunavik compared to the southern regions of Canada (Aenishaenslin et al., Reference Aenishaenslin, Brunet, Lévesque, Gouin, Simon, Saint-Charles, Leighton, Bastian and Ravel2019; Daigle et al., Reference Daigle, Delesalle, Ravel, Ford and Aenishaenslin2022). Challenges associated with remoteness, limited human, structural and financial resources hinder the provision of veterinary services, including dog vaccination against rabies and antiparasitic treatments. Limited access to sterilization, along with dogs being allowed to roam freely, further complicates the management of canine populations, which is believed to contribute to dog bite rates. Moreover, the lack of adequate veterinary services also has detrimental effects on the health and well-being of dogs themselves, so do social tensions, fear and other negative perceptions toward dogs which may sometimes lead to neglect or mistreatment. Some of these risk factors emerged or developed as a result of significant and sudden changes in the Inuit lifestyle and their relationship with dogs during the 20th century (Lévesque, Reference Lévesque2018). Indeed, colonization, settlement, mass culling of dogs in the 1950s–1960s and the adoption of snowmobiles as a means of transportation have led to the decline of traditional practices, including dog sledding (Qikiqtani Inuit Association, 2013). Nonetheless, dogs continue to hold a central role in Nunavik communities.
Since the 1950s, various local, provincial and federal institutions have made efforts to prevent human exposure to rabies through dogs and to better control canine populations. They include local bylaws mandating dog tethering; a provincial program to promote dog vaccination against rabies, by providing vaccine doses and training local lay vaccinators (MAPAQ, 2017); free telemedicine services by the Faculté de médecine vétérinaire (FMV) of the Université de Montréal (https://chuv.umontreal.ca/vetnunavik/); temporary neutering and spaying clinics by non-governmental organizations commissioned by some communities – which remain exceptional. However, no substantial a reduction in dog bite rates, potential human exposure to rabies or dog abundance of dogs have been observed, nor has been any improvement in dog welfare (Aenishaenslin et al., Reference Aenishaenslin, Simon, Forde, Ravel, Proulx, Fehlner-Gardiner, Picard and Bélanger2014; Lévesque, Reference Lévesque2018; Mediouni et al., Reference Mediouni, Brisson and Ravel2020; Daigle et al., Reference Daigle, Delesalle, Ravel, Ford and Aenishaenslin2022; Mediouni et al., Reference Mediouni, Brisson and Ravel2020). Several obstacles may explain this lack of effectiveness, including difficulties in monitoring dog populations and dog bite incidents, inconsistent allocation of resources, reliance on external organizations and insufficient consideration of Inuit perspectives (Simon et al., Reference Simon, Saint-Charles, Lévesque and Ravel2017). Additionally, current initiatives often overlook the benefits of dogs for human well-being, such as promoting physical activity, providing emotional support and preserving connections with traditional Inuit culture (Lévesque, Reference Lévesque2018; Pinello et al., Reference Pinello, Palmieri, Ruiz, Zaidan Dagli, Niza-Ribeiro, Prata, Ribeiro and Rocha-Santos2022). According to the authors’ experience, each of these interventions was implemented independently and no integrated, context-adapted management structure for complex health issues at the human–dog interface exists at the community- or province-level. Furthermore, none of these initiatives has been formally evaluated, including assessing their implementation, which could provide valuable insights into the factors underlying their successes or failures, in relation to their context, and guide potential adjustments (Skivington, Reference Skivington2024).
To address these gaps, in January 2020, a multifaceted pilot project was implemented in the village, with the goal of addressing issues at the interface between humans and dogs. This “Kuujjuaq Dog Project” (KDP) consisted of four main components: on-site veterinary services, workshops conducted in schools, educational materials on Facebook and reinforcement of local dog control measures. The logic model of the KDP details its components, inputs, outcomes and expected effects (Appendix 1). Its design, implementation and evaluation were conducted through close collaboration with various local and regional institutions: the NV of Kuujjuaq (municipal council); the Kativik Regional Government (KRG), a non-ethnic public organization created in 1978 pursuant to the James Bay and Northern Québec Agreement (JBNQA) to deliver public services to Nunavimmiut (inhabitants of Nunavik); the Makivvik Corporation, whose mandates include socioeconomic development and preservation of the Inuit language, culture and lands; the Nunavik Research Center (NRC, part of Makivvik Corporation); Kativik Ilisarniliriniq (school board); the Nunavik Regional Board of Health and Social Services (NRBHSS); the Kativik Municipal Housing Bureau (KMHB) and several mushers (i.e., drivers and breeders of dogsledding teams). Its development was based on a community-based multicriteria decision analysis (MCDA) (Aenishaenslin & Ravel, unpublished) and an EcoHealth approach (Charron, Reference Charron2014). The KDP built on ten years of participatory, multidisciplinary research in Kuujjuaq led by Professor André Ravel as part of the “Indigenous People, Dogs and Wellness” (IPDW) project. The four KDP’s components were managed separately. In 2018, IPDW researchers and key community actors – mostly volunteers – formed a committee to coordinate the veterinary services. The NV hired its first veterinarian in January 2020. The veterinary services were subsidized thanks to funding from Société du Plan Nord and provided at low rates. In April–May 2021, three IPDW researchers, in collaboration with Kativik Ilisarniliriniq, organized a series of five workshops for 174 students aged 10 to 15 from Jaanimarik Ilisarniliriniq school. Four workshops, facilitated by the veterinarian and an assistant, focused on dogs’ behavior, safe interactions and dog cares. Another was a demonstration of Inuit dog sledding by a musher. Each student also received a copy of the book Ulaayu learns about rabies in Inuktitut or English (Whitney, 2018). Between November 2020 and January 2022, a dedicated Facebook page posted eight informative posts on topics such as rabies, dog behavior, core vaccination and deworming. Measures to enhance enforcement of dog bylaws involved mandatory dog registration with tags and increased resources for dog-catching. Under the direction of the Bylaw Enforcement Officer (BLEO), dog catchers are responsible for capturing free-roaming dogs. The dogs are then held in a municipal pound and can be retrieved for a fine. Unclaimed dogs are euthanized after a period ranging from a few days to a few weeks.
