WOMEN’S PERCEPTIONS OF HEALTH AND WELL-BEING IN A RURAL,
REMOTE, AND RESOURCE-DEPENDENT COMMUNITY:
STRENGTHS AND OPPORTUNITIES
by
Shayna Dolan
B.T.R., Douglas College, 2013

THESIS SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE
IN
COMMUNITY HEALTH SCIENCE

UNIVERSITY OF NORTHERN BRITISH COLUMBIA
April 2019
© Shayna Dolan, 2019

ABSTRACT
This research sought to explore the perceptions of health and well-being for women in a rural
and remote northeastern British Columbia community experiencing intense social,
ecological, and economic change as a result of its dependence on natural resource extraction.
Designed as a qualitative inquiry into the health of local women, this research is informed by
social constructivism, feminist theory, and ecosystems approaches to health. Engagement
with participants and data collection was heavily influenced by Appreciative Inquiry, a
strengths-based approach that identifies assets within a given system with the aim of
contributing to positive change. Findings indicate that equitable access, perceptions of people
and place, and leadership, communication, and collaboration are factors that strongly impact
women’s health and in this context. The insights gained through the research suggest that
integrative approaches to equity for women’s health and well-being can lead to improved
health and well-being for women and their communities.

ii

TABLE OF CONTENTS
CHAPTER 1: INTRODUCTION ..............................................................................................1
1.1 Research Goal, Questions, and Objectives ...................................................................... 3
1.2 Researcher Positionality .................................................................................................. 5
1.3 Motivation for Research Topic ....................................................................................... 6
1.4 Outline of Chapters ......................................................................................................... 9
CHAPTER 2: LITERATURE REVIEW .................................................................................10
2.1 Introduction ................................................................................................................... 10
2.2 Orienting to Women’s Health Issues in northern BC ................................................... 11
2.3 Resource Extraction, Gender, Place, and Women’s Health & Well-being ................... 16
2.3.1 The impact of place on women’s health and well-being ........................................ 17
2.3.2 The impact of gender on women’s health and well-being...................................... 17
2.3.3 The Impact of Resource Extraction on women’s health and well-being ................ 19
2.4 Integrative Approaches to Equity for Women’s Health & Well-being ......................... 21
2.4.1 Health equity in relation to social and ecological determinants of health .............. 23
2.5

Conclusion ................................................................................................................ 25

CHAPTER 3: STUDY CONTEXT .........................................................................................26
3.1 Introduction ................................................................................................................... 26
3.2 Fort Nelson .................................................................................................................... 26
3.3 Brief Overview of History of Resource Extraction in the Fort Nelson Area ................ 33
3.4 Health Service Delivery in Fort Nelson ........................................................................ 35
3.5 Conclusion ..................................................................................................................... 38
CHAPTER 4: METHODS & METHODOLOGY ...................................................................39
4.1 Introduction ................................................................................................................... 39
4.2 Theoretical and Philosophical Assumptions ................................................................. 39
4.2.1 Social constructivism .............................................................................................. 40
4.2.2 Feminist theory ....................................................................................................... 40
4.2.3 Ecosystems approaches to health ........................................................................... 41
4.3 Appreciative Inquiry...................................................................................................... 43
4.4 Research Design and Phases ......................................................................................... 45
4.4.1 Research ethics protocol and research design ........................................................ 48
4.4.2 Community partners ............................................................................................... 49
4.4.3 Sampling strategy and recruitment ......................................................................... 50
4.5 Data Collection .............................................................................................................. 52
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4.5.1 Field notes............................................................................................................... 53
4.5.2 Semi structured individual interviews .................................................................... 54
4.5.3 Semi structured group interviews ........................................................................... 55
4.6 Data Analysis ................................................................................................................ 57
4.7 Research Quality ........................................................................................................... 62
4.7.1 Research rigor ......................................................................................................... 62
4.7.2 Ethical considerations ............................................................................................. 64
4.7.3 Reflexivity .............................................................................................................. 65
CHAPTER 5: FINDINGS........................................................................................................67
5.1 Introduction ................................................................................................................... 67
5.2 Participant Demographics ............................................................................................. 68
5.3 Equitable Access ........................................................................................................... 70
5.3.1 Equitable access to healthcare ................................................................................ 70
5.3.2 Equitable access to education and employment ..................................................... 73
5.3.3 Equitable Access to Services, programs, and events .............................................. 74
5.4 Perceptions of People and Place.................................................................................... 76
5.4.1 Resource extraction and the boom and bust cycle .................................................. 77
5.4.2 Valuing and utilizing local and traditional knowledge and culture ........................ 78
5.5 Leadership, Communication, and Collaboration........................................................... 79
5.5.2 Division in the community ..................................................................................... 80
5.6 Participant Experience................................................................................................... 82
5.7 Conclusion ..................................................................................................................... 84
CHAPTER 6: DISCUSSION AND CONCLUSION ..............................................................85
6.1 Introduction ................................................................................................................... 85
6.2 Discussion and Synthesis .............................................................................................. 85
6.2.1 Local women’s insights into equity ........................................................................ 86
6.2.2 Local women’s insights into place ......................................................................... 88
6.2.3 Local women’s insights into processes of change .................................................. 91
6.3 Methodological Insights ................................................................................................ 94
6.3.1 Strengths and limitations of using Appreciative Inquiry ........................................ 94
6.3.2 Participant recruitment ........................................................................................... 95
6.3.3 Limitations of research design ................................................................................... 96
6.5 Recommendations and Implications ............................................................................. 97
6.6 Conclusion ..................................................................................................................... 99

iv

REFERENCES ......................................................................................................................100
APPENDICES .......................................................................................................................114
APPENDIX A: Letter of support from Fort Nelson Community Literacy Society .......... 115
APPENDIX B: Letter of support from Fort Nelson Aboriginal Friendship Society ........ 116
APPENDIX C: Letter of support from Northern Lights College ...................................... 117
APPENDIX D: Letter of support from the Northern Rockies Aboriginal Women Society
……...…………………………………………………………………………………….118
APPENDIX E: Project Information Sheet for Group Participants ................................... 119
APPENDIX G: Consent Form for Group Participants...................................................... 123
APPENDIX H: Consent Form for Individual Participants ............................................... 124
APPENDIX I: UNBC Research Ethic Board Approval letter (E2017.0103.001.00) ....... 125
APPENDIX J: Recruitment Poster .................................................................................... 126
APPENDIX K: Group Interview Guide ............................................................................ 127
APPENDIX L: Individual Interview Guide ...................................................................... 130
APPENDIX M: Demographic Questionnaire ................................................................... 132
APPENDIX N: Post Group Interview Evaluation ............................................................ 133

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LIST OF APPENDICES
Appendix A: Letter of support from Fort Nelson Community Literacy Society
Appendix B: Letter of support from Fort Nelson Aboriginal Friendship Society
Appendix C: Letter of support from Northern Lights College
Appendix D: Letter of support from the Northern Rockies Aboriginal Women
Society
Appendix E: Project Information Sheet for Group Participants
Appendix F: Project Information Sheet for Individual Participants
Appendix G: Consent Form for Group Participants
Appendix H: Consent Form for Individual Participants
Appendix I: UNBC Research Ethic Board Approval letter (E2017.0103.001.00)
Appendix J: Recruitment Poster
Appendix K: Group Interview Guide
Appendix L: Individual Interview Guide
Appendix M: Demographic Questionnaire
Appendix N: Post Group Interview Evaluation

115
116
117
118
119
121
123
124
125
126
127
130
132
133

LIST OF TABLES
Table 1: Fort Nelson demographic information from Statistics Canada (2016)
Table 2: Research activity timeline.47 Table 3: Participant demographics for
the primary data collection methods
Table 4: Research question and associated data sources
Table 5: Supportive services, programs, and events identified by participants
Table 6: Post group interview questionnaire responses

30
53
60
75
83

LIST OF FIGURES
Figure 1: Framework depicting interrelationships among literature review
Figure 2: Map of northern BC from Basemap: Esri, USGS, NOAA; other
spatial data: BC Government
Figure 3: “Shale gas play areas from British Columbia” from Ministry of Energy,
Mines and Petroleum Resources (2010, p. 16)
Figure 4: “The 4 D Cycle of Appreciative Inquiry” from Cooperrider & Whitney
(1999, p. 252)
Figure 5: “Data Analysis Sprial” adapted from Creswell (2013, p.183)
Figure 6: Participant Age
Figure 7: Number of Years Participants have Lived in the Community

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11
27
31
45
59
69
70

ACKNOWLEDGEMENTS
This thesis research would not have been possible without the support of the incredible
research participants in the community of Fort Nelson, BC. Thank you for believing in me,
engaging in the research process, and contributing your invaluable perspectives. I look
forward to continuing to advocate for the health and well-being of women in the community
alongside you.
Thank you to my supervisors, Professor Dawn Hemingway and Dr. Margot Parkes, and my
committee member, Dr. Theresa Healy. I would not have completed this research if not for
your unwavering support, guidance, and patience. I am honoured to have had the privilege of
learning from you.
Thank you to all the strong women I have had the pleasure of knowing throughout my life.
You have inspired me more than you will ever know, and I share this accomplishment with
you. To my family, friends, and colleagues near and far, I offer my sincerest thanks for
coming on this journey with me.

vii

CHAPTER 1: INTRODUCTION
Health is influenced by natural resource extraction and development through
interrelated socioeconomic, ecological, cultural, and gendered pathways (Gillingham,
Halseth, Johnson, & Parkes, 2016). This is particularly evident in northern British Columbia
(BC) where the economy is tightly linked with the extraction and development of natural
resources (Gislason et al., 2017). This dependence on resource extraction coupled with the
large scale of social and environmental change occurring in rural and remote communities
has unique contextual impacts on women’s health and well-being. Women in such
communities face challenges in maintaining and improving their health and well-being when
compared to both men and those living in urban settings, experiencing worse overall health
(British Columbia Centre of Excellence for Women’s Health, 2004; Leipert, Leach, &
Thurston, 2012; United Nations, 2016), multiple compounding responsibilities of work and
family (Reid & LeDrew, 2013; Peters et al., 2010), and higher rates of poverty and violence
(Aalhus, 2018; Amnesty International, 2016).
Fort Nelson is a prime example of a community dealing with the challenges that exist
at the intersection of gender, place, and natural resource extraction and development. Located
in the northeastern corner of BC, Fort Nelson is the largest community in the Northern
Rockies Regional Municipality. The economy has historically been built on natural gas, oil,
and forestry and has experienced several iterations of the “boom and bust” cycle that is
characteristic of natural resource extraction (Northern Rockies Children and Family Action
Committee, 2017). In 2016, the population of the community was 3366 people (Statistics
Canada, 2016). Between the years of 2006 and 2016 the population decreased by 25.4%,
largely due to the most recent “bust” of the economy. Fort Nelson has a fairly even split of
self-reported females (48.5%) and males (51.5%) (Statistics Canada, 20176). In 2016, 760

individuals self-identified as having Aboriginal Identity (First Nations, Metis, Inuit), which is
22.6% of the total population.
Literature on health issues affecting women in remote northern communities dependent
on resource extraction has been increasing in recent years but remains limited in scope. Such
inquiries have traditionally treated categories of gender, place and resource extraction as
distinct entities explored separately (Dhamoon & Hankivsky, 2011; Parkes, 2016). This
research sought to address this gap by exploring the connections among themes of gender,
place, and resource extraction and development.
Concerns regarding the negative impacts of resource extraction on women’s health
and well-being have been raised by several activists, researchers, government organizations,
and non-government organizations (Baikie & Dean, 2016; Caron-Beaudoin et al., 2018; First
Nations Health Authority & Northern Health, 2015; Women’s Earth Alliance & Native
Youth Sexual Health Network, 2016). This is well articulated in the 2016 Amnesty
International report Out of sight, out of mind: gender, indigenous rights, and energy
development in northeast British Columbia, Canada. The report aimed to shed light on the
largely ignored “serious- and sometimes deadly consequences for women’s wellness and
safety” that accompanies oil and gas extraction in rural and remote communities (p. 4). This
thesis seeks to explore both: 1) the interrelated pathways that make women vulnerable to the
negative health impacts associated with resource extraction, and 2) the mechanisms that
women use to maintain their health and well-being in this context.
Addressing issues that impact the health of humans, non-human species, and the
environment can be facilitated by participatory and collaborative approaches that incorporate
a variety of different knowledges and disciplines (Buse, Oestreicher, & Ellis, 2018;
Oestreicher et al., 2018; Parkes, 2015). Rather than seeing the health of individuals and
2

communities as separate from that of the environment, holding space for the consideration of
how multiple systems interact and influence each other can lead to more sustainable and
equitable action (Gillingham et al., 2016). Northern Health’s 2012 Position on the
Environment as a Context for Health calls for the recognition of the environment as a key
factor in the health of individuals and communities. Exploring the interrelationships between
environment, community and health within a given context can help to design effective and
sustainable interventions to address challenges in maintaining and improving health and wellbeing for all (Hanlon & Halseth, 2005). Ultimately, those who live, work, and play in a
community are the best equipped to identify, explore, and act on issues that impact their
health. Reid, Brief, LeDrew, and the Women’s Health Research Network (2009) articulate
this powerfully, stating:
Using Community Based Research in women’s health research forges links between
groups who ought to talk to each other, but rarely do. That is the challenge, the
richness, and the power of Community Based Research (p. 64).
While the site for this research was small, it can not be assumed that residents and
organizations have had opportunities to connect on issues arising at the intersections of
gender, place, and resource extraction. An intent of this research was to facilitate such
opportunities in order to explore such intersections in relation to women’s health and wellbeing.
1.1 Research Goal, Questions, and Objectives
The goal of this research was to engage in a co-learning experience with women in Fort
Nelson to identify and explore the aspects of the community that promoted their health and
well-being. To help achieve this goal I spent prolonged periods of time in the community
with the intention of both building on existing relationships and creating new connections to

3

help add voice to the experiences of women in the community regarding their health and
well-being. Existing relationships proved to be very advantageous to the overall research
process as they provided a foundation of familiarity and trust to work from.
With this goal in mind and informed by interactions in the community (see Section 1.2) I
developed the following research questions:
1. What do women in a rural, remote, and resource-dependent community perceive as
contributing to their health and well-being?
2. Which factors are most prominently identified by women as contributing to their
health and well-being? (Social, ecological, economic, etc.)
3. What are the strengths and limitations of using an appreciative inquiry approach to
research involving women’s perceptions of health and well-being?
To answer these research questions, I developed the following objectives:
I.

To complete a literature review that explored issues affecting women in a rural,
remote, and resource-dependent community

II.

To explore the connections between gender, resource extraction, and place

III.