The final phase of this project aimed to evaluate the implementation and effects of the KDP. This evaluation was conducted within the broad framework of complex health interventions evaluation (Skivington, Reference Skivington2024) and with a One Health approach, which aims to balance the health of people, animals and ecosystems (OHHLEP, 2022). This paper reports on the implementation analysis, which objectives included assessing the KDP’s reach and sociocultural acceptability, and identifying potential barriers and facilitators.
Methods
The first author (LD) led the data collection, analysis and writing. Three authors are veterinarians and researchers, another is a researcher in social sciences; all four are trained in multidisciplinary approaches and familiar with the context of dogs in Kuujjuaq. They present as non-Indigenous people living in southern Québec. One author presents as a non-Indigenous person living in Kuujjuaq for more than 10 years.
Theoretical frameworks and study design
This observational study evaluated the KDP’s implementation using mixed methods after 2.5 years of operation, in June–July 2022. The multiplicity of its outcomes, the complexity of the underlying causal relationships, the large number of stakeholders and the strong influence of context on its design and implementation make the KDP a complex intervention (Skivington, Reference Skivington2024). Assessing the implementation of such interventions, including contextual factors influencing their reach, facilitating or hindering their delivery, is key to increase their impact and uptake (Skivington, Reference Skivington2024). It also helps understanding how and to which extent an intervention was adapted to fit its context, which can inform its transferability to other settings (Meyers et al., Reference Meyers, Katz, Chien, Wandersman, Scaccia and Wright2012; Skivington, Reference Skivington2024). In addition, it was grounded in key principles of the One Health approach, as defined by the One Health High-Level Expert Panel in 2022 (OHHLEP, 2022). In particular, efforts were deployed to include multiple sectors, traditional forms of knowledge and a diversity of perspectives, especially indigenous ones.
Two conceptual frameworks, Meyers et al. (Reference Meyers, Katz, Chien, Wandersman, Scaccia and Wright2012) and Love (Reference Love, Wholey, Hatry and Newcomer2004) informed the implementation indicators detailed in Table 1. Potential factors of exposure to the KDP, implementation facilitators and barriers were also identified through previous research on the specificities of human–dog interactions in the Nunavik settings (Brunet and Lévesque, Reference Brunet and Lévesque2017; Aenishaenslin et al., Reference Aenishaenslin, Brunet, Lévesque, Gouin, Simon, Saint-Charles, Leighton, Bastian and Ravel2019; Mediouni et al., Reference Mediouni, Brisson and Ravel2020) and discussion among the IPDW research team. They included sociodemographic factors (gender, age and indigenous status), living with children under 18, participants’ dog breeds (huskies or “southern” breeds) and husbandry (kept inside or outside) and their use of veterinary services outside of the village.
Table 1. Themes and indicators used for the implementation analysis of the KDP (adapted from [1] Wholey et al., Reference Wholey, Hatry and Newcomer2004; [2] Meyers et al., Reference Meyers, Katz, Chien, Wandersman, Scaccia and Wright2012)
Mixed-methods designs and the integration of key stakeholders have been recommended to evaluate complex interventions, as they help contextualize the results and identify the main facilitators and barriers to its delivery (Skivington, Reference Skivington2024). Similar recommendations have been made for the evaluation of One Health initiatives, with the added need for an intersectoral approach to take account of the different fields involved, in our case human and canine health (Delesalle et al., Reference Delesalle, Sadoine, Mediouni, Denis-Robichaud, Zinszer, Zarowsky, Aenishaenslin and Carabin2022). Quantitative data were collected through a survey of Kuujjuamiut. Qualitative data were collected through semi-structured individual interviews. Part of these interviews targeted key stakeholders of various sectors and organizations directly involved in the KDP, including education, policy/regulation, veterinary and public health. Quantitative and qualitative data were interpreted together. All participants gave their written consent.
Data collection
Appendix 2 details indicators, survey questions/interview themes and corresponding variables. Data were collected by the first author (LD) on-site in June–July 2022.
The survey included 79 questions: Likert-scales, Yes/No and multiple choices. They assessed the veterinary services, school workshops and Facebook posts on three indicators: (1) Relevance, (2) Awareness and exposure and (3) Sociocultural acceptability. For the school workshops, these indicators were evaluated among the students’ parents. A previous unpublished study by Simon et al., focused on the students themselves. Potential factors and sociodemographic data were also included. Recruitment followed a convenience sampling approach with two inclusion criteria: being at least 18 (legal adults) and having lived in Kuujjuaq for at least two years. Solicitation was done through local radio, social media, posters and strategic locations in the village. The survey was administered in English or French, either face-to-face or by phone by the main researcher, or filled out independently by the respondent. Respondents received a $40 gift card to the local store as compensation.
In this study, “key stakeholders” refers to individuals who were/had been actively involved in the implementation, planning or coordination of at least one KDP’s component. They were identified through known partnerships and snowballing, then solicited for an interview via email, phone or in person. Themes centered on their experience and perspectives as KDP’s key stakeholders, as well as adaptations of the intervention (see Appendix 3.1). For the latter, participants completed a timeline of significant events that could have affected the project’s implementation, or the inhabitants’ awareness, perspectives and experiences of the KDP.
For the interviews, other community members were recruited using purposive sampling to ensure representation of diverse sociodemographic groups and exposure levels to the KDP’s components. The same inclusion criteria applied. When appropriate, solicitation occurred at the end of the questionnaire. Otherwise, the same methods as for the survey were used, supplemented by snowballing. All interviewees were compensated with a $40 gift card to the local store. Recruitment continued until saturation of perspectives. Sociodemographic data was collected when necessary. Themes focused on the participants’ experiences and perspectives on the KDP, its strengths and weaknesses (see interview guide in Appendix 3.2).
All interviews were conducted in English or French and audio recorded. Although offered, none of the participants asked for translation to Inuktitut. Interviews lasted 45 to 105 min for key stakeholders, 30 to 60 min for others.
Data analysis
Quantitative data (survey)
We conducted a descriptive analysis of each implementation indicator variable. Likert-scales were reduced to three levels (Agree, Neutral, Disagree). An awareness and exposure score e i was then calculated for each component: not aware = 0; aware but not exposed = 1; exposed once = 2 (i.e., one post read, veterinary services used once, household children exposed to the workshops); multiple exposure = 3 (not applicable to the school workshops). An overall exposure score E, ranging from 0 to 8, was obtained by summing the individual scores e i . It was categorized into three modalities: “No exposure” (E = 0), “Low exposure” (1 ≤ E ≤ 3) and “High exposure” (4 ≤ E ≤ 8). A descriptive analysis was conducted on both individual and global scores.
Analysis was performed using R Statistical Software (v4.3.1; R Core Team, 2023) in RStudio (v2023.06.1+524, RStudio Team, 2022).
Qualitative data (individual interviews)
The first author (LD) and two firms transcribed the audio recordings. Data were denominalized by assigning an alphanumeric code to each participant. We conducted a computer-assisted thematic analysis with NVivo® software (v2022.7.1.554, QSR International Pty Ltd, 2022). The codebook was developed following both inductive and deductive approaches (Miles et al., Reference Miles, Huberman and Saldaña2020), with initial themes drawn from the theoretical frameworks and subcodes created and refined as the analysis progressed. A second researcher (CA) validated the codebook during the initial stages of this process. Interviews of key stakeholders, other community members and timelines were analyzed together.
Integration of quantitative and qualitative data
A triangulation method guided the integration of the survey and interviews data, in the sense of “a process of studying a problem using different methods to gain a more complete picture” (O’Cathain et al., Reference O’Cathain, Murphy and Nicholl2010). After analyzing the data separately, we compared them to identify meta-themes crossing both quantitative and qualitative data. Analysis also followed an iterative approach with quantitative results informing the qualitative analysis, and vice versa.
Results
Recruited participants
Descriptive characteristics of all study participants are presented in Table 2. Seventy-four Kuujjuamiut answered the survey. In total, 89 non-stakeholders were solicited for the interviews; 25 participated, among whom 10 also completed the questionnaire. Regarding key stakeholders, 22 were identified, 10 were interviewed, among whom four also completed the questionnaire. We excluded from the analysis two interviewees (out of 25) and eight survey respondents (out of 74) who had lived in Kuujjuaq for less than two years or had missing data on this variable.