To share in the exploration of local knowledge on the strengths and opportunities for
health and wellness in the current context of the community
Designed to address these questions and objectives the research was informed by social

constructivism, feminist theory and ecosystems approaches to health. The research design
included a series of complementary methods that aimed to engage local women in a colearning experience exploring the factors that impact their health and well-being.
Engagement with participants and data collection was heavily influenced by Appreciative

4

Inquiry, a strengths-based approach that identifies assets within a given system with the aim
of contributing to positive change.
Specific data collection methods included individual interviews, group interviews,
demographic questionnaires, post interview questionnaires, and field notes. Participants were
recruited through partnerships with four community organizations that serve a diverse range
of women. While these elements are examined in Chapter 4, this introduction places these
approaches in the context of researcher positionality and motivation.
1.2 Researcher Positionality
Who you are and where you are impacts the knowledge that you produce (Reid, Greaves,
& Kirby, 2017). Referred to as “positionality” (p. 48), one’s place in a social hierarchy has
the potential to both limit and broaden an understanding of others. Researchers that share
participants’ backgrounds and experiences must be careful to not make assumptions that can
interfere negatively with the production of knowledge. I am a 33-year-old Caucasian woman
born and raised in Fort Nelson, BC. Having been born and raised in Fort Nelson, I consider
myself part of the community, however I have been largely absent for the last ten years while
attending post-secondary education. My father’s parents came to the Fort Nelson area in the
early 1950s and my mother’s parents in the early 1970s. I was fortunate enough to be raised
in a community with my grandparents, many aunts and uncles, cousins and extended family.
My family has a history of being engaged in the community through business, volunteerism,
recreation and leisure, and engagement in local politics.
This dual “insider and outsider” (p. 50) position has required me to be particularly
attentive to the decisions made throughout the research process and the impact that my
positionality may have on data gathered and interpretation of findings. This research could
5

not have occurred without the support of the organizations, partners, and participants. I
believe that my positionality as a researcher and community member is an asset and helped to
achieve an exploratory yet nuanced documentation of women’s perceptions. In October of
2018, I was hired by the Northern Rockies Regional Municipality in Fort Nelson to lead their
Community Health Plan. The Health Plan can be found here
https://www.northernrockies.ca/EN/main/residents/health/CommunityHealthPlan.html. The
potential impacts of my positionality on the research process is discussed further in Section
4.7.3 (Reflexivity) and Section 6.3 (Study Limitations).
1.3 Motivation for Research Topic
After graduating high school in 2003 I attended several years of post-secondary school,
taking a variety of courses in different disciplines. This eventually led to me obtaining a
Bachelor’s degree in Therapeutic Recreation and Health Promotion from Douglas College in
2013. I was drawn to the program’s focus on a holistic view of health combined with
opportunities for both practical and research-based training. In the third year of the program I
took the required research methods course which involved designing a research project of my
choice. I chose to explore an issue that was becoming increasingly more prevalent in my
home community of Fort Nelson: the repeated absence of women’s partners due to their
employment in the oil and gas industry.
My undergraduate thesis titled “Alone, Together: The Experiences of women whose
significant others are repeatedly absent due to their employment in the oil and gas industry”
is the product of my introduction to the research process and was the first time I
systematically explored issues related to women’s health in the context of a rural and remote
northern community. This undergraduate research began in December of 2011 and the

6

literature reviewed focused on the various negative effects (physical, social, emotional)
women experience when their partner works away from the home for extended periods of
time (Diamond, Hicks, & Otter-Henderson, 2008; Forsyth & Gauthier, 1991; Kaczmarek &
Sibbel, 2008; Morrison & Clements, 1997). At the time I had many friends and family that
were experiencing this situation and had heard many anecdotes of related negative health
impacts. Having spent prolonged periods of time working in an industrial camp in the area of
Fort Nelson I already had a keen interest in the social and psychological health impacts of the
resource industry that I had grown up immersed in.
The findings of my undergrad research project signaled a need for a deeper exploration of
the health and well-being of women living in this context. Having used literature from many
researchers based at the University of Northern British Columbia, I looked into the
university’s Masters programs and was excited to see the that Community Health Sciences
program focused on health issues in northern, remote and First Nations communities. I
applied to the program and was placed with Professor Dawn Hemingway as a supervisor. I
had read much of Professor Hemingway’s work while conducting the literature review for
my undergraduate thesis and had been following the development of the Northern Feminist
Institute for Research and Evaluation (FIRE). Shortly after starting my graduate studies I was
introduced to Dr. Margot Parkes. After being employed as research assistant by Dr. Parkes I
was exposed to several new areas of health research, including ecosystems approaches to
health. This opened my eyes to an even broader view of health that integrates the
environmental and social determinants of health within the economic context of system
(Charron, 2012). This led to Dr. Parkes becoming co-supervisor for my thesis.
Reflecting on my undergraduate research work, I can see that my initial interest in the
impact that place, resource extraction and gender on women’s health was focused on
7

individuals. I used a problem-based approach, asking participants to share the negative
aspects of their experience. It was not until I began to think of recommendations prompted by
the research that I began to consider these factors at the community level. To me, the most
impactful finding from this project was women’s desire to share their experiences and how
doing so made them feel validated and empowered. This led me to consider graduate studies
in order to further explore women’s health in a rural, remote and northern context.
Recognizing the limitations that a problem or deficit-based approach had, I knew I wanted to
explore alternative approaches to exploring the factors that were impacting women in the
same community several years later.
Throughout my graduate studies I have had the opportunity to gain insight into the issues
affecting northern rural and remote communities, particularly as it relates to the health
impacts of resource extraction and development. My work as a research assistant with the
ECHO Network (Environment, Community, Health Observatory): Strengthening
intersectoral capacity to understand and respond to health impacts of resource development
is one such opportunity. This 5-year research program, funded by a Canadian Institutes of
Health Research Team Grant, is focused on working together across sectors to take notice ofand respond to- the influence of resource development on health and well-being, with
specific emphasis on rural, remote and Indigenous communities and environments (Parkes et
al., 2019). More information on the ECHO Network is available here
https://www.echonetwork-reseauecho.ca/.
In addition to my research assistant work I have also sought out volunteer opportunities
in Prince George to gain further knowledge on issues affecting women in northern
communities. I have been a board member of the Prince George New Hope Society for the
past 3 years (http://princegeorgenewhopesociety.ca/). New Hope is a drop-in centre for self8

identified women working in the sex trade and serves those in Prince George and
surrounding communities. I have also been a member of the organizing committee for the
Girls Rock Camp North since its inception in 2017 (https://www.girlsrockcampnorth.com/).
This volunteer work has given me the opportunity to share ideas and resources from
initiatives in Prince George with service providers in Fort Nelson and contributed to
discussion both in the individual and group interviews.
1.4 Outline of Chapters
The research process that was designed to address the objectives and research
questions listed above is presented as a thesis with the following structure. Chapter two
provides an overview of the primary areas of literature that I drew upon on to inform the
research. The themes of gender, place and resource extraction are discussed as they relate to
women’s health and well-being. Chapter three introduces the study context and provides a
brief history of the community of Fort Nelson and important historical events in resource
extraction and healthcare. Chapter four explores the methodology and methods, beginning
with the theoretical and philosophical assumptions that framed the research. Also detailed are
the methods used to recruit participants, collect and analyze data, and ethical considerations.
Chapter five presents findings from the various data collection methods with excerpts from
participant interviews. Discussion on the study findings in relation to the literature and recent
community developments is presented in Chapter 6. This final chapter also provides
methodological insights and recommendations for service providers, those in leadership
positions, and areas for future research.

9

CHAPTER 2: LITERATURE REVIEW
2.1 Introduction
The first objective of this research project was to complete a literature review that
explored issues affecting women in rural, remote, and resource-dependent communities.
Building on the introduction in Chapter 1, this chapter provides a review of interrelated
literature and how it informed the research process.
It is difficult to put strict parameters on the timeframe of the literature review as I
have been attuned to information on this topic since my undergraduate studies in 2011.
Literature that fuelled my interest in this topic is presented in the next section. The formal
literature review process for this thesis began in September of 2014. I used both academic
and grey literature to help inform the research process. I accessed electronic databases
through the University of Northern British Columbia library, including CINAHL, Science
Direct, Academic Search Complete, and Google Scholar. Using the key search terms of
“women”, “gender”, “northern”, “rural”, “remote”, “health”, and “resource development, I
located relevant journal articles and books. The same terms were used in Internet searches to
include relevant information not found in academic databases. A snowball approach was used
for gathering information for the literature review, ending in September of 2018.
The following chapter explores literature on women’s health in relation to gender,
place, and resource extraction and the need for a more integrative approach to address the
health impacts of intersections between them. Figure 1 (p.11) provides a simple framework to
depict and prompt consideration of the interrelationships discussed in the following sections.
Section 2.2 provides an orientation to women’s health issues in northern BC, profiling
foundational research conducted over the past forty years. Section 2.3 reviews the ways in
which place (2.3.1), gender (2.3.2), and resource extraction (2.3.3) impact women’s health
10

and well-being. Section 2.4 provides an overview of the need for more integrative approaches
to addressing inequities that exist for women at the intersection of place, gender, and
resource extraction. It also briefly discusses health equity in relation to the social and
ecological determinants of health (Section 2.4.1).

(2.3.3)
Resource Extraction

(2.3.1)

(2.4.1)
Equity )
(gender and social)

Place
(rural, remote, northern)

Health and well-being
(2.2)
Figure 1: Framework depicting interrelationships among literature review themes (with links
to relevant section of Chapter 2).
2.2 Orienting to Women’s Health Issues in northern BC
This section provides an orientation to women’s health issues in northern BC by
profiling foundational research conducted over the past forty years. The following research
projects all touch on one or more themes of gender, place, and resource extraction and sought
to explore how they impact women’s health and well-being (see Figure 1). It is important to
note that the work described in the following section is not indicative of the full scope of
each organization’s work. A complete history of the contributions of the centers and
11

institutes mentioned in this section is beyond the scope of this thesis. Instead, this review
profiles projects and reports most relevant to the research. Note that names of relevant
projects or reports are italicised in the text.
The Northern British Columbia Women's Task Force Report on Single Industry
Resource Communities was published by the Women’s Research Centre in 1977. The report
documents research conducted in the northern British Columbia communities of Kitimat,
Fraser Lake, and Mackenzie. The goal of the task force was to assist women in identifying
their needs, and to increase women’s participation in the planning, governing and evaluating
processes taking place in their single industry communities. The authors state that life for
women in such communities was difficult, particularly because “as women we are taught that
our role should lie in the home and that community involvement should be non-political and
non-challenging” (Women’s Research Centre, 1977, p.2). Recommendations of the task force
focused on increasing access to services related to transportation, obstetrics and gynecology,
childcare, employment, and training.
In 1979, the Women’s Research Centre conducted a study titled Beyond the Pipeline,
based in Fort Nelson, British Columbia, and Whitehorse, Yukon. The study aimed to identify
the socio-economic concerns of women related to the proposed construction of the Alaska
Highway gas pipeline project. Substantial oil and gas discoveries were made in Prudhoe Bay
in Alaska in 1968, and the Alaska Highway gas pipeline was designed to transport the
Alaskan gas and oil to U.S. markets by passing through Canada. At the time, it was
increasingly being recognized that communities along related transportation corridors are
impacted by development. Therefore, researchers sought to explore related concerns of
women in both communities.
The three main recommendations made from the 1979 report (Women’s Research
12

Centre, 1979) were the need for impact assessment in economic development planning, the
need for increased service provision in both communities (whether the pipeline was built or
not), and the recommendation that construction not begin until the necessary social services
are in place. In discussing the challenges in accessing adequate social services the report’s
authors explain,
Apparently, the fact that Fort Nelson and Whitehorse are northern
communities is accepted as justification for low standards of service.
Northerners are expected to accept the romantic mystique of the north. They
are told they must be tough to endure. They are told to move to southern cities
if they want higher standards of service and care. However, geographic
isolation is not an acceptable justification for inadequate goods and services
(Women’s Resource Centre, 1979, p. xv)
Due to competitive foreign markets and high construction costs the Alaska Highway pipeline
was never built.
Established in 1996, the Northern Secretariat of the BC Centre of Excellence for
Women’s Health was a part of a national network of Centres of Excellence. This northern
node was based out of the University of Northern British Columbia (UNBC) and sought to
address health issues impacting women in northern BC and contribute to decision making
influencing health care services and policy. In 2001, the Northern Secretariat became
Northern FIRE: The Centre for Women’s Health Research. Since then Northern FIRE has
undergone changes in leadership and has experienced funding challenges, with UNBC
researchers, students, and community members working (often voluntarily) to conduct
research on women’s health (Women North Network/Northern FIRE, n.d.).
An early initiative of Northern FIRE was the Women North Project, funded by the
Status of Women Canada. From this community-based research project came the Women
North Network (WNN). WNN is a primarily web-based network of more than 400 women

13

and organizations in various northern communities that facilitates sharing information and
resources. The development of the network is discussed in the 2005 article Harnessing
Information and Communication Technology to Build an Online Community of
Northern/Rural Women (Hemingway & McLennan, 2005). Northern BC women that
participated in the network explained that challenges in accessing health and social services
were exacerbated by geographic, social, and cultural isolation and that WNN provided a
mechanism for them to come together as women and share experiences, information, and
resources.
Currently, members of Northern FIRE continue to conduct research and support
community work relating to the health of women in northern BC. In March of 2018 Northern
FIRE held their first symposium at UNBC. Titled Addressing Gendered Violence: Local and
Northern Perspectives. The symposium brought together provincial, local, and northern
perspectives on various forms of gendered violence (Slack, 2018). The recent 2019 Northern
FIRE symposium was focused on gendered realities in northern BC and how gender and life
stage can affect how women experience their bodies, health and relationships.
Building on the early work of Northern FIRE, the Northern Women’s Wellness
Information Centre (NWWIC) was established in Prince George, BC in 1998. Spurred by
women’s concerns about their health and accessing healthcare services, the organization
received non-profit status in 2000. The organization started by providing support and
resources to existing service agencies and later offered clinical outreach health services
facilitated by nurses and mental health counsellors. The NWWIC also facilitated health
initiatives and research projects, engaging women in Prince George and rural communities
located further north (including Fort Nelson).

14

In particular, and funded by the Vancouver Foundation, Planning from Strength was a
project led by the Northern Women’s Wellness and Information Centre (NWWIC), based in
Prince George, BC (Madrid, 2003). Designed to identify unique healthcare needs of northern
BC women and implement initiatives, the qualitative research project occurred in two phases,
Planning from Strength and Mobilizing from Strength. Planning from Strength found that
women in the north face considerable challenges and must be resourceful in developing
creative solutions to maintain and improve their health. Women voiced that they needed
support to advocate for a women’s centered model of care.
The second phase of the project, Mobilizing from Strength: Assisting Young Women
through Participatory Action Research and Community Involvement, took place from
January to December of 2005 (LeBreton, 2005). The project partnered with communities
across northern BC to design, develop and implement strategies to empower women in
relation to their health. The purpose of the project was to mobilize young women to identify
health issues of concern to their community. Mechanisms to do so included participatory
action research workshops, scholarships, and the development of research manuals to bring
awareness to young women’s health and wellness needs. By focusing on and building
capacity within local young women, the project was designed to create a legacy of strength
and empowerment within each community.
In 2014, the Fort St. John’s Women’s Resource Society released the report The Peace
Project: Gender based analysis of violence against women and girls in Fort St. John
(Eckford & Wagg, 2014). The report presented findings from a three-year, community-driven
project aimed at reducing violence against women and girls. Funded by the Status of Women
Canada, the project took place in the community of Fort. St. John, the largest city centre
north of Prince George, located 380 kilometres south of Fort Nelson. The gender-based
15

analysis found that many aspects of resource development contribute to violence against
women in the community. For example, in March of 2012 87% of the total number of
industrial work camps in northern BC were located near Fort St. John (Eckford & Wagg,
2014, p. 24). Participants spoke of the influence that the hypermasculinity and sexism present
in “rigger culture” has on their health and well-being. A lack of access to counseling services,
childcare, affordable housing and transportation were mentioned as well.
Out of sight out of mind: Gender, indigenous rights, and energy development in
Northeast British Columbia, Canada was released by Amnesty International in 2016. After
being approached by Indigenous leaders and community members in Fort St. John, BC,
Amnesty International conducted two years of research into the human impacts of large-scale
energy development. As the title indicates, the report focuses on the negative impacts
resource development has on Indigenous women and how a failure to acknowledge and act
on these impacts is having serious- and sometimes deadly consequences for women.
Recommendations are targeted towards the federal and provincial governments, the RCMP,
local governments in northeastern BC, and private industry.
2.3 Resource Extraction, Gender, Place, and Women’s Health & Well-being
The following sections provide an overview of the literature in terms of how place,
gender, and resource extraction impact women’s health and well-being. I recognize that these
are not discrete concepts, but they are divided into sections to provide the reader with a clear
overview of relevant literature. After conceptually disassembling these interrelated concepts,
I discuss the need for and examples of integrative approaches to equity for women’s health
and well-being in Section 2.4.