Table 2. Samples structure for the survey and interviews and comparison with 2021 Kuujjuaq’s general population
Note: *Statistical difference with general population (z-test, p < 0.5).
1 Source: Census of Population.
2 Statistics Canada 2021 census also reports 10 persons identifying from First Nations, 10 from Métis and 10 from multiple Indigenous groups.
3 Excluded from the analysis.
Relevance of the KDP
For brevity, results regarding the KDP’s relevance are detailed in Table 3 and will only be summarized here. Most of our participants considered dogs to be significant for Inuit culture and the community, while still mentioning associated risks and nuisance, such as bites and rabies (see events in Figure 1). Nuisances were often attributed to “loose” dogs and overabundance, stressing the necessity to better control the population, and confirming the relevance of including better bylaws enforcement in the KDP. Several interviewees emphasized the need to raise awareness of dogs’ care and well-being. Some Inuit interviewees explained how mistreating dogs is against their culture and the necessity to integrate Inuit knowledge and perspectives in canine-related interventions. Improving access to veterinary care in the village was a major concern, both to improve dogs’ health and to reduce the distress of owners who sometimes have “no choice but to put a dog down because there [was] no services” (K04). Most interviewees (exposed or not) stressed the importance of training the next generation in dog behavior and care in order to bring about change: “It’s good for kids to learn early when they’re younger, so they’ll keep those knowledge as they grow older” (K19). More generally, most survey respondents (see Table 4 and Figure 2) and interviewees felt that the KDP’s components met a need and should be continued.
Table 3. Perceptions of dogs
Note: Proportion (with [95% confidence interval]) of the survey participants agreeing with each statement, and related quotes from the individual interviews.
Figure 1. Timeline of the Kuujjuaq Dog Program and significant dogs-related events. Synthesis of the timelines completed by the stakeholders and of the interviews with stakeholders and other community members.
Table 4. Perceived relevance and sociocultural acceptability of the Kuujjuaq Dog Project’s components
Note: Percentage of participant agreeing with each statement by intervention, and related quotes from the individual interviews.
Figure 2. Relevance and acceptability of the Kuujjuaq’s Dog Program. Percentage of participants by degree of agreement to each affirmations. Legend (from left to right): chevron on dark background: disagree; chevron on light background: somewhat disagree; solid gray: neither agree nor disagree; dots on lights background: somewhat agree; dots on dark background: agree.
Participant’s exposure and responsiveness to the KDP
Table 5 provides a detailed overview of general exposure. Over half of the respondents had a low score, indicating exposure to only one component or awareness of several but no exposure. All 25 interviewees were aware of at least one component, with 19 being exposed to at least one. No significant differences were found between factors, although the mean score was higher among women, non-Inuit, dog carers and participants who had used external veterinary services before 2020.
Table 5. Global exposure to the Kuujjuaq Dog Program
Note: Exposure score mean and mode, and percentage of survey respondents, with [95% confidence interval]. *Significant relationship (exact Fisher test, p < 0.05).
Nearly 90% of the survey respondents were at least aware of the veterinary services, with 69% of dog owners having utilized them at least once. The proportion of exposed participants was higher among those who had used external services before 2020 (Table 6). Table 7 details the reasons for consulting veterinary services. Overall, perceptions were positive: “People, no matter what, are really grateful to have a veterinary service” (S05, translated). Furthermore, 75% of the respondents agreed that the services respected the values and beliefs of their community (Table 4 and Figure 2). Some interviewees raised concerns about reaching Inuit people: “If you have a dog and you’re qallunaaq [that is non-Inuit], it’s pretty automatic to use the vet services, but for people for whom those services are brand new, what’s the point? Maybe they don’t see it, the value” (K22, non-beneficiary). However, the proportions of Inuit and non-Inuit exposed to the veterinary services were similar (see Table 6). Additionally, key stakeholders made different observations: “[The vet] get calls from everybody, like both southerners and beneficiaries and non-beneficiaries alike is an even mix” (S09).
Table 6. Awareness of, and exposure to each component of the kuujjuaq dog program
Note: Proportion of participants with [95% confidence interval].
Table 7. Reasons for consulting the veterinary services
Note: Percentages of the survey respondents who used the KDP’s veterinary services with [95% confidence interval]. As respondents could give several answers for breed and husbandry, these variables categories are not exclusive.
Twenty-seven percent (27%) of the survey respondents and 39% of those living with children were at least aware of the school workshops (see Table 6). Two interviewees shared their children’s positive experience and notions they learned: “They love animals, so they were very interested in how they get rabies and how to prevent, how to identify if they got sick from the rabies” (K11). Exposed survey participants also reported their children being happy or very happy with the activities (86% [49–87], n = 6/7). Stakeholders involved with the workshops confirmed the students’ interest: “engaging with the kids is 100% good. They need it, they want it” (S10). Quantitative results also supported a good sociocultural acceptability (see Table 4 and Figure 2).
Just over half of the survey participants were aware or exposed to the Facebook posts, with a lower proportion among Inuit, males, respondents aged 55 or over, and those living with children (see Table 6). This social media was confirmed as “a good way to get the word out,” given that “a lot more people are on social media these days” (K03), although the dedicated page was unknown to some study participants (see Table 4 and Figure 2). A few non-Inuit community members expressed concerns that posting about bites and rabies could negatively affect the perception of dogs. According to some, conflicts often emerge in the comments of dog-related posts; such an event occurred for one of the posts. Nevertheless, all exposed interviewees gave positive feedback: “They were useful in the fact that they give you tips” (K01).
Perceptions of enforcement of the dogs’ bylaws were mixed. Indeed, numerous interviewees, mainly Inuit, perceived tethering northern dogs as contrary to their natural behavior: “When they’re puppies, growing up, when you have it tied up, it’s heartbreaking. Because these dogs were made to run around, not tied up in a limited space” (K13, Inuit). Catching free-roaming dogs, impounding them and euthanizing them when unclaimed were also sensitive issues. But at the same time, all acknowledged that these measures were “necessary, because we get too overpopulated by dogs, loose dogs that have no owners” (K13).
Differentiation, strengths and weaknesses of the KDP
The proximity and continuity of veterinary services were major improvements compared to previous interventions: “I think one-time services, you know, it’s a plaster, but now, by having a constant presence, that’s where a change can be made” (S07, translated). Nonetheless, some interviewees reported delays and interruptions during the veterinarian’s leave of absence. Moreover, several services were unavailable at the time of the study due to a lack of equipment. This included sterilization, accessible only for males: “It would certainly be great to be able to operate on both males and females. I really think it could make a difference. It hasn’t been very accessible yet though” (K17, translated). Since autumn 2022, the construction of a clinic has remedied some of these gaps. Finally, the services’ affordability was a major asset: “Before, I used to say that we were about 1/6 of the prices in the South, but now I think we’re 1/8. 1/10 sometimes” (S05, translated). Indeed, prior to the KDP, the only way to access complete veterinary care was to send the animal to a Montréal clinic, which was an expensive option that many Kuujjuamiut could not afford.
The school workshops were also perceived as a novelty. Exposed participants and involved key stakeholders particularly emphasized the added value of integrating Inuit cultural elements: “When they did it with the dog team, that was nice. It made me feel proud that, hey, they do care about our mushers. […] And [my girls] feel proud that somebody wants to help and keep the tradition alive” (K11, Inuit). Another strength laid in them being run by a veterinarian, which according to parents “gives kids an opportunity to dream a little bit” (K02). Meanwhile, some called for more contextualization within the school curriculum and a repetition of the workshops, so that “the discourse is sustainable in the long term. Because otherwise, it’s an activity, but after that, what’s the basis for it in the community?” (S03, translated).
Regarding the Facebook posts, the interviewees confirmed the media’s practicality for disseminating information within the community: “You don’t have to look everywhere for answers. […] You can go to one place and you can ask questions at one place” (K11). Furthermore, the posts helped spread the word about the veterinary services: 46% ([36–62], n = 27/55) of the respondents aware of the services learned about them through social media.
Adaptation, barriers and facilitators
Interviews and timelines revealed deviations from the KDP’s initial plan, as synthesized in Figure 1, including direct and indirect impacts of Covid-19. Participants identified several factors affecting the project’s implementation and underlined their interrelations. In addition to remoteness and lack of material, financial and structural resources, two other levers were highlighted.
First, the challenges of multiple engagement, unclear roles and mandates, high turnover and extended leaves of absence of outside workers hindered the delivery of the KDP’s components: “Here it’s difficult because people go on vacation every two months, and sometimes two people go on vacation for two months at a time, so it’s always a big challenge to keep projects going” (S07, translated). More generally, the lack of human resources was a significant impediment, especially for veterinary services and dog control. Nevertheless, a few also identified cooperation and teamwork as facilitators: “It’s been a long arduous trip with a lot of people putting out at some time, a lot of people helping out at other times” (S09).
Second, resistance was sometimes encountered from community members or other stakeholders. This was the case for the enforcement of dog bylaws: “People don’t respect that they have to leash their dogs. Not 100% yet anyways. I would say 50% of the population do respect that” (K09). Interviewees recounted people – including children – untying dogs, freeing them from the pound or from dog catchers’ traps. Wariness and social tensions around dog-related topics also hindered the engagement of some of the stakeholders. Meanwhile, trust between external academics and the community members benefitted from the long-term commitment of the researchers: “That’s the great thing about your program, it’s that you’re there every year. […] And also that you come to the North, there’s a lot of research that’s done from the south, and they don’t understand the reality, but being on site, you see that reality” (K24, translated). Presenting as a veterinarian also facilitated acceptance by the population and local partners. Finally, to “encourage discussions with groups of stakeholders who are involved locally” (S03, translated), especially mushers, was a major facilitator.