16

2.3.1 The impact of place on women’s health and well-being
The rural and remoteness of many northern BC communities has several impacts on
residents’ health (Canadian Institute for Health Information, 2006). Compared to those in
urban areas, those living in rural areas are more likely to experience poorer socio-economic
conditions, have lower education attainment, and engage in less-healthy behaviours. These
conditions all contribute to the higher overall mortality rates found in rural areas.
One of the first Canadian books focused specifically on rural women’s health was
published in 2012 (Leipert, Leach, & Thurston, 2012). The multiple case studies included in
the book demonstrate the critical role that women play in rural contexts in relation to the
health of their families and communities. Despite the many challenges experienced by
women living in a rural community they provide invaluable insight and actions, often at the
expense of their own personal health and well-being. Leipert et al. (2012) explain that those
in urban centers tend to dismiss rural Canada as either an idyllic vacation destination or as
problem areas besieged with deficits and lacking infrastructure and environmental
degradation. These perceptions can influence the ways in which both locals and outsiders
understand such places and decisions made.
2.3.2 The impact of gender on women’s health and well-being
Prior to the 1970s the term “gender” was rarely found in the biomedical and public
health literature (Krieger, 2003). The Gender, Sex and Health Research Casebook published
in 2012 by the Canadian Institute of Health Research provides the following definition of
“gender”: “Socially constructed roles, relationships, behaviours, relative power, and other
traits that societies ascribe to women and men” (p. x). Their definition of biological “sex” is:
“The biological and physical characteristics that distinguish females from males” (p. x).
CIHR states that this distinction between gender and sex is made cautiously and contextually
17

as the two concepts are interrelated and sometimes inseparable.
In British Columbia, as elsewhere, women’s health research has been continually
underfunded, leading to a male-bias in both health care policy and practice (Northern
Secretariat of the BC Centre of Excellence for Women’s Health, 2001). Although there are
an increasing number of studies being done on health issues affecting northern communities,
research specifically focusing on women’s health is limited.
The research to date has shown that women in rural and remote northern BC
communities face unique challenges (Dhamoon & Hankivsky, 2011). The impact of gender
on one’s health is influenced by the ways in which other social determinants of health
interact (Northern Secretariat of the BC Centre of Excellence for Women’s Health, 2001).
Factors that are known to more likely affect women than men include: lower education
levels, multiple responsibilities of work and family, lower income and higher rates of
poverty, underemployment, social and geographic isolation, and all types of violence. These
factors are intensified when placed in the context of a rural and remote Northern BC
community. Women in such communities have reported the following factors to be
particularly challenging: both physical and emotional isolation, the often-transient
populations, seasonal employment, and limited access to transportation.
The situation becomes even more complex when the heterogeneity of women is
considered. Aboriginal women, lesbians, young women, elderly women, women with
disabilities, and women living with a substance use issue have been shown to experience
intersecting inequities that negatively impact their health (Anderson, Healy, Herringer, Issac,
& Perry, 2001). Many services specific to women’s health are not available in communities
in northern BC Specialist gynecological and maternity services are often limited and women
must travel to access them. If services are available in community, the choice is limited and
18

wait times are long (Northern Secretariat of the BC Centre of Excellence for Women’s
Health, 2001). The small size and remoteness of communities in northern BC can lead to
issues surrounding confidentiality and anonymity. Many women seeking health care may be
put in danger due to the lack of privacy available. Women dealing with complex health
issues, such as HIV/AIDS or addiction are at a much higher risk of stigmatization,
stereotyping, and both physical and emotional abuse (Hughes, 2010; Northern Secretariat of
the BC Centre of Excellence for Women’s Health, 2001).
Due to the lack of needed health services for all populations in northern BC, women
are disproportionately tasked with the majority of caregiving (Peters, 2010). This unpaid
work can contribute to increased physical and psychological ill health due to the stress of
balancing multiple roles (Williams et al., 2011). Formal work outside of the home can also
creates situation of inequity. Women in rural and remote resource extraction communities do
not have equal access to the high paying jobs available (Reid & LeDrew, 2013). The lack of
childcare present in many communities further contributes to this increased burden. Women
also report limited access to training and education along with increased violence and
discrimination.
2.3.3 The Impact of Resource Extraction on women’s health and well-being
Scholars have documented various health issues associated with resource extraction
communities in northern British Columbia (Goldenberg, Shoveller, Koehoorn, & Ostry,
2010; Hanlon & Halseth, 2005; Northern Health, 2013; Shandro et al., 2011). A recent report
of the Fraser Basin Council to the BC Ministry of Health identified a range of health issues,
grouped into the categories of physiological, psychological and social/cultural (Fraser Basin
Council, 2012). Health issues experienced are influenced by one’s demographics and the
history of resource development in the community. Research has identified several
19

significant issues associated with resource extraction communities, including an increase in
the prevalence of substance use and communicable diseases, occupational health and safety
concerns for employees, and negative health effects on employees’ families (Goldenberg et
al., 2010; Northern Health, 2012; Kaczmarek & Sibbel, 2008). These health issues are further
exacerbated when placed in the context of a rural and remote northern community in which
healthcare resources and services are limited (Fraser Basin Council, 2012; Grzybowski,
2011).
Research conducted on impacts of oil and gas development in BC has shown that
changes to the community are of concern to residents (Fraser Basin Council, 2012; Petkova
et al., 2009; Shandro et al., 2011). Factors that contribute to changes in community include a
large transient workforce, disruption to traditional cultures, rapid population growth,
economic inequity, reduced social cohesion, and demands placed on existing infrastructure.
Citizens in such communities often have different perspectives and relationships to the oil
and gas industry. These differences can lead to conflict within communities, adding increased
stress and negative health effects (Garvie & Shaw, 2014).
The oil and gas industry in northern British Columbia contribute heavily to both the
provincial and federal economy (Hemingway & Margolin, 2016). Despite this contribution
the majority of the funds generated by resource extraction is sent to industry owners,
shareholders, and governments that know little about what residents in northern communities
need and desire. This “rip it and ship it” practice (para 2) has contributed to chronic
underfunding of the health care resources.
Harder (2016) contends that the psychological impacts of resource extraction such
communities face are rarely considered. A recent bulletin from the Canadian Medical
Association Journal reports an alarming rise in the number of people seeking mental health
20

care in response to the economic insecurity spurred by low oil prices in Alberta (Colburne,
2015). By adopting a wider view of impacts, beyond the usually identified environmental
hazards, communities can become better equipped and work towards “honouring the Earth
and its resources” (Harder, 2016, p. 140).
2.4 Integrative Approaches to Equity for Women’s Health & Well-being
This research project focused on the three themes of gender, place, and resource
extraction as they relate to the health and well-being of women in the community of Fort
Nelson. As discussed previously, exploring and addressing issues at the interface of social
and ecological health requires an integrative approach that incorporates a variety of
perspectives, disciplines and collaboration (Gillingham et al., 2016; Gislason et al., 2017;
Parkes, 2015). The following section discusses such approaches and how they connect to
health equity (Section 2.4.1).
The term “intersectionality” was originated by Kimberlé Crenshaw in the late 1980s
in the seminal work Demarginalizing the Intersection of Race and Sex: A Black Feminist
Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics (1989).
Since the publication of this paper, intersectionality theory has been used in a variety of
different disciplines and contexts. Intersectionality can be used as a framework for research
that explores how multiple interacting “social locations” (such as sexuality, gender, ethnicity)
shape people’s individual and collective identities (Reid et al., 2017, p. 31). Hankivsky
(2012) explains that while intersectionality is a widely acknowledged theoretical construct, it
has not been well integrated into research, policy, and practice.
While intersectionality is still a relatively new concept, there is a growing body of
literature around how to operationalize its theoretical aspects through quantitative and

21

qualitative research. Gislason et al. (2017) advocate for the use of intersectionality when
conducting research linking social and ecological determinants of health of women and
children in communities experiencing intensive resource extraction. The authors (Gislason et
al., 2017) explain that intersectionality can help to reveal and understand how discrimination
and resulting health inequities are reflections of wider systems of power and oppression.
Published in 2016, The Integration Imperative: Cumulative Environmental,
Community and Health Effects of Multiple Natural Resource Developments is a response to
the inadequacies of current environmental assessment processes of the cumulative impacts of
resource development (Gillingham, Halseth, Johnson, & Parkes, 2016). The authors, all
based at the University of Northern British Columbia, advocate for an integrative approach to
identifying and responding to the cascade of impacts communities, families, social systems
and local cultures are faced with when exposed to multiple natural resource development.
Halseth et al. (2016) explains that despite rapid changes in the health of the world’s species
and environment, current environmental assessment processes have not significantly changed
in over 40 years.
Research on women’s health in relation to resource development conducted over 30
years ago clearly indicated the need for such assessment processes to include what are now
referred to as the social determinants of health yet inclusion of such determinants is still not
common practice (see Section 2.4.1 for more information on the social determinants of
health). There now exists a substantial amount of evidence of the harmful impacts of resource
development, both biophysical and social (Aalhus, 2018; Goldenberg et al., 2010; Northern
Health, 2013; Reschny et al., 2018). Badenhorst, Mulroy, Thibault, & Healy (2014) report
findings from a collaborative workshop hosted by the Health Officers Council of BC and
Northern Health looking at the socio-economic impacts of proposed natural resource
22

development projects in northern British Columbia. The authors explain that such
developments drastically change the demographics of communities and impact already
strained services and infrastructure. Opportunities for community members to get engaged
and share their experience is essential, challenging the notion that negative impacts of boom
and bust cycles are inevitable and that “it doesn’t have to always be this way” (Badenhorst et
al., 2014, p. 5).
2.4.1 Health equity in relation to social and ecological determinants of health
The previous sections include literature on the impacts that resource extraction,
gender, and place have on women’s health and well-being and how integrative approaches
can help to address such impacts. This section introduces social and ecological determinants
of health and how consideration of a range of health determinants can contribute to health
equity. The National Collaborating Centre for Determinants of Health (2013) explains that
health equity
means that all means that all people can reach their full health potential and should
not be disadvantaged from attaining it because of their race, ethnicity, religion,
gender, age, social class, socioeconomic status or other socially determined
circumstance (p.1)
While it has long been recognized that disparities in the above social determinants
impact health, the intersections between social and ecological determinants of health have not
adequately been explored (Commission on Social Determinants of Health, 2008).
Gender inequalities are pervasive in societies around the world, and impact women’s
health and well-being. In 2005, Leipert and Reutter conducted one of the first studies that
looked specifically at how geographic location affects women’s health in a northern
Canadian setting, with emphasis on determinants of physical and social environments and
gender. Since then the necessity of considering both social and ecological determinants of
23

health when addressing issues of health equity has continued to be advocated for. As Parkes
(2016) explains, an integrative approach to assessing the cumulative impacts of natural
resource development challenges the “long-standing false dichotomy” between the social and
ecological processes that impact the health of individuals and the community (p. 117).
The social determinants of health are social and economic factors that strongly
influence an individual’s health and well-being (Mikkonen & Raphael, 2010). One’s
education, housing, employment, Aboriginal status, and gender interact to influence how
healthy or unhealthy you are and have the potential to be. For example, women worldwide
experience more adverse social determinants of health when compared to men (p. 44). This
can be explained by several factors, such as women bearing more work in the home, having
less access to education and employment, and the wage gap. A report prepared for Northern
Health and the Provincial Health Services authority directly addresses the social determinants
of health impacts of resource extraction and development in rural and northern communities
(Aalhus, 2018). The report calls for intersectoral action and research as mechanisms to
further understand, prevent and mitigate negative impacts of resource development.
The ecological determinants of health are “Earth’s life supporting systems” that
determine the health of humans and other species and include oxygen, water, food, waste
decomposition and recycling and climate stability (Hancock, Spady, & Soskolne, 2015, p. 2).
There is plenty of evidence showing the negative impacts that resource development can
have on the environment (Fraser Basin Council, 2012; Reschny et al., 2018) yet attending to
these impacts while maintaining a healthy economy has proven to be a highly complex issue
that continues to be debated. Often, when impacts of resource development are discussed in
relation to the environment, the ecological determinants of water and land are viewed as
potential conduits for hazards and disease (Parkes, 2015). This contrasts to a more
24

integrative view of the environment and ecosystems as a source of health and well-being, as
has been the way for most Indigenous cultures around the world (Gislason et al., 2017).
Resource development has the potential to drastically alter the landscape and the living
systems we depend on and, impacting physical, mental, and cultural health.
2.5 Conclusion
The review of literature in this chapter began with an overview of some of the research
done with women in northern BC over the last forty years. This body of research helped me
to inform and refine my research questions and associated research design process. Sections
on the impacts of place, gender, and resource extraction on women’s health and well-being
sought to highlight the ways in which such categories are each relevant in isolation but have
also been segregated in research and practice. The final section of the literature review
discusses integrative approaches to health equity and how social and ecological determinants
of health contribute to overall health and well-being. Figure 1 (pg.11) provides a visual
representation of the above literature review. The next chapter will provide contextual
information about the community of Fort Nelson, a brief history of resources extraction in the
area, and an overview of health service delivery for the community.

25

CHAPTER 3: STUDY CONTEXT
3.1 Introduction
Chapter 2 provides a review of relevant literature as it relates to gender, place and
resource extraction and its impact on women’s health and well-being. In this chapter, I
provide a brief overview of Fort Nelson, natural resource extraction and development in the
area, and health service delivery. This provides important contextual information about the
community in which the research took place. A comprehensive and detailed history of
resource extraction in Fort Nelson is beyond the scope of this thesis. Instead, key events have
been presented in order to provide readers with a sense of the temporal and spatial scale of
resource extraction in the area.
3.2 Fort Nelson
The town of Fort Nelson is located in the northeastern corner of British Columbia
near the confluence of the Fort Nelson, Muskwa, and Prophet Rivers (Northern Rockies
Regional Municipality, 2015) (see Figure 2 on p.26). The first book published about Fort
Nelson was titled “The Fort Nelson Story: The story of how a town grew out of the
wilderness”. Published in 1980 and written by local historian and librarian Gerry Young, the
terrain is described as:
…generally gently rolling plateau, an extension of the great Interior Plains. From the
rivers the wooded slopes rise steeply until they level out on this this plateau. All the
rivers flow east and north to the Arctic (Young, 1980, p.9).