Discussion
This study used mixed methods to evaluate the implementation of the first integrated intervention addressing issues at the human–dog interface in northern Québec with an EcoHealth approach. Results indicate a varying reach depending on the component and sociodemographic factors, such as gender or JBNQA status. Barriers to implementation included limited human and structural resources, stakeholder engagement and individual resistance. Few similar interventions have been documented in remote indigenous communities of the Canadian (sub)arctic (Lidstone-Jones and Gagnon, Reference Lidstone-Jones and Gagnon2016; Boissonneault and Epp, Reference Boissonneault and Epp2018; Baker et al., Reference Baker, Rock, Bondo, van der Meer and Kutz2021; Schurer, McKenzie, et al., Reference Schurer, McKenzie, Okemow, Viveros-Guzmán, Beatch and Jenkins2015). Evaluations of these interventions often focus on their impacts, with little information on how the context could have impacted the production of these effects. However, it is crucial to comprehend these processes to evaluate the quality and applicability of the evidence “in real-world settings,” and to assess their transferability to other contexts (Skivington, Reference Skivington2024).
Reach and acceptability of the KDP
The sociocultural acceptability of the KDP was generally positive, except for the regulation of free-roaming dogs, perceived as a “necessary evil.” Mixed perceptions about dog regulations are consistent with previous studies in Kuujjuaq or other Nunavik communities (Aenishaenslin et al., Reference Aenishaenslin, Brunet, Lévesque, Gouin, Simon, Saint-Charles, Leighton, Bastian and Ravel2019; Daigle et al., Reference Daigle, Ravel, Lévesque, Mokoush, Rondenay, Simon and Aenishaenslin2023). The predominance of positive outlooks on the project, as well as the evidence of its relevance to the community settings and concerns, may be attributed to its participatory design, which allowed prioritizing the community’s needs, and to the strong demand from Kuujjuamiut for this type of intervention (as shown in Table 4).
The project reached almost all study participants, with only four individuals reporting no awareness of any of its components. The high uptake of the veterinary services was expected and is consistent with other veterinary programs in remote Canadian communities, although differences in objectives and measurement indicators make comparisons difficult (Lidstone-Jones and Gagnon, Reference Lidstone-Jones and Gagnon2016; Baker et al., Reference Baker, Rock, Bondo, van der Meer and Kutz2021; Schurer, Phipps, et al., Reference Schurer, Phipps, Okemow, Beatch and Jenkins2015). Although some studies have reported Indigenous people’s mistrust of veterinary services, exposure to and acceptability of services were similar between Inuit and non-Inuit participants (LaVallee et al., Reference LaVallee, Mueller and McCobb2017; Baker et al., Reference Baker, Kutz, Toews, Edwards and Rock2018; Schurer, McKenzie, et al., Reference Schurer, McKenzie, Okemow, Viveros-Guzmán, Beatch and Jenkins2015). However, reasons for visits differed, with fewer sterilizations among non-Inuit participants and less illness/injury visits among Inuit participants. Several factors may explain these variations, such as differences in perspectives on dogs, access to southern clinics for sterilization, or profiles of participants’ dogs owned (e.g., breed and husbandry, see Appendix 4) (Brook et al., Reference Brook, Kutz, Millins, Veitch, Elkin and Leighton2010; Lidstone-Jones and Gagnon, Reference Lidstone-Jones and Gagnon2016; Baker et al., Reference Baker, Rock, Bondo, van der Meer and Kutz2021).
A quarter of the survey respondents reported indirect exposure to school workshops. Although parents’ exposure to and perception of the workshops does not represent that of their children, both provided valuable information on the implementation of the KDP. First, as participation to the workshops required parental consent, the sociocultural acceptability of said workshops by parents could have affected their reach among students. Second, exposed interviewees recalled concepts learned by the children, suggesting while targeting children, these educational activities may have had a positive impact on their relatives (Table 6). The participation of the veterinarian was welcomed as a way of inspiring students to pursue a career in veterinary medicine and possibly return to their village as veterinarians themselves. Brook et al. (Reference Brook, Kutz, Millins, Veitch, Elkin and Leighton2010) reported similar findings after conducting an intervention in communities in the Sahtu settlement area (Northwest Territories, Canada), during which young students were invited to participate in temporary veterinary clinics. Working with mushers increased interest in and acceptance of the workshops. In addition to transmitting traditional knowledge, it promoted a positive image of dogs.
The Facebook posts reached just over half of survey respondents. According to our local partners and to the interviewees, the platform is widely used by Kuujjuamiut. Nevertheless, it excludes some residents, particularly older ones (Table 6). Furthermore, the posts were not translated into Inuktitut and their mostly-text format was sometimes considered inappropriate. To increase the reach of such educational efforts, distribution channels should be diversified. Radio, in particular, is the primary local and regional medium and can reach other communities. Relying on key events, such as the Ivakkak Dog Sled Race, could contribute to a positive perception of dogs and the KDP.
An innovation in northern Québec and Canada
The KDP represents a significant shift from previous dog-related interventions in Kuujjuaq, northern Québec and more broadly, northern Canada. First, participants identified on-site, quasi-permanent and low-cost veterinary services as the major innovation, stating that “there was nothing before” (K02). Subsidized veterinary services in northern Canadian communities typically consists of temporary clinics providing a limited range of services (spay/neuter, vaccination) and, with one exception, are short-term interventions (Baker et al., Reference Baker, Kutz, Toews, Edwards and Rock2018, Reference Baker, Rock, Bondo, van der Meer and Kutz2021 ; Boissonneault and Epp, Reference Boissonneault and Epp2018 ; Lidstone-Jones and Gagnon, Reference Lidstone-Jones and Gagnon2016; Schurer, McKenzie, et al., Reference Schurer, McKenzie, Okemow, Viveros-Guzmán, Beatch and Jenkins2015; Schurer, Phipps, et al., Reference Schurer, Phipps, Okemow, Beatch and Jenkins2015). Second, to our knowledge, only two other dog-related interventions in northern Canada have included an educational component (Brook et al., Reference Brook, Kutz, Millins, Veitch, Elkin and Leighton2010; Lidstone-Jones and Gagnon, Reference Lidstone-Jones and Gagnon2016), despite the documented need (Beaver et al., Reference Beaver, Baker, Gloster, Grant, Harris, Hart, Hattaway, Houston, Koschmann, Lockwood, Rieck, Sacks, Strauss, Strother, Golab and Horvath2001; Boissonneault and Epp, Reference Boissonneault and Epp2018; Daigle et al., Reference Daigle, Ravel, Lévesque, Mokoush, Rondenay, Simon and Aenishaenslin2023). Finally, only one of these interventions explicitly claimed a One Health approach and considered the “spiritual and cultural needs of the communities” (Schurer, McKenzie, et al., Reference Schurer, McKenzie, Okemow, Viveros-Guzmán, Beatch and Jenkins2015; Schurer, Phipps, et al., Reference Schurer, Phipps, Okemow, Beatch and Jenkins2015).
Challenges to overcome for a sustainable intervention
Our study highlighted an array of interrelated barriers and facilitators that may influence outreach, acceptability and long-term sustainability of the KDP, which are illustrated in Figure 3. Most had already been identified as factors affecting northern communities’ dog-related issues (Aenishaenslin et al., Reference Aenishaenslin, Simon, Forde, Ravel, Proulx, Fehlner-Gardiner, Picard and Bélanger2014; Mediouni et al., Reference Mediouni, Brisson and Ravel2020; Daigle et al., Reference Daigle, Delesalle, Ravel, Ford and Aenishaenslin2022; Mediouni et al., Reference Mediouni, Brisson and Ravel2020), implementation of interventions addressing these issues (Baker et al., Reference Baker, Kutz, Toews, Edwards and Rock2018 ; Beaver et al., Reference Beaver, Baker, Gloster, Grant, Harris, Hart, Hattaway, Houston, Koschmann, Lockwood, Rieck, Sacks, Strauss, Strother, Golab and Horvath2001, p. 20; LaVallee et al., Reference LaVallee, Mueller and McCobb2017; Daigle et al., Reference Daigle, Ravel, Lévesque, Mokoush, Rondenay, Simon and Aenishaenslin2023), or One Health and community-based interventions (McCloskey et al., Reference McCloskey, Akintobi, Bonham, Cook and Coyne-Beasley2011; Delesalle et al., Reference Delesalle, Sadoine, Mediouni, Denis-Robichaud, Zinszer, Zarowsky, Aenishaenslin and Carabin2022; Potes et al., Reference Potes, Bouchard, Rocheleau, Richard, Leighton, Pelletier, Baron and Aenishaenslin2023). Since dogs are “nobody’s mandate” (S06), stakeholder engagement seemed difficult to sustain and intersectoral cooperation was essential. This collaboration, however, was only partial, as the KDP’s components were managed independently. Since the study, the veterinary services and population control measures, both managed by local stakeholders, are still in progress. Veterinary services are now delivered through regular visits of intern students of the FMV to Kuujjuaq’s clinic.
Figure 3. Factors affecting the implementation of the Kuujjuaq’s Dog Program. As identified through the interviews, survey and/or literature. Legend: from inner to outer circle: factors at the individual level; factors at the community level; factors related to the program’s design; systemic / environmental factors.