26

Figure 2: Map of northern BC from Basemap: Esri, USGS, NOAA; other spatial data: BC
Government.
The original inhabitants of the Fort Nelson area were Aboriginal people from the
Beaver, Sikanni, Granlaker, Nahanni and Dog Rib nations. The Slavey band arrived in the
area around 1775 from the Great Slave Lake area in the Northwest Territories. Those of Cree
lineage came to the area from the East. Initial conflict arose but the Cree were soon part of
the “Fort Nelson Indian Culture” (Young, 1980, p. 17)
There is evidence to support the existence of five different sites bearing the “Fort
Nelson” name that were either burned or abandoned (Fort Nelson Heritage Museum, 2016).
The first Fort Nelson was founded in 1805 by the North West Fur Trading Company (Young,

27

1980). This brought the first non-Aboriginal people to the area. The company fur traders
travelled via the Mackenzie River to Fort Simpson and then on the Liard and Fort Nelson
Rivers.
A second Fort Nelson located further south along the Fort Nelson River was
destroyed in 1813 when a massacre against the First Nations people occurred (Young, 1980).
Abandoned until 1865, a third Fort Nelson was established by the Hudson Bay Company.
The series of connected river systems made the location an ideal fur trading post. The small
community was destroyed by a flood in 1890. The fourth Fort Nelson was located further
upstream and on higher ground, known today as “Old Fort”. Old Fort Nelson had a trading
store, post office, restaurant, a Catholic Church and “homes for the fur traders, Indians, white
trappers, and the priests” (Young, 1980, p. 57).
Life in Fort Nelson in the 1920s was no easy feat. An isolated community of “less
than 200 Indians and a handful of white men” navigated survival among trap lines and the
freezing and unfreezing of the many rivers in the area (Young, 1980, p. 31). Although the
1930s factory closures affected those in the southern portion of the country, those in the
northern BC were kept busy with the “struggle to stay alive” (Young, 1980, p. 41).
Women in Fort Nelson during this time period were characterized as hard-working
counterparts to “their men”. This hard work helped to ensure that there was no time to feel
“isolated or cut-off from civilization” (Young, 1980, p. 41). Recent research by Leipert
(2005) has shown this “hardiness” persists today and can be a resilience characteristic of
women living in northern geographically isolated settings.
The development of Fort Nelson as it is known today in 2019 was spurred in large
part by the Japanese attack on Pearl Harbour in December of 1941 (Young, 1980). President
Roosevelt made the decision to commission the building of a highway that could be used to
28

transport equipment and supplies to Alaska in case of another attack. The U.S. Army brought
much infrastructure and services to the isolated northern community including a bridge over
the Muskwa River, telephone wires, and water drainage holes. The U.S. Army was in
command of Fort Nelson from 1942 to 1946 during the construction of the Alaska Highway.
Because the Old Fort was never designated as a reservation, the community was
forced to move in 1959. A reservation was designated at Mile 295 and Old Fort residents
were told to move with little notice. This harsh cultural change included a move to an area
with poor soil for growing food, no direct access to the river, and close proximity to the busy
highway. Local elder Mary Loe recounted:
It was just awful, people were crying, thought it was the end of the world. They were
used to the River, they were part of the river (Young, 1980, p. 97).
In 2009, the Northern Rockies Regional Municipality (NRRM) was incorporated,
combining the town of Fort Nelson with the Northern Rockies Regional District (Northern
Rockies Regional Municipality, 2015). The area governed by the NRRM encompasses
approximately 10% of the province’s total landmass but only 0.12% of the province’s total
population (Statistics Canada. 2017). Communities in the NRRM include Fort Nelson, Fort
Nelson First Nation, Prophet River First Nation, Tetsa River, and Toad River. Fort Nelson is
also the main service community for those in the northeast region of the province and the
southern Yukon and Northwest Territories. Fort Nelson is the largest community in the
municipality, with a population of 3366 people (Statistics Canada, 2017). Additional
demographic information is presented in Table 1 (on pg.30)

29

Table 1: Fort Nelson demographic information from Statistics Canada (2016)
Total population
Median age of population
Females
Median age of female population
Males
Median age of male population
Individuals with Aboriginal Identity
Visible Minority population

3366 people
35 years
1630 people (48.5% of total population)
35.5 years
1735 people (51.5% of total population)
34.6 years
760 (22.5% of total population)
330 (9.8% of total population)

Fort Nelson is located approximately 380km away from the closest city of Ft. St.
John, BC (Hanlon & Halseth, 2005). A history of resource exploration, extraction, and
production has led to several fluctuations in population, due in large part to the transient
workforce. With the current economic down turn the community is facing the current
population is estimated to be much lower than that of the 2016 census.
The Fort Nelson economy is built on natural gas, oil, forestry, tourism and
agriculture. The 2016 unemployment rate was 13.7%, the highest in 10 years of available
data (Northern Rockies Children and Family Action Committee, 2017). This is over twice as
high as the 2016 provincial unemployment rate of 6%.
Put simply, natural gas, or “shale gas” as it is often referred to, is extracted from rocks
beneath the earth’s surface that are rich in organic plant and animal matter (Northern Rockies
Children and Family Action Committee, 2017). The decay of this material over millions of
years creates the natural gas that has been extracted, processed, and transported in the Fort
Nelson area. Fort Nelson is in close proximity to several natural gas deposits, including the
Horn River and Liard basins (see Figure 4 below):

30

Figure 3: “Shale gas play areas from British Columbia” from Ministry of Energy, Mines and
Petroleum Resources (2010, p. 16).
Classified as an “upstream” region, inhabitants of Fort Nelson have been involved in
the exploration, extraction and production of natural gas, providing this resource to
communities downstream in the rest of the province and country. The recent downturn in the
community’s natural resource economy is due to distance from markets, the type of shale gas
present, and decreasing global oil prices (Northern Rockies Children and Family Action
Committee, 2017).
Forestry has a long history in the community and is a focus for improving the
community’s economy. Despite recent years of forestry inactivity (due to Canfor being the
major tenure holder and not operating in the area) the Municipality has begun to see interest
from both foreign and domestic investors. In terms of tourism, Fort Nelson is referred to as
the “Gateway to the Northern Rockies” and boasts “thousands of square miles of mountain
31

wilderness as its backyard” (Northern Rockies Children and Family Action Committee, 2017,
p.6). Hiking, wildfire viewing, fishing, camping and hunting opportunities bring many
visitors to the region each year. In terms of agriculture, the Northern Rockies region has land
that is suitable for agriculture, however the distance from outside markets makes it a less
viable economic option. In recent years there has been an increase in local farming and
agriculture to supply the community with better access to fresh food, which has been a longstanding challenge due to its geographic isolation. Many individuals in the community
continue to trap and hold trapline licenses in the area. Aboriginal and non-Aboriginal
residents use this method to support themselves financially and as a means to stay connected
to traditional culture and the land. Traplines are governed by the Ministry of Forest, Lands
and Natural Resource Operations.
Fort Nelson is often referred to as a family centered community. In 2016 there were
950 families in the community (Northern Rockies Children and Family Action Committee,
2017). This is an 11.6% decrease from 2011 when there were 1075 families listed as residing
in the community. Of the 950 families, 81% are couples and 18.9% are lone parent. Of that
18.9%, 75% of lone part households are run by women (n=135). This is particularly relevant
given my focus on women for this research.
A fulsome overview of the community of Fort Nelson should not exclude
acknowledgement of Fort Nelson First Nation (FNFN). The community of FNFN is located
approximately 7 kilometers South from Fort Nelson. Band members were historically known
as the Fort Nelson Slavey Band and have been residents of the region for thousands of years
(Fort Nelson First Nation, 2015). The FNFN reservation was established in the early 1960s.
FNFN has a total registered population of 951 members (on and off reserve), with 450 people
listed as living in the community in 2016 (Statistics Canada, 2017). Of those members who
32

live off reserve, it can be assumed that some are part of the 760 individuals reporting
Aboriginal identity in the 2016 census for Fort Nelson (see Table 1). FNFN became a Treaty
8 community in 1910 and has traditional territory overlaying the Horn River Basin. The Horn
River Basin is one of the largest collections of unconventional gas fields in North America
(Garvie & Shaw, 2014).
3.3 Brief Overview of History of Resource Extraction in the Fort Nelson Area
Boom and bust economic cycles in rural communities have been occurring for
decades (University of Alberta, 2016). Fort Nelson is unique in that rather than oil, gold,
railways, or timber fueling the first “boom”, Fort Nelson’s first boom was brought on by the
influx of American soldiers in WWII. (Young, 1980). When the war ended in 1945 the U.S.
Army transferred the Canadian portion of the highway to the Canadian Government.
In 1946, the first sawmill was opened (Young, 1980). By 1979, three mills were in
operation, employing approximately 750 people in the community. Once logging and
lumbering began a major economic driver of the community, reforestation became a concern.
In 1980, the average age of spruce trees being logged was 125 years (Young, 1980). During
the early 1960, Pacific Petroleums Ltd. began large scale drilling in the Clarke Lake area
which led to the 1964 development of a natural gas treatment plant constructed by Westcoast
Transmission Co. (Young, 1980). The gas plant increased its processing capacity throughout
the 1960s and is still one of the largest gas processing plants in the world, located about 24
kilometers south of Fort Nelson. It continues to send processed natural gas to BC.’s lower
mainland and the United States.
Fort Nelson has historically been a community dependent on natural resource
extraction (Hanlon & Halseth, 2005). The next noticeable “boom” of resource development

33

occurred between 1971-1981, with the forestry industry. This included one of the world’s
largest oriental strand board plants, along with a major sawmill and significant natural gas
exploration. By the year 2000, the oil and gas industry was a leading employer, with the Fort
Nelson gas plant contributing over 25 percent of the province’s total gas royalties. The
discovery and exploration of the Horn River Basin in 2004 resulted in another “boom” of
activity as major companies began to heavily invest in Shale Gas development (Adams,
Janicki, & Balogun, 2016).
Recently however, there has been a downturn in the oil and gas economy in the
community. This is due in large part to the price of oil decreasing, caused by competition
between global producers (Bennett, 2015). An article from the CBC in June of 2016 details
the economic downturn (the “bust” of the boom and bust cycle) in the community with their
article “Gas Industry downtown devastating Fort Nelson BC” It is reported that over 200
people have lost their jobs in the oil and gas sector over the last 18 months. Effects include
the closures of over 50 local businesses and families being split up over the need to move for
employment while family homes fail to sell (Larsen, 2016).
Although British Columbia produces relatively little oil when compared to Alberta
and Saskatchewan, the province has multi-million dollar proposals underway for oil pipelines
and refineries. Uncertainty over the liquefied natural gas (LNG) industry in the province
came to an end in October of 2018 with the announcement of approval for a 40 billion-dollar
LNG Canada project (Schmunk, 2018). This project involves the building of the 670
kilometre Coastal Gaslink Pipeline, which will ship gas from Dawson Creek in northeast BC
to the coastal community of Kitimat BC.
While many believe this project to be a “much needed linchpin” for the economic
well-being of the province (and country), it is not without opposition (Seskus & Bakx, 2018,
34

para. 7). Those in environmental organizations and government have voiced concerns over
the negative impacts to human, environmental, and animal health. The planned Coastal
Gaslink Pipeline runs through traditional Wet’suwet’en territory, located west of Prince
George, BC. Although the nation’s elected band council had approved the pipeline, the
hereditary chiefs of the five Wet’suwet’en clans have not (Jeong, 2019). In early January of
2019, the RCMP set up a roadblock near a Wet’suwet’en clan checkpoint, turning away
media and members of the public before arresting 14 people.
Given that the Coastal Gaslink Pipeline begins in Dawson Creek, the project will not
bring work directly to those in Fort Nelson but proponents of industry are hopeful that the
decision will spur other projects to go ahead (Schmunk, 2018). This largest private sector
investment in Canadian history is projected to employ as many of 10,000 people in
construction and up to 950 full time jobs. As one optimistic Fort Nelson resident stated, “My
town has just been saved” (Kurjata, 2019).
3.4 Health Service Delivery in Fort Nelson
In terms of healthcare, the northern BC region is served by both the Northern Health
Authority (NHA) as well as the newly established First Nations Health Authority (FNHA).
Both organizations operate using similar health service delivery areas (HSDAs). The HSDAs
include: The Northern Interior with 141,700 residents, the Northwest with 73,103 residents,
and the Northeast with 68,102 residents (Northern Health, 2017).
Northern Health was formed during the provincial regionalization process in 2001.
This included the creation of 5 main health authorities and 16 health service delivery areas
(Northern Health, 2017). Northern Health has more than 7000 employees who provide
services to 300,000 people, with a budget of $724 million reported for the 2012-2013 year.
35

The First Nations Health Authority was established in 2013 (First Nations Health
Authority, 2017). The FNHA is responsible for providing programs and services that were
previously organized by Health Canada’s First Nations Inuit Health Branch- Pacific Region.
This is the first province-wide health authority in Canada that is both run by and organized
specifically for First Nations populations. There are 54 First Nations communities in the
Northern BC region, representing 35.6% of the First Nations population in British Columbia
(Aboriginal Affairs and Northern Development Canada, 2011). The FNHA works in
collaboration with both the Ministry of Health and the Northern Health Authority to deliver
effective health care to First Nations populations. For a detailed discussion of the ways in
which Northern Health and the First Nations Health Authority have partnered to support the
health and well-being of First Nations in northern BC (Johnson, Ulrich, Cross, &
Greenwood, 2016).
A major focus in terms of local health service delivery is access to maternity services
(stated as a community health priority below). Starting in 2010, maternity and surgical
services offered at the Fort Nelson General Hospital were drastically reduced. This was due
to a local physician phasing into retirement (and thus reducing his services), the lack of
obstetrical competency of remaining physicians, and the geographical distance to health
services needed in cases of emergency. In 2014, local women who were pregnant and seeing
their doctor in Fort Nelson began to be referred to physicians and hospitals outside of the
community. Women had to (and still do) sign a form with their doctor stating they
understand they are not able to deliver in the community and must leave several weeks before
their expected due date, releasing doctors of liability in the case of an emergency. Costs
associated with waiting to give birth outside of your home community are substantial and
only subsidized for women with recognized Aboriginal status (Northern Rockies Children
36

and Family Action Committee, 2017). In 2016, 62 babies were born to women who had to
access maternity services outside of the community.
There are several negative health outcomes associated with women having to leave
their communities to give birth (Kornelsen & Grzybowski, 2004). Such women report
extreme stress, feelings of isolation, and a lack of psychosocial support. A 2011 article
summarized a research project that aimed to document newborn and maternal outcomes as
they related to distance travelled to access the nearest surgical maternity centre (Grzybowski,
Stoll, & Kornelsen, 2011). Their conclusion, and title of the article, is “Distance Matters”.
Rural women and their newborn babies who have to travel to access maternity services have
increased rates of adverse health outcomes. These impacts may be further intensified when
experienced by Indigenous women who perceive birth as being an event inextricably tied to
kindship and traditional lands (Kornelsen, Kotaska, Waterfall, Willie, & Wilsons, 2011).
In March of 2018, a community health plan for Fort Nelson was released (Okenden,
2018). The report details a consultation process that took place in the Fall of 2017 that
involved public questionnaires, facilitated meetings and interviews. The community health
plan process was led by the Northern Rockies Regional Municipality, Northern Health, Fort
Nelson First Nations and local physicians. Representatives and staff from each of these
organizations comprise the Steering Committee that was responsible for guiding the
consultation process as well as the implementation of the health plan.
More than 500 residents provided input that, along with previous documents,
culminated in the identification of six priority areas for action. The consultation process and
report were conducted by Gary Ockenden, lead consultant with Withinsight Services.
Withinsight Services is based in Nelson, BC and has worked on several projects for Northern
Health.
37

The six priority areas identified by the Ockenden (2018, p.3) report are as follows:
-

Increase efforts to recruit and retain health care providers
Improve health care travel services: improve support for people who have to travel for
health care and improve emergency response and transfers
Improve maternity care locally, from pre-natal registry to birthing to post-care
Increase visiting health services and the use of telehealth (to provide local services
and to reduce travel)
Improve cancer care locally

The report states that at the time of its release, the Steering Committee was investigating
the feasibility of hiring a contracted part-time employee to move the priority areas forward.
In October of 2018, I was hired as the Project Implementation Lead for the Fort Nelson
Community Health Plan.
3.5 Conclusion
This chapter has provided context in terms of the community of Fort Nelson, its
history of resource extraction, and its current health service delivery. The next chapter will
outline the methodology and methods used in the research, from theoretical and philosophical
assumptions that guided the research, to specific data collection methods.

38

CHAPTER 4: METHODS & METHODOLOGY
4.1 Introduction
To introduce how this research was designed, it is helpful to distinguish between
methodology and methods. A clear distinction between these two ideas is presented by Carter
and Little (2017). The authors state that “methodology shapes and is shaped by research
objectives, questions, and study design” (p. 1316). The methodologies chosen help dictate
which methods are best suited to gather data to answer the research question(s). Methods can
be thought of as the “practical activities of research” (p. 1317), such as participant
recruitment, data collection, and analysis (Carter & Little, 2017). This chapter begins with a
discussion of the theoretical and philosophical assumptions that guided this research,
followed by an overview of the overall research design, community partners, sampling
strategy and recruitment, data collection, analysis, and research quality.
4.2 Theoretical and Philosophical Assumptions
Individuals engaging in research bring with them a deeply rooted set of theoretical and
philosophical influences and approaches that dictate everything from the research question
chosen to the research design and data gathering methods used (Reid, Greaves, & Kirby,
2017). The influences and approaches used are an accumulation of one’s life experiences,
educational and academic training, and interactions with different living and non-living
systems (Creswell, 2013). The following sections provide a brief explanation of influences
on the methodology of this research in relation to social constructivism, feminist theory, and
ecosystem approaches to health.

39

4.2.1 Social constructivism
In designing a study, the researcher must be explicit about the philosophical
worldview that they bring to the inquiry (Creswell, 2014). This qualitative study is informed
by social constructivism. Social constructivism is built upon the premise that individuals
make sense of the world based on their subjective experiences and through interactions with
others (Patton, 2015). An individual’s reality is influenced by the historical and social context
in which they operate (Lincoln, Lynham, & Guba, 2011). Using broad and open-ended
questioning the researcher documents the various meanings that participants ascribe to
certain topics and things as well as the interactions among participants. The researcher then
interprets these various meanings acknowledging that their interpretation will be influenced
by their own personal, cultural, and historical experiences (Creswell, 2014).
The goal of this research study aligns strongly with social constructivism; to engage
in a co-learning experience with women in Fort Nelson to identify and explore the aspects of
the community that promote their health and wellbeing in the community at a given point in
time. Social constructivism is based on the premise that individuals construct meaning
socially and historically through interactions with those around them. The information
gathered from participants cannot be analyzed in a vacuum, but rather in relation to the time,
place and environment in which data was collected. If this research was conducted by a
different person, with different participants, in a different place and at a different time, the
data would likely be different, and findings must be interpreted with this in mind.
4.2.2 Feminist theory
This study is informed by feminist theory. Feminist theory challenges the view that
knowledge is created solely by those in privileged positions (Hesse-Biber, 2014). Hesse-

40

Biber contends that research can be described as “feminist” when it is designed to seek and
value women’s issues, voices, and lived experiences” (p. 3). It is not the specific methods
used that classify research as feminist but rather the process and overall intent of the
research. Such research explores gendered experiences and makes gender a main focus of
inquiry (Frost & Elichaoff, 2014). Researchers informed by this theoretical perspective must
work to balance the power between the researcher and participants, and not reinforce
hierarchies. The goal of feminist research is to both explore and work towards remediating
gender inequities that exist in a given context (Pini, 2002; Wickramasinghe, 2010).
As discussed in the literature review, women are impacted by resource extraction and
development differently and arguably more intensely than other populations (Gislason et al.,
2017). In order to address the health impacts of resource development in an effective and
sustainable way, data from such vulnerable populations needs to be gathered (World Health
Organization, 2010). Feminist theory prompted me to continually consider how I could best
collect, analyze and disseminate the data in a way that privileges women’s voices.
4.2.3 Ecosystems approaches to health
Another influence on the approach to research is Ecosystems approaches to health,
also known as “ecohealth” research. Ecohealth prioritizes the integration of environmental
and social determinants of health within the economic context of the given system (Charron,
2012). Ecohealth is one of several approaches that looks at the relationships between the
health of ecosystems, humans, and non-human species (Buse et al., 2018; Oestreicher et al.,
2018). While the use of such approaches has gained popularity in recent decades, the
foundational concepts are not new. Ecosystems approaches to health draw upon several
different knowledges, including public health, environmental and occupational health, and
Indigenous knowledge systems that have guided Aboriginal people since the beginning of
41

time (Parkes, 2011).
Charron (2012) describes ecosystem approaches to health in relation to six principles
formulated through experiences in ecohealth research and practice. The six principles
described by Charron include three that pertain to the process and methodological aspects of
conducting ecohealth research (systems thinking, transdisciplinary research, and stakeholder
participation) and three that pertain to goals and conceptual aspects of ecohealth research
(sustainability, gender and social equity, and knowledge to action). This research project has
been especially informed and analyzed according to the principles of systems thinking,
stakeholder participation and gender and social equity.
Systems thinking can help to reveal the drivers of a particular issue by taking note of
the connections between social and ecological health (Charron, 2012). Oestreicher et al.
(2018) point out that traditional public health research and practice has been based on siloed
and linear conceptualizations of human and environmental health. Viewing challenges that
impacts health as existing within changing nested spatial and temporal scales, as opposed to
static states, can lead to more effective and sustainable solutions (Buse et al., 2018). Systems
thinking is closely tied to Appreciative Inquiry, another approach that shaped this thesis
research and will be described in the following section.
Facilitating the participation of a diverse group of stakeholders of a given research
project helps to “share power, reconcile conflicting priorities and intentions, and develop
more inclusive and equitable intervention strategies” (Buse et al., 2018, p. 423). Stakeholder
participation was crucial to this project. In order to elicit information from women in the
community I spent prolonged periods in the community building relationships with service
providers and their clients. Not surprisingly, meaningful stakeholder participation increases
the likelihood of developing effective and sustainable outcomes that will benefit research
42

participants and the wider community (Charron, 2012). Oestreicher et al. (2018) calls for a
“re-centering” of communities in the research process to disrupt established power
imbalances between researchers and those being researched (p. 54). In discussing stakeholder
participation Parkes et al. (2012) explore the relationship between “research” and
"participation” and emphasize the role of reciprocity. The guiding questions of “for whom?”
and “with whom?” were useful guideposts as I navigated the research process (p.120).
Being attentive to participation in research is a principle of its own, but also a means
to promote gender and social equity (Parkes, 2015). This thesis research was designed in a
way to facilitate the participation of women who are experiencing the intersecting impacts of
place, gender, and resource extraction on their health and well-being. Gender and social
equity were considered throughout the research process, but particularly when making
decisions regarding participant recruitment and developing the interview guides.
4.3 Appreciative Inquiry
As discussed in Section 1.3 (Motivation for Research Topic), the decision to use a
strengths-based approach to qualitative inquiry was made early on in the research design
process. During the scoping phase of this research (described further in Section 4.4),
conversations with women in the community centered around the negative aspects present in
the community and ended with a sense of despair and hopelessness. After being introduced to
Appreciative Inquiry I framed scoping conversations by inquiring about the strengths present
in the community and the focus of the conversations immediately changed. Since the
approaches used in health research related to resource extraction has been predominantly
problem-based, the decision to use a strengths-based approach was made.
Appreciative Inquiry operates from the premise that every group, organization,

43

community, etc., has positive aspects that “give life” to the given system (Finegold, Holland,
& Lingham, 2002). Appreciative Inquiry (AI) was initially developed by David Cooperrider
in 1985 as part of his doctoral work at Case Western Reserve University in Cleveland, Ohio
(Whitney & Trosten-Bloom, 2003). Originally designed as an action research technique for
organizational change, the use of AI quickly spread to other disciplines and has been
increasingly used as a method to discover the successes and strengths within systems
(Finegold, Holland, & Lingham, 2002; Grant & Humphries, 2006). Appreciative Inquiry is
one of several asset-based approaches commonly used in ecohealth research (Parkes et al.,
2012).
Appreciative Inquiry fits well within the social constructivism paradigm as it operates
on the premise that communities are socially constructed and molded by the imagination and
beliefs of its members (Bushe, 2011). Constructivist theories see language to be central to
action, with meaning being constantly negotiated between participants (Grant & Humphries,
2006). Appreciative Inquiry is also well suited for use in feminist research. When used
thoughtfully, Appreciative Inquiry offers a non-confrontational and inclusive way for those
who would not typically participate in community development work to contribute their
thoughts and experiences (Whitney & Trosten-Bloom, 2013). Traditionally, Appreciative
Inquiry has been used to move people from oppression to liberation through the recognition
that individuals can contribute to community change through creative interaction.
I designed the Interview questions based on the core question of “What’s going right
and how do we get more of it?” (Finegold, et al., 2002, p. 135). In contrast to traditional
problem-solving approaches used in community-based research, which can often create more
of the problems the inquiry seeks to solve, the use of Appreciative Inquiry works to create
new ideas, opportunities and partnerships. An Appreciative Inquiry begins with the selection
44

of an affirmative topic. For this project the overarching topic was “What are the factors that
contribute to health and well-being for women living in a northern community dependent on
resource extraction”. From this topic I led participants through the 4D Cycle (see Figure 4
below):

Figure 4: “The 4D Cycle of Appreciative Inquiry” from Cooperrider & Whitney (1999, p.
252).
4.4 Research Design and Phases
The focus of this research is on women’s health and well-being in the context of a rural
and remote community experiencing intense social, ecological and economic change due to
its dependence on natural resource extraction. In order to elicit an in-depth exploration of
participant knowledge, I used a qualitative approach to inquiry (Creswell, 2014). Informed by
social constructivism, feminist theory and ecosystem approaches to health the research

45

design was developed based on Appreciative Inquiry. Methods used to collect data were
chosen for their ability to gather information in a variety of contexts.
In order to access a diverse range of women in the community I chose to contact four
different organizations that serve women. Once I began to discuss the research with a staff
member at each organization it became apparent that they themselves had valuable
perspectives on women’s health and well-being, both as women and as service providers. As
our discussions progressed, staff members voiced their desires to be interviewed as part of
the research. Therefore, staff members at organizations had the dual role of being individual
interview participants and a crucial liaison between myself and their clients as potential
group interview participants. Each organization I worked with during this scoping phase
wrote a letter of support for the research (see Appendices A-D), which was submitted as part
of the application to UNBC Research Ethics Board (see below and Appendices E to I).
Group interviews were conducted with patrons of each organization to gather
information in a collective setting while also giving women a chance to provide input on their
individual experiences. The research was also supported by field notes taken throughout the
research process, as well as by participant demographic questionnaires, and post-group
interview evaluation questionnaires.
Table 2 (pg. 47) the different research phases, activity, types of data gathered, date, and
locations of activity:

46

Table 2: Research activity timeline
Phase

Research Activity

1

Scoping work and relationship
building with community partners
Developed research proposal

2

3

Defend research proposal and seek
ethics approval from UNBC REB
(See Appendix I)
Travelled to community to
coordinate with community
organizations re: recruitment, dates
for data collection, etc.
Conduct Individual interviews and
group interviews

Transcribe audio recordings of
interviews and group discussions
- Organized data
Analysis activities
- Became familiar with data
- Generated initial codes
- Reviewed themes
Presentations

4

Writing

Types of data
gathered
- Field notes

Date
Conducted
Began Sep
2014

Location

Jan 2015Aug 2016

Prince George

(led to REB approvals,
see Appendix E-1)

Aug 2016

Prince George

- Field notes

Dec 2016Feb 2017

Fort Nelson

Feb 2017Mar 2017

Fort Nelson

Apr 2017Oct 2017

Fort
Nelson/Prince
George

Apr 2017Sep 2018

Prince George

Feb 2018

Prince George

Mar 2018

Prince George

April 2018
Oct 2017Feb 2019
Jul 2018Feb 2019
Mar 2019

Fort Nelson
Prince George

(See Appendices A-D)
- Field notes

(see recruitment poster
Appendix J)
- Individual
interviews
- Group interviews
- Participant
demographics
- Post group interview
evaluations
- Field notes
(see Interview Guides
Appendix K-L)
Field notes
Participant checking
in community and by
mail

UNBC Grad Student
Conference
Northern FIRE
symposium
NRAWS Gala

Chapter review with supervisors
Thesis defence

47

Fort Nelson

Prince George
Prince George

4.4.1 Research ethics protocol and research design
All research conducted by students at the University of Northern British Columbia must
be reviewed by the Research Ethics Board. The research must adhere to the guidelines set out
in the UNBC Policy on Research Involving Human Participants, which is guided by the TriCouncil Policy Statement on the Ethical Conduct for Research Involving Human Subjects.
Applications can be submitted as either “minimal risk” or “above minimal risk”, depending
on the vulnerability of participants and the risks involved in participating in the research.
The research ethics board application for this research was submitted as “minimal
risk” (see Table 2 Phase 1) since there was no greater risk in participating in an interview
than the participant would encounter in their everyday life (see Appendix I). However, due to
the current context of the community at the time I did acknowledge that participants may be
experiencing high levels of stress and uncertainty. There were several ways in which the
research design was well suited to address these factors. First, the study adopted a strengthsbased approach (Appreciative Inquiry) which provides a basis to explore the opportunities
and assets present in the community, as well as to hear and validate negative emotions and
reactions. Second, the interviews took place at four different community organizations in
Fort Nelson that serve women in the community (The Fort Nelson Community Literacy
Society, the Northern Lights College, the Northern Rockies Aboriginal Women Society and
The Fort Nelson Aboriginal Friendship Society). Participants were recruited from within
these organizations and as such were familiar with the supports available. As a further
measure, a list of community support resources was made available to all participants and
discussed at the beginning of each interview. The details provided to research participants
were provided in Information Letters and Consent Forms (see Appendix E, F, G, H). These
materials were submitted, revised and approved through UNBC Research Ethics Board
48

review processes, leading to approval of the research protocol in January 2017, with the REB
number of E2017.0103.001.00 (see Appendix I).
4.4.2 Community partners
This project involved collaboration with four different community organizations. I had
worked with each organization in various capacities (past employee and/or volunteer) but the
formal research partnerships were not established until September of 2014 during Phase 1
(see Table 2) of the research process. As mentioned previously, I worked closely with staff
members at each organization to inform their respective clients about the research and invite
them to be participants in a group interview. Staff members were instrumental in helping to
design the group interviews as they offered existing program time and/or their facilities to
host the group interviews (see Table 2 Phase 2). Each organization wrote a letter of support
for the research (see Appendices A-D).
One of the community partners was the Fort Nelson Aboriginal Friendship Society
(FNAFS). The FNAFS was established in 1975 to assist Aboriginal people with the transition
to the community (Fort Nelson Aboriginal Friendship Society, 2018). The Society’s mandate
is “To provide holistic services to all people, promoting unity and health in the rural and
urban areas in a collaborative effort to address the needs of Aboriginal and non-Aboriginal
people” (Fort Nelson Aboriginal Friendship Society, 2018). The society serves both
Aboriginal and non-Aboriginal people, of all ages and genders. Programs and services
include mental health and addictions awareness and advocacy, family violence awareness
and counseling, women’s outreach, youth outreach, a food bank program, a women’s
transition house, a men’s shelter, a youth centre, elders programming, and special community
events.

49

The second community partner was the Fort Nelson Community Literacy Society
(FNCLS). The non-profit organization opened in 2007 and provides family, adult and
English as a second language programming (Fort Nelson Community Literacy Society,
2018). I became familiar with the society when I was employed as their Family Literacy
Coordinator over a one-year contract in 2007. Since that time the society has had a complete
turnover in staff. I contacted the Executive Director of the Society during the scoping phase
of this project and she agreed to advertise the focus group with clients and provide space to
hold the focus group. The Society serves community members of all ages, ethnicities and
genders however their client base is predominantly female foreign workers new to the
community who speak English as a second language.
The third community partner was the Northern Lights College (NLC). Opened in
1966, the Fort Nelson campus provides a wide range of services to residents (Northern Lights
College, 2018). Programming includes Career and College Preparation, University Arts and
Sciences, Applied Business Technology, and certain Trades and Apprenticeship programs.
The fourth community partner was the Northern Rockies Aboriginal Women Society
(NRAWS). The organization’s mandate is to “provide culturally appropriate, safe and
empowering options for women, children, and all families” (Northern Rockies Aboriginal
Women Society, 2018). NRAWS aims to preserve and promote Aboriginal culture, language,
heritage, traditions and customs through strengthening families.
4.4.3 Sampling strategy and recruitment
Qualitative research involves purposefully identifying participants and sites that will
enable the researcher to explore their area of study (Creswell, 2014). Since it was my
intention to explore perceptions of women’s health and well-being in the community, I

50

wanted to engage a diverse range of women using two different methods, individual and
group interviews (see Table 2, Phase 2 and 3). Eligibility criteria for participation in both
focus groups and interviews included those that were 19 years of age or older, identified as
being female, and were currently living in the community of Fort Nelson. Staff members at
each organization were initially approached to assist with recruitment but as discussed above,
it became clear that they themselves wanted to be involved as interview participants. I
initially planned to interview one staff member at each organization (for a total of four
individual interviews), but an additional staff member at two of the organizations asked to be
interviewed as well. This resulted in six individual interviews with six staff members at four
different organizations in the community. Four of the six women that participated in
individual interviews also acted as liaisons between myself and potential group interview
participants.
I initially thought of these staff member liaisons as “gatekeepers”. Gatekeepers are
defined as “individuals at the site who provide access to the site and allow or permit the
research to be done” (Creswell, 2016, p. 188). It soon became clear that while access to the
organizations and their clients was indeed required, the staff members were providing far
more than just formal access. Wanat (2008) draws an important distinction between gaining
access to a research site and gaining the cooperation of those at the site. Staff members went
far beyond just providing access to their organizations and clients and therefore the term
“community partner” is more suitable than “gatekeeper”.
Posters advertising the group interviews were posted at each organization and staff
members invited their clients to each group interview (see Appendix J). Women interested in
participating were asked to notify the organization contact and/or call myself. I continually
51

checked in with the community organization staff members to follow up with potential
participants. This led to using existing program time for focus groups as well as scheduling
special events to collect data.
Sampling strategy and recruitment design were strongly influenced by the methodology
(see Section 4.2). Social constructivism posits that individuals’ knowledge, beliefs and
opinions are constructed based on their interactions with others (Patton, 2015). Therefore, it
was necessary to not only elicit information in individual interviews, but through group
interviews where women could openly engage with each other. Informed by feminist theory
to guide the research, I worked with community organizations to reach a diverse range of
women with the intent of seeking and valuing women’s voices that otherwise may not be
heard. The decision to have individual interviews in addition to group interviews was made
in order to allow women to explore sensitive topics that they may not feel comfortable doing
in a group environment.
4.5 Data Collection
Qualitative research uses several data collection methods in order to elicit enough
information to yield the “thick, rich description” it is known for (Patton, 2015, p. 533). Data
for this project included transcripts from individual interviews, group interviews, field notes,
demographic questionnaires and post group interview evaluations (see Table 2 Phase 3).
In total, 37 women from the community participated in this research. There were 6
women who engaged in individual interviews and a total of 31 women who engaged in 4
different group interviews at different community organizations (see Table 3 on pg. 53):

52

Table 3: Participant demographics for the primary data collection methods
Method

Number of
Participants

Age range

Ethnicity

Years spent living
in the community

Individual
Interviews

6

29-67 years

5 years-67 years

Group
interviews
- FNAFS
- NLC
- NRAWS
- FNCLS

31

19-63 years

3 participants identified as First
Nation
3 participants identified as
Caucasian
9 participants identified as First
Nation
12 participants identified as
Caucasian
7 participants identified as Metis
3 participants identified as Other

6 months-43 years

Acronyms:
- FNAFS (Fort Nelson Aboriginal Friendship Society), FNCLS (Fort Nelson Community Literacy
Society), NLC (Northern Lights College), NRAWS (Northern Rockies Aboriginal Women
Society)
All interviews took place within a two-week period in February of 2017. Individual
interviews and group interviews were staggered accordingly to the availability and
preferences of participants. I wanted to ensure that all interviews took place within a short
time frame so that external variables (time of year, weather, current economic situation, etc.)
were consistent across participants.
4.5.1 Field notes
Reid et al. (2017) state that field notes document “the path you take and your thinking
about that path” (p. 90). By recording thoughts, feelings and observations throughout the
research process, the researcher can document important contextual information that
otherwise may be lost, as well as deepening their understanding of their personal biases. I
took field notes by hand throughout the research process. Following interactions with
community partners, participants, and my thesis supervisors I dedicated time to reflect on the

53

interactions and recorded observations, questions and insights. Field notes were also taken
after seeing various forms of media on the internet concerning the community, particularly
on facebook. Seeing what community members were posting while I was away from the
community helped to keep a “finger on the pulse” of recent events and showed the diversity
of opinions regarding topics of concern in the community. The recorded field notes have
been helpful throughout the writing process but particularly in the analysis of findings and
writing of discussion chapters.
4.5.2 Semi structured individual interviews
Interviews are used in qualitative research to gather the views and opinions of
research participants (Creswell, 2014). Semi-structured interviews involve using an interview
guide of pre-determined questions but allowing for flexibility according to the flow of the
conversation and information that arises (Patton, 2015). Using examples from The
Appreciative Inquiry Handbook: For Leaders of Change (Cooperrider, Whitney, & Stavros,
2008) I drafted questions pertaining to each stage of the 4D cycle presented in Section 4.3.
The interview guide included introductory, content, and evaluative questions (see
Appendix L for interview guide). Introductory questions were designed to elicit demographic
information about the participant. Evaluative questions sought to gain feedback on the use of
Appreciative Inquiry in exploring women’s health and well-being. This set of questions
helped to answer Research Question #3, “What are the strengths and limitations of using an
Appreciative Inquiry approach to research involving women’s perceptions of health and wellbeing?”

54

All individual interviews took place at the participant’s place of work on a date and
time chosen by them. Individual interviews were only completed by those employed at one of
the four community organizations. The implications of this decision will be discussed in
Chapter 6 ( section 6.3 Methodological Insights). Interviews ranged in length from 45
minutes to 1.5 hours. As outlined in my Research Ethics Board application, participants were
given a $10 IGA grocery store gift card as a token of my appreciation.
4.5.3 Semi structured group interviews
As noted above, the decision to use both individual and group interviews was made in
order to gather a diversity of perspectives in different formats. The group interviews took
place at each of the four community organizations. The group interviews were designed
using literature about focus groups. A focus group is defined as a facilitated group discussion
revolving around a certain topic (Munday, 2014). Focus groups originated in the 1920s as a
means to collect data in the social sciences, however the data collection method began to be
widely used by those in market research in the 1950s. In recent years, more attention has
been paid to the utility and validity of focus groups in health and social science research and
they have become a widely used tool for collecting data in qualitative research (Liamputtong,
2011).
Group interviews are informed by the premise that meaning is generated and
expressed when individuals engage with each other in a social context (Patton, 2015).
Information gathered in a group differs from that of a traditional one-on-one interview as
individuals are provided with the opportunity to consider their opinions in relation to others
through discussion and debate (Wilkinson, 1999). This situates group interviews within the
social constructionist paradigm as knowledge is formulated through the interaction of

55

participants’ multiple realties as opposed to a singular objective source. Although no research
method can be said to be “inherently feminist”, several characteristics of a group interview
make the method well suited for research using a feminist approach (Munday, 2014). By
having the focus of data collection be information gained through interaction between
participants, the balance of power can be shifted from the researcher to participants
(Wilkinson, 1999). The use of group interviews helped to achieve the goal of this research,
which was to engage in a co-learning experience with women in Fort Nelson to identify and
explore the aspects of the community that promote their health and well-being in a
community experiencing intense social, ecological and economic change due in large part to
natural resource extraction in the area (see Section 1.1).
Group interviews can provide a much-needed space for women to share their
experiences, and to receive support from each other (Peek & Fothergill, 2007). Pini (2002)
argues that this is particularly valuable for women in rural communities where women are
often relegated to the domestic sphere and experience feelings of isolation. In this way, the
very act of research can bring about benefits associated with the valuing of women’s
perspectives and experiences.
The Group interview content questions were the same as those used in the individual
interviews. An additional step in the group interview process was to include participant
demographic and evaluative questions were asked using a paper questionnaire (see Appendix
M and N). Participants were instructed not to put their names on the questionnaires to protect
their anonymity (See Appendix K for the Group Interview Guide). Group interviews took
place at each of the four community organizations and ranged from 50 minutes to 1.5 hours.
All participants were given a $10 IGA grocery store gift card as a token of my appreciation. I
also provided a meal for each group interviews and childcare for those who needed it.
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4.6 Data Analysis
At its core, data analysis answers the deceptively simple question of “what do the data
say?” (Reid et al., 2017, p. 240). It is deceptive in that analysis is often written about
passively, making it seem as though once the data is collected the codes and themes
effortlessly sort themselves. In qualitative research the researcher her or himself is the
instrument used to analyze the data in order to answer the research questions (Braun &
Clarke, 2006). As such, the researcher must make a series of decisions that each affect the
outcome of the research (Creswell, 2013). There are various data analysis methods that can
provide a framework to guide and assist the researcher. While qualitative methods vary in
epistemological and disciplinary background, the process of organizing data into themes
through some sort of coding process is common among many of them (Creswell, 2013).
Data analysis conducted for this research was informed by Braun and Clark’s (2006) 6-phase
process of thematic analysis and the process outlined in Reid et al.’s (2017) Experience,
Research, Social Change.
I chose to use thematic analysis because it is considered a foundational method for use
with qualitative research (Braun & Clarke, 2006). This method is particularly suited for
researchers who are new to analysis as it is a flexible approach that does not require the same
degree of theoretical and technical knowledge that many other approaches do (Nowell,
Norris, White, & Moules, 2017). Thematic analysis is a method of “identifying, analyzing,
and reporting patterns within the data (Braun & Clarke, 2006, p. 6). This fits well with the
exploratory nature of this research and the goal of identifying and exploring the health and
well-being of women in a given context.
Reid et al.’s 2017 text Experience, Research, Social Change is written for aspiring
researchers interested in contributing to research with the goal of social change. The authors
57

guide the reader through the research process using accessible language and many real-world
examples. The method of data analysis presented in the book is described as an analytical
approach that cycles between both inductive and deductive thinking. The concept of
“intersubjectivity” is presented as a central component of critical social research.
Intersubjectivity is defined as “an authentic dialogue between all participants in the research
process in which all are respected as equal knowing subjects” (Reid et al., 2017, p. 241). This
aligns well with the goals and methodology of this research.
A core feature of qualitative analysis is the iterative nature in which it is conducted
(Braun & Clarke, 2006; Creswell, 2013; Nowell, 2017). In contrast to a fixed linear
approach, researchers move back and forth between the data, concepts, and possible
explanations informed by the literature. This “iterativity” is the process used to build the
analysis by repeatedly moving between analytical steps (Reid et al., 2017, p. 241). Braun and
Clarke (2006) describe thematic analysis as a “recursive” process with the researcher moving
between phases as needed (p. 86). Cyclical diagrams are often used to illustrate this process.
Figure 5 (pg. 59) is adapted from Creswell’s (2013) Data Analysis Spiral (p. 183).

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Figure 5: “Data Analysis Sprial” adapted from Creswell (2013, p. 183).
Data analysis requires the organizing and managing of data as a way to increase the
researcher’s familiarity with it (Creswell, 2013). This is Phase 1 of Braun and Clarke’s
(2006) 6-phase process of thematic analysis. I personally transcribed the audio from the
digitally recorded individual and group interviews verbatim. Any editing or “tidying up” of
the transcripts was avoided as it can alter the data and inaccurately portray what was actually
said (Liamputtong, 2011, p. 174). I had several data sources that were designed to gather
information relating to the three research questions (see Table 4 pg. 60). Reid et al. (2017)
suggest analyzing different data sources separately to start, and then consider how they
should be integrated.

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Table 4: Research question and associated data sources
Research Question

Data source

1. What do women in a rural,
remote, and resourcedependent community
perceive as contributing to
their health and well-being?

Individual interviews
Group interviews
Field notes

Research Phase
(see Table 2)
Phase 3
Phase 3
Phase 1,2,3

2. Which factors are most
prominently identified by
women as contributing to
their health and well-being?

Individual interviews
Group interviews
Field notes

Phase 3
Phase 3
Phase 1,2,3

3. What are the strengths and
limitations of using an
Appreciative Inquiry
approach to research
involving women’s
perceptions of health and
well-being?

Individual interviews
Post group interview questionnaire
Field notes

Phase 3
Phase 3
Phase 1,2,3

Demographic questionnaire
(group)
Demographic interview questions
(individual)

Phase 3

Provided information on the
diversity of women who
participated in the research

Phase 3

After organizing the data, I listened to all of the individual and group interviews
separately, stopping to take notes of anything that would not be recognizable through simply
reading the transcripts. I then read and re-read all of the individual interview transcripts, and
then all of the group interview transcripts. Starting with the individual interviews, I created a
spreadsheet that organized the data by participant and interview question (which
corresponded to the Appreciative Inquiry 4D cycle). I extracted the salient pieces of text from
each transcript as “bits” in order to divide the mass of information into more manageable
parts (Reid et al., 2017, p. 244). This process allowed me to see how each participant
answered each question, in relation to other individual participants.

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I then began to descriptively code the extracts of text by adding a word or phrase that
summarized each bit. Braun and Clarke (2006) classify this as Phase 2 of the 6-phase process
of thematic analysis in which initial codes are generated. I was careful to tag each extract of
text to ensure it could continue to be traced back to its original source and re-contextualized
when needed (Reid et al., 2017). Moving into Phase 3 of Braun and Clarke’s (2006) process I
began to organize the codes into preliminary themes. Phase 4 involved reviewing the
preliminary themes, continually checking to see if the coded extracts “fit” with the themes.
Reviewing the codes and themes is an important step as they may expand, contract and shift
as you work with the data (Reid et al., 2017). To do this I wrote down all codes on sticky
notes and organized them into the preliminary themes. As a way to further test the themes I
completely re-organized the data by interview question and theme (as opposed to participant
and interview question) to see themes across questions. This helped to complete Phase 5 of
the 6-phase process of thematic analysis in which themes are defined and named (Braun &
Clarke, 2006). The same process described above was used to analyze the data from group
interviews.
Critique of thematic analysis is often focused on the same qualities that make it an
attractive option for novice researchers-- it’s accessible and flexible nature. When compared
to grounded theory or phenomenology, there is much less written about exactly how to
conduct a rigorous thematic analysis (Nowell et al., 2017). Braun and Clarke (2006)
acknowledge the “potential pitfalls” (p. 94) of thematic analysis, most of which center around
either not analyzing the data enough or a mismatching between data and analytical claims.
Nowell et al. (2017) state that in order for any qualitative analysis to be trustworthy, the
research must demonstrate that the analysis was carried out systematically and consistently.

61

The next section will further explain how trustworthiness in data analysis and thus findings
was achieved.
4.7 Research Quality
Assessing the quality of research is dependent on the knowledge available at the
current time as well as the context in which the research is conducted. Methods and
techniques to assess quality have increased over the last decade, demonstrating the “creative
complexity of the qualitative methodological landscape” (Tracy, 2010, p. 837). The
following section discusses research rigor, ethical considerations and reflexivity as central
components of this research.
4.7.1 Research rigor
There has been considerable debate about the most effective way to assess the quality
of qualitative research (Elo et al., 2014). While guidelines for assessing quality have
continued to be updated in recent years (Tracy, 2010), most qualitative researchers still
reference Lincoln and Guba’s criteria for “trustworthiness”, published in 1985. Simply put,
trustworthiness is a way that researchers can feel confident that their findings are accurate
(Nowell et al., 2017). Lincoln and Guba (1985) proposed four criteria that can help assess the
trustworthiness of findings: credibility, dependability, confirmability and transferability.
These components of trustworthiness will be defined below along with examples of how they
were incorporated into the research.
Credibility involves the accurate identification and description of research
participants’ contributions (Lincoln & Guba, 1985). To enhance the credibility of the
research I used member checking with both individual and group participants. This involved
sending full transcripts back to each individual participant and asking if what was said
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accurately reflected the experience they wanted to share. I provided group participants with a
summary of the group interview they attended, asking for any feedback they wanted to
provide. At the group interviews participants were given the opportunity to give me a mailing
address or e-mail address for the summary to be mailed and I left several copies at each
partner organization with a designated staff member (see Table 2 Phase 3). Thirteen women
(of thirty-one total) asked for a summary to be mailed directly to them. I used peer debriefing
to add an external check on the research process by regularly meeting with another graduate
student to discuss our respective research and talk through the challenges and successes we
were experiencing (Nowell et at., 2017).
Dependability refers to the stability of the findings (Lincoln & Guba, 1985). To
demonstrate this, researchers must clearly show that their research follows a logical and
clearly documented process (Elo et al., 2014). Presenting the research in the form of clear
and comprehensive thesis is one mechanism to achieve this. Confirmability relates to
dependability as it involves showing that findings are indeed derived from the data. Nowell et
al., (2017) explains that this is done by explicitly stating the theoretical, methodological and
analytical choices made throughout the research process.
Generalizing findings from one study to another is typically a goal of quantitative
research, not qualitative, however the transferability of findings is considered a marker of
qualitative research quality (Lincoln & Guba, 1985). Not all findings from a study will apply
perfectly to a different context but by providing a detailed and thorough description of the
research, others can assess what aspects of the study apply to their unique context (Nowell et
al., 2017).

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4.7.2 Ethical considerations
Although ethical considerations are introduced earlier in this section, consideration of
ethical issues that may arise throughout the research must take place once the researcher
chooses a research topic (Reid et al., 2017). In order to conduct research as a graduate student
enrolled at UNBC I had to obtain ethical approval from the University’s Research Ethics
Board (REB). The REB requested clarifications regarding how data would be stored and
electronically transmitted. Once this was addressed ethical approval was granted for a period
of 12 months. Ethics approval was renewed as necessary.
Privacy and confidentiality are fundamental elements of ethical research,
guaranteeing confidentiality and anonymity to participants in research conducted in small
communities can be difficult (Edwards, Lund, & Gibson, 2008). Since my research involved
face-to-face focus groups and interviews the participants were not anonymous. Participants
of the group interviews were asked not to share information outside of the group but it was
explained that this could not be guaranteed. Participant names were not recorded on
transcripts or field notes. I was surprised to discover that participants did not seem concerned
with issues of privacy and confidentiality. I asked individual participants if they would like to
use a pseudonym and they all declined. Only one of the six individual interview participants
asked for information to be redacted from the transcript and this was requested verbally
during the actual interview. These portions were removed from the transcript and not used for
analysis.
Reid et al. (2017) define informed consent as receiving consent from research
participants to participate in the research after “carefully and truthfully” informing them
about the research (p. 61) (See Appendix E and F for Participant Information Sheets). The
Tri-Council Policy Statement for Ethical Conduct for Research involving Humans, which
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informs the UNBC Ethics Approval process, states that consent must be given voluntarily
and can be revoked at any time, with participants able to withdraw their data. The risks and
benefits were clearly communicated to all participants at several points during the research
process, both in writing and verbally. I emphasized to participants that the research was not
an activity of the organization and their participation had no bearing on the services they
access there. Participants did not seem concerned but I cannot guarantee that this did not
affect participant’s responses, as they may have felt pressure to comment in ways that
showed the organization in a positive light (See Appendix G and H for Consent Forms).
The concept of reciprocity was extremely important to this research. Being from the
community I conducted research in, it was important to me to acknowledge what participants
were contributing and provide them and the wider community with something of value. As
previously mentioned, I provided all participants with a $10 gift card to a local grocery store.
Group interviews involved a meal and childcare, if needed. Mechanisms for reciprocity also
involve the creation of new opportunities for research participants, advocating for community
issues, and enabling participants to use the findings in some way (Reid et al., 2017).
While in the community I stored all data and data recording materials in a locked
cabinet at my place of residence that only I had access to. Upon my return to Prince George
all data was stored at the University of British Columbia in a locked filing cabinet located in
the lab of my co-supervisor, Dr. Margot Parkes. Only Dr. Parkes and I have access to the
filing cabinet.
4.7.3 Reflexivity
Reflexivity involves being transparent about how who you are as a person and a
Researcher has shaped the research process. Creswell (2013) explains that being reflexive
requires the researcher to discuss their experience with the topic being explored and how
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experiences with work, schooling, and family may influence the findings and interpretation
of the work. These ideas were introduced in relation to my own positionality as a researcher
in Section 1.2, and are discussed further in Section 6.3, Study Limitations.
A central component of practicing reflexivity is exploring the ways in which identity
is formed through interactions between the researcher and participants (Tracy, 2010). Reid et
al. (2017) explain even those who conduct research in their own community with people they
identify with will assume some degree of “outsideness”, just by being a researcher (p. 50). As
mentioned previously, my family has a relatively long history in Fort Nelson. My paternal
grandparents came to area in 1952, followed by my maternal grandparents in 1974. Many of
their children chose to stay in Fort Nelson and raise families of their own. I was born and
raised in the community and knew many of the research participants. While I have designed
the research to avoid practices and assumptions that could interfere with the accuracy of
findings, I cannot completely guarantee that who I am and how I am viewed by participants
did not impact this research. Strategies such as journaling and peer debriefing helped to
continually reflect on this.

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CHAPTER 5: FINDINGS
5.1 Introduction
This chapter presents the findings from my thematic analysis of the data described in
the previous chapter. As discussed in Chapter 1, the overarching goal of this research project
was to engage in a co-learning experience with women in Fort Nelson to identify and explore
the factors that promoted their health and well-being in a community experiencing intense,
social, ecological and economic change due in large part to resource extraction and
development in the area.
My first research question explored what women in this rural, remote, and resource
extraction dependent community perceive as contributing to their health and well-being. The
second research question asked what factors were most prominently identified by women.
The themes and sub themes presented in this chapter will help to answer these questions. My
third research question was about the strengths and weaknesses of using an Appreciative
Inquiry approach in this research project. This question will be addressed in Chapter 6 as part
of a discussion of the findings presented in this chapter as they relate to the literature
presented in Chapter 2.
Chapter 5 presents findings from the analysis of data from six individual interviews,
four group interviews, demographic information from all participants, the post group
interview questionnaire, as well as my own field notes taken throughout the research process
(see Table 3 Phase 3). Chapter 6 begins with an overview of participant demographics,
including participant age, ethnicity, and years spent in the community. This information was
gathered to get a sense of the range of women participating in the research project. The
findings are then presented in relation to the themes of 5.3 Equitable Access, 5.4 Perceptions
of People and Place, and 5.5 Leadership, Communication and Collaboration. Equitable
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Access (5.3) presents findings in relation to healthcare (5.3.1), Education and Employment
(5.3.2) and Services, Programs, and Events (5.3.3). Perceptions of People and Place (5.4)
presents findings in relation to Resource Extraction and the Boom and Bust Cycle (5.4.1) and
Valuing and Utilizing Local and Traditional Knowledge and Culture (5.4.2). The theme of
Leadership, Communication, and Collaboration (5.5) presents findings in relation to division
in the community (5.5.1). Findings as they relate to participant experience are presented in
section 5.6.
5.2 Participant Demographics
There were 37 self-identified female participants who took part in either an individual
interview or a group interview. Six women took part in individual interviews and 31 women
took part in one of four group interviews held at different organizations in the community
(see section 4.4.2). The following figures display participants self-reported age (see Figure 6
p. 69), and number of years participants have lived in the community (see Figure 7 p. 69).
As a whole, the participants ranged in age from 19 to 67 years with the majority of
women falling in the 19-39 age range category (24 women). The demographic questionnaire
(Appendix M) asked participants to report their ethnicity by answering an open-ended
question: “Ethnicity___________ (For example: Caucasian, First Nation, Metis, Filipino,
South Asian, etc)”. I then grouped responses into four categories: First Nation, Metis,
Caucasian, and other. The two most prevalent reported ethnicities were Caucasian (15
women) and First Nation (12 women). Several First Nations women identified their nation
when reporting their ethnicity, but these have been omitted in order to protect participants’
anonymity. For the same reason the category of “other” was used to identify participants that

68

did not identify as Caucasian, First Nation or Metis. See Table 3 (p.53) for a table displaying
this information.

Figure 6: Participant Age
In terms of years spent living in the community there was an almost even split
between those who have lived in community 15 years or less (19 women) and those who
have lived in the community 16 years or more (18 women) (see Table 6 p. 70). Individual
interview participants were asked how long they had been in their role at the community
organization. Time involved with the community organization ranged from 2 months to 27
years.
Quotes presented in this thesis from the six individual interviews are identified with
“Ind” and tagged with 1-6, depending on what individual interview the quote came from.
Data from the four group interviews are identified with ‘Group’ and tagged with 1-4.

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\
Figure 7: Number of Years Participants have Lived in the Community
5.3 Equitable Access
The theme of Equitable Access was identified across all interview questions in both
individual and group interviews. Equitable access pertained to several different things which
led to the decision to identify the subthemes of healthcare (5.3.1), education and employment
(5.3.2), and programs, services and events (5.3.3). Subthemes are discussed below.
5.3.1 Equitable access to healthcare
Healthcare was a prevalent topic of conversation in both the individual and group
interviews, which is not surprising given the longstanding lack of healthcare facilities and
services in the community. In terms of strengths of healthcare in the community, both
individual and group participants mentioned the number of doctors in the community as
important because it allows for timely access to doctors as well as some choice regarding
healthcare providers:

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So if you’re a female and comfortable going to a female, we have 2 different, maybe
3 totally different styles of doctors, so if you’re not satisfied with one approach you
have an alternative and that’s really big, having choices (Ind-3)
Two doctors in particular were named for their comprehensiveness and integration of both
traditional and nontraditional medicine. Another strength identified was the prevalence of
women in the healthcare industry in the community.

Maternity services were an additional aspect of healthcare identified by participants.
While maternity services were a common and passionate topic among both individual and
group participants, the topic was discussed more deeply during the group interviews. A
consistent perspective when this topic was raised was that not having access to maternity
services in the community is a major source of stress and negatively impacts their health and
well-being. Participants emphasized the negative health impacts associated with the need to

leave the community to give birth, the financial burden this causes, and the fact that many
women have other children needing care. Such factors were described by one participant in a
group interview:
It’s stressful, you have to plan four weeks ahead, you have to travel when you’re
extremely pregnant, pay for hotels, pay for fuel. See a doctor that you don’t know, that
you aren’t familiar with. (Group-4)
In discussing healthcare, participant responses centered around the need to leave to the
community to access healthcare and the challenges that brings. When discussing possible
solutions to this challenge, two major actions were identified: assistance with the scheduling
and coordination of medical appointments, and financial assistance for travel outside of the
community for medical appointments. In response to questions pertaining to the Dream stage
of the Appreciative Inquiry cycle (see Figure 5), participants stated that ideally, they would
like to see more health services such as sonography (ultrasound), optometry, and
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physiotherapy consistently available in the community. As an alternative to traveling to
access medical services, women voiced that they want medical specialists and diagnostics
services to travel to the community. Several participants spoke of delaying or neglecting to
attend medical appointments out of town due to the lack of time and money as well as the
often-dangerous driving conditions. While women seemed grateful for the mobile health
services that do visit the community, it was clear they are not ideal:
There’s that bus that comes and sits in the Overwaitea parking lot, for mammograms,
but then everyone knows what you’re doing. It’s kind of a personal thing to get done
in a bus. It’s like you just walk in and throw it on the table, come on. (Group-4)
Another prominent topic that was mentioned in relation to equitable access to
healthcare was the need for drug and alcohol treatment in the community. This topic was
discussed much more frequently and more in depth in the group interviews. Ideally, the

women want detoxification and rehabilitation services available in the community, as they
see this as an integral aspect to treatment and recovery. While the financial hardship in
accessing treatment out of community was mentioned, the biggest challenge in accessing
these detoxification and rehabilitation services was the fact that people have to leave behind
their family and children to do so. Women in one of the group interviews discussed knowing
women who had their children apprehended by the Ministry of Children and Family
Development. Participants perceived this as a potential consequence of accessing treatment:
Do you go for help and get the help you need to make yourself better, and risk losing
your kids, or do you have something where you can see your kids. You can work on
things and know your child is safe, and you’re trying to make things better. I’ve had
friends where that’s happened (Group-1)
In addition to the need for detoxification and rehabilitation services in the community,
participants voiced support for those in recovery from drug and alcohol addiction. The

72

importance of trained and qualified staff as well as women-focused supports were identified
as impacting women’s health and well-being. Women in several of the four group interviews
specifically advocated for women only Alcoholics Anonymous and Narcotics Anonymous
support groups.
5.3.2 Equitable access to education and employment
A prevalent topic of discussion in both the individual and group interviews was the
importance of accessible education and employment, and their relationships with local
women’s health and well-being. While there were many examples shared of how women are
continuing to provide for themselves and their families despite the current economic climate,
participants emphasized the barriers they face in terms of access, which in some instances
women directly attributed to their gender, as one participant in an individual interview
described:
Women should have that same right as men to go into the workforce, it’s very
frustrating when they’re left without that, it seems that single men seem to have more
alternatives, I don’t know what it is. (Ind-3)
In keeping with discussions about equitable access to healthcare (5.3.1), participants
expressed that they need education and training in the community and that it needs to be
tailored to the needs of local women. This includes offering more face-to-face educational
opportunities, women only workforce training (e.g., CPR, First Aid), and childcare (which
will be discussed more in section 5.3.3). Participants also identified the importance of
accommodating different learning styles by offering both distance and in-person training and
education. The participants mentioned training and education as a way to protect their
livelihoods during times of economic uncertainty:

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And more education, I could see more focus on education, because when you have a bust,
that’s where everything is lacking, all of a sudden everyone is out of a job and they have
no education, just doesn’t seem to always be a priority in a town like this (Group-3)
While education and employment were discussed in both individual and group
interviews, the discussion was from different perspectives. The individual interview
participants spoke to education and employment primarily as providers, or in roles that
contributed to the provision of education or employment. In comparison, participants in the
group interviews spoke to education and employment as recipients, or from the perspective
of women who wish to access education and employment. This is noteworthy but not
surprising given the research design choice to target individual participants based on their
role within a service organization.
5.3.3 Equitable Access to Services, programs, and events
In terms of strengths, both individual and group participants identified many services,
programs and events that contribute to their health and well-being. See Table 5 (p. 75) for
those most prominently identified.
Participants identified children and youth services, housing, and food security as areas
that needed to be improved. Both individual and group participants discussed the impacts that
services, programs, and events for children and youth have on their health and well-being.
Participants spoke to how they needed more childcare options in order to access employment
and education for themselves, with one participant stating:
I think we have so many good things but one thing that is always a constant is more
childcare options, I know of women that dropped out last month (of continuing
education courses) because there’s just inadequate childcare opportunities. (Ind-6)

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Table 5: Supportive Services, Programs, and Events by Participants
Recreation & Leisure

Entertainment

The local Recreation Centre

Events put on by the local
movie theatre (live music,
theatre productions, movies)

Farmer’s Market (every
Saturday year-round)

Public library

Women’s support groups
(offered by various
organizations)

Opportunities to volunteer
with local organizations and
at community events
Kids play Gym at Rec
Centre

Museum

Outdoor trails

Gatherings

Free community events

Culture Fest*
Trapper’s Rendezvous*

* Culture Fest is an annual volunteer-run community event that celebrates the diverse cultures of residents.
Trapper’s Rendezvous is an annual volunteer-run series of community events that celebrate the local
history and culture of the community and surrounding area. The event is held each Spring to
commemorate the time of year that Trapper’s would traditionally leave their traplines and travel to the
community to celebrate a prosperous winter.

Participants also commented on the importance of services, programs and events
specifically for children and youth. When women spoke of services, programs and events for
children and youth it was often in the context of preparing them for the future. Women
commented on the lack of both extracurricular activities and educational opportunities for
youth in the community.
Only women in the group interviews mentioned housing as something that could improve
their health and well-being. Group participants discussed the challenge of coordinating
subsidized housing with an agency that is based outside of the community, making it difficult
for housing prices and availability to align with the current needs of the community:
Lots of them (BC Housing units) are empty because you can go rent other places for
the same price as they want to rent for, and then you can choose where you live. They
(BC Housing) don’t know the situation here (Group-1)

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Food security was discussed mainly by group participants as opposed to individual
participants. Participants stated that food prices have increased while the economy has
worsened, making it difficult to access nutritious food for themselves and their families.
While many group participants mentioned the local food bank as an asset, they stated they
wanted an increase in provision and variety of food.
5.4 Perceptions of People and Place
Analysis of the individual and group interviews identified perceptions of people and
place as an important influence on women’s health and well-being. Discussions of people
and place mainly took place during the Discover phase of the Appreciative Inquiry cycle (see
Figure 5), when women were asked to identify the strengths of the community. In terms of
people, women in both individual and group interviews emphatically expressed their
perception that overall, people in the community are kind and go out of their way to help
each other. Participants often followed their comments regarding shortcomings of the
community with statements relating to the strength that familiarity and close-knit
relationships provide, and often contrasted this to past experiences in urban centers.
In terms of perceptions of the community as a place, participants in both individual
and group interviews commented on the different types of impacts that living in a small
community has on their health and well-being. The lack of traffic and subsequent short
commuting time as a positive feature was mentioned several times. Participants in both
individual and group interviews discussed the concept of safety in relation to the community.
While many participants perceived the community to be safe, it was noted in the group
interviews that participants knew of other women who did not share these feelings of safety
and that safety is associated with the size of the community, as one participant stated:

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I just don’t like to see our town grow too big, I don’t know. I think the more bigger it
gets the more wild it will be. It’s wild enough! (Ind-6)
In discussing aspects of the community, participants focused predominantly on the
impact that resource extraction and the boom and bust cycle (5.4.1) had on the community
and identified valuing and utilizing local knowledge and culture (5.4.2) as a potential
mediating factor on the negative impacts of resource extraction. These subthemes are
discussed below.
5.4.1 Resource extraction and the boom and bust cycle
Women did not specifically use the term “resource extraction” when discussing this
theme but instead used the terms of “industry”, “economy”, and “boom and bust”. Women
discussed these terms in relation to the negative impacts the downturn in the economy has
had on women’s health and well-being but also the positive outcomes that it had. Participants
in two of the individual interviews mentioned the “spoiledness” (Ind-3) that accompanies a
boom in the economy:
there was just more money to put into programs (during the boom) but I don’t know if
it was always being utilized…there’s definitely less financial supports right now, but
still, it almost seems to be thriving, something about suffering brings people together
too, so maybe the money isn’t there so people are getting creative, they’re finding
ways to get, becoming more resourceful, because they have to be, ‘cause I think with
Fort Nelson there’s probably a little bit of spoiledness when we boom”(Ind-3)
Participants in both the individual and group interviews spoke of the strength and resiliency
exhibited by local women during “busts”. An individual interview participant captured this
by stating,
Interestingly enough it’s the women who are keeping their businesses afloat, the stuff
that’s died is the male component of industry, I don’t know what the stats are but on a
visual, women are still running things. (Ind-3)

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Participants expressed that the negative impacts of resource extraction have created the need
for residents to be innovative and unite to address challenges. Women perceived a
relationship between how residents treat each other and the state of the local economy.
Participants commented that people seem to look after each other more in a “bust” than they
do during a “boom”:
I think Fort Nelson was blessed with so much that a lot more people were living off
the high hog and not really, it was like okay to be mean to somebody, okay to be rude
and disrespectful but now we have to be friendly to our neighbors. We are coming
back to a place where we’re a small close community (Group-1)
5.4.2 Valuing and utilizing local and traditional knowledge and culture
Valuing and utilizing local traditional knowledge and culture was discussed by both
individual and group interview participants. Women perceived such knowledge and culture
as strengths inherent in the community and their valuing and utilization as a mechanism to
improve the health of the community, particularly when in a “bust”, with one participant
stating:
We need to have our own life, we should be promoting our tourism, that’s important.
Promote our culture, like bring people in, everything is around the oil, but people
could be coming to see our culture or the northern lights…(Group-3)
There was also concern voiced over the loss of culture and the negative impact that
this has on health. Reciprocity, collectivism, and traditional ecological knowledge were
discussed as things that the community “needs to get back to” (Ind-6). During the data
collection period several Indigenous Elders from First Nations communities in the area
passed away, prompting both individual and group interview participant to reflect on the
ramifications of the sense of loss:
So these women (Elders) have raised their grandchildren, their great grandchildren
and this community. I don’t just mean Fort Nelson First Nation, the outlying bands,
they are all losing these huge pieces of their culture and their family right now (Ind-3)
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5.5 Leadership, Communication, and Collaboration
Leadership, communication, and collaboration was identified most during the Destiny
and Design stage of the Appreciative Inquiry Cycle (see Figure 5). During these stages
participants were asked questions about specific details that make the community a place that
supports women’s health and well-being and first steps towards positive action. In terms of
leadership, women in both the individual and group interviews described local women being
resilient, strong, and essentially the ones holding the community together. When discussing
formal leadership, one participant stated,
the women rule this place. In terms of politics, even if men are given a position of
power the women have the influence. Men may be the head of the household, but
women are the back. All the Chiefs have been women since I’ve been here. Our
council is full of women… (Ind-3)
5.5.1 Communication and collaboration
In every individual and group interview the need for better communication with
residents by political leadership was mentioned. This may be partly due to the fact that one of
the questions in the interview guide was “If you were Mayor of Fort Nelson what services,
events, opportunities for women would you put into place?”. It may also speak to the desire
that women have to be informed about what is going on in and for their community,
especially given the current challenging economic situation, and they feel that they are not.
Participants stated that it was difficult for them to access information regarding both the
economy and health services, commenting that “no news is not good news”. Many
participants expressed that information is largely inaccessible to them due to factors such as
literacy, time, and comfortability. In addition to accessibility, women want to know that
leadership understands what they and other residents are going through:

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You see things popping up, like efforts in forestry, or the Mayor met with so and so,
oil and gas. This is going to happen or that is going to happen. I think that we just
need, it would be so simple to do, but more positive messaging for the people that are
still here, you know, a bit of compassion, like something more personal, like if I could
open the newspaper and read more of a personal letter from the Mayor to the town of
Fort Nelson, that says “Hey, I know you’re struggling, so many people are struggling,
but you know we’re going to try our best, we’re gonna get through this. (Ind-2)
Related to the equitable access to healthcare (5.3.1), participants in group interviews
discussed the lack of communication between Northern Health and residents regarding
available health services and capacity. Participants stated that there is an abundance of
conflicting information from various sources regarding the reasons behind a lack of local
maternity services. In response to these challenges, women voiced their desire for clear,
accessible, and regular communication from Northern Health.
Participants in the individual interviews spoke of collaboration in terms of their roles as
service providers at the respective community organizations. Five of the six individual
participants identified overlapping program times and mandates as challenges for women in
the community. They also stated that collaboration between organizations was needed in
order to build capacity and better access the limited funding and resources available, with one
service provider stating:
We (service providers) need to come together on things, you get more funds when you
collaborate, it’s proven (Ind-5)
5.5.2 Division in the community
Despite participants stating that relationships and social connections are important to
their health and well-being, division between women of different incomes, social status, and
ethnicities was mentioned in both individual and group interviews. Individuals in individual
interviews discussed issues of division among women in the community more deeply and

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more frequently than those in group interviews. One interpretation of this is that participants
did not feel as comfortable to discuss such divides in a group setting.
Divisions between women of different incomes and social status was evident when
participants discussed social events in the community and the types of women that attend
them. Several group interview participants stated that they felt such events were “too up here
(gesturing above their heads) “(Group-2) and that they didn’t have the money to afford to
look the way they feel they would need to in order to fit in. Several of the women who
participated in individual interviews identified the same socio-economic divide group
participants did but did so as women who attended such events. One such participant
expressed her desire to have events be accessible to all women in the community:
Those kinds of events, they’ve been so beneficial and it shouldn’t just be middle to
upper class White ladies, cause it isn’t a “White” thing, people all like to gather
together, win prizes, to feel empowered and beautiful and get dolled up even though
we’re up North in a small town, so making women feel proud of their, who they are,
their sexuality, whether they want to wear makeup or not wear makeup (Ind-3)
As mentioned above, divisions between Indigenous and non-Indigenous women in the
community were mentioned more frequently by participants in individual interviews. When
probed as to factors contributing to divisions between Indigenous and non-Indigenous
women in the community, a lack of knowledge was identified as a contributing factor. As one
participant noted:
If I was Mayor, I’d make the whole damn town read it [The Truth and Reconciliation
Commission Report Introduction] and understand you can’t just get over shit. We are
moving forward but it’s not going to happen overnight. (Ind-3)
In response to the challenges described above, participants called for opportunities for
women in the community to connect with each other and establish “common ground” (Ind1). Participants in both individual and group interviews stated that bringing women of diverse
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backgrounds together is important and a first step to combatting issues of isolation,
discrimination, and other adverse health impacts. One participant suggested the following:
What we need to do is have a big meeting, like have all the women come together, it
might be 2-3 hours, and we all say a bit about each other, who we are…you get to know
each other and see people beyond….people need an opportunity to get to know one
another…that’s totally irrelevant, who you’re with, that’s not what I’m looking for, I
don’t care what you drive, what you wear, I don’t care if you had your teeth done last
year, what I want to know is, who are you? (Ind-5)
5.6 Participant Experience
The post-group interview questionnaire (see Appendix N) was designed to gather
participant feedback about the experience of taking part in the group interview. Thirty-one
women took part in the four focus groups and twenty-six questionnaires were returned. Five
participants left the group interviews early and therefore did not fill out the questionnaire.
All of the twenty-six group participants that completed the post group interview
questionnaire responded that they either strongly agreed (23) or agreed (3) that the group
interview was worthwhile and a good use of their time. When asked if they felt the group
interview was well facilitated and organized, twenty-two participants responded “strongly
agree” and four participants responded “agree”. Twenty-one participants responded that they
strongly agreed that they were able to contribute to the discussion and five participants
responded that they agreed. This suggests that participants found the group interviews to be a
positive experience, or at the very least not a negative one. It must be acknowledged that I
knew of many of the participants and this may have created a positive response bias.
The post-group interview questionnaire asked participants what the best part of
participating in the group interview was and what could have made the experience better. The
responses to the question on what the best part of interview focused on three aspects: being in

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a group, sharing ideas and information, and emotional support. See Table 6 (below) for a
summary of participant responses.
Table 6: Post-group interview questionnaire responses
The best part about
Participant responses
taking part in the group
interview
Being in a group
- Hearing everyone’s input on women’s health and contributing my
own (Group-1)
- Great discussion (Group-1 and 2)
- Everyone was interacting, many different points of view (Group-4)
- Open conversations, safe space (Group-3)
- Being able to brainstorm with other women about benefitting our
community’s health in a variety of ways (Group-4)_
- Open discussions, airing our concerns (Group-2)
Sharing ideas and
- The great ideas everyone had and ways to get things going
information
(Group-2)
- Everyone was informative and concerned about our community
(Group-1)
- Listening to other women’s ideas and views (Group-2)
- Speaking of ideas for Fort Nelson, like things we need, which is a
lot (Group-1)
- Happy this is being addressed by someone, very grateful for this
lots of ideas (Group-3)
- Being able to brainstorm with other women about benefitting our
community’s health in a variety of ways (Group-4)
- I found out about services I didn’t know existed (Group-1)
Emotional support
- Finding out that I am not alone