Systemic inequities and historical determinants (colonial past, Inuit dogs slaughter) underlie many of these barriers and facilitators. Access to education is one of them, with no animal health training available in Nunavik to date and, more generally, limited access to post-secondary education for Inuit living in Inuit Nunangat (i.e., Inuit lands of the Canadian Arctic). Indeed, in 2021, less than 24% of them had completed post-secondary education, a proportion three times lower than that of the general population in Québec (74%) and Canada (72%) (percentage of 25–64 age group, Statistics Canada, 2023, 2024). These barriers could be overcome by developing local training of community-based animal health workers, capable of providing basic veterinary care, in addition to vaccination. Paraprofessionals are a proven asset to equitable access to veterinary services and public health in remote communities (Catley et al., Reference Catley, Leyland, Mariner, Akabwai, Admassu, Asfaw, Bekele and Hassan2004). They would also improve language accessibility, valorization of local knowledge and community engagement.
Limits
The study has several limitations. Convenience sampling was recommended by local partners but makes it difficult to extrapolate findings to the general Kuujjuaq population. Selection bias in favor of Kuujjuamiut most interested in dog-related topics is likely and may have resulted in overestimating the project’s reach and social acceptability. The sex ratio is skewed toward women (Table 2). As gender may affect the risk of dog bites (Daigle et al., Reference Daigle, Delesalle, Ravel, Ford and Aenishaenslin2022), it may indirectly influence response to the KDP. The proportion of dog owners in our sample is consistent with estimates from local stakeholders, although comprehensive data on the dog population in Kuujjuaq are not currently available. The proportion of Inuit participating in the survey is not significantly different from that of the general population, which has been considered difficult to reach (Aenishaenslin et al., Reference Aenishaenslin, Brunet, Lévesque, Gouin, Simon, Saint-Charles, Leighton, Bastian and Ravel2019). On the other hand, they were underrepresented among the key stakeholders and other community members interviewed. Nevertheless, five mushers – more than half of those from Kuujjuaq – participated in the study, which contributed to the inclusion of Inuit perspectives. Finally, recall bias may have affected the assessment of the project’s reach, especially for school activities. In addition, the low power of the study, due to small sample size, prevented the identification of statistically significant associations between exposure to the components and potential factors. However, the use of mixed methods partially mitigates the limitations of the study (Creswell and Plano Clark, Reference Creswell and Plano Clark2018). Triangulating qualitative and quantitative data helped to contextualize the findings, increasing their depth and validity. Document analysis (e.g., veterinary and dog registration records, Facebook comments…) would have further strengthened this triangulation, but such data were difficult to access at the time of the study.
Conclusions
This paper presents results from the implementation analysis of a pilot project aimed at addressing issues at the human–dog interface in an Inuit community of northern Québec, Canada. The KDP’s multisectoral, participatory approach, combining veterinary services and population management with education, is innovative in the Canadian (sub)Arctic. The evaluation of its implementation emphasizes the critical role of local stakeholder engagement and intersectoral collaboration in the sustainability of such community-based interventions. Our study will not only guide future evolution of the KDP but also inform its transferability to other villages in northern Québec and Canada. Additionally, it fills knowledge gaps about the facilitators and barriers to implementing complex dog-related interventions in northern indigenous communities.
Supplementary material
The supplementary material for this article can be found at https://doi.org/10.1017/one.2024.10.
Data availability statement
In accordance with the recommendations of the Ikaarvik Youth ScIQ summit (2018) and the Assembly of First Nations Québec-Labrador (AFNQL, 2014), the data supporting the results of this study are considered to be the property of the community of Kuujjuaq. Consequently, they will be shared upon request to the corresponding author, LD, and with the agreement of village representatives.
Acknowledgements
We express our sincere appreciation to the NV of Kuujjuaq, the Kuujjuamiut and our local partners for their collaboration in this and previous IPDW research. We extend a special thanks to Angma Angma and Liam Callaghan for their previous assistance with data collection and (for LC) the review of this article. We also appreciate the advice and support provided by the IPDW team.
Author contribution
The authors confirm contribution to the paper as follows: conceptualization: LD, CA, AR. Investigation: LD. Data curation: LD. Data analysis: LD, CA. Visualization: LD. Funding acquisition: AR, CA. Project administration: AR, CA. Supervision: CA, AR. Writing – original draft: LD. Writing – review and editing: LD, CA, JSC, LC, AR.
Funding statement
This research was supported by grants from the Canadian Institutes of Health Research (grant number 376,191).
Competing interests
None.
Ethics statement
The protocol of this study was approved by the ethical committee of the Université de Montréal (Comité d’éthique de la recherche en santé, CERSES-21–062-D).
Open access
Comments
No accompanying comment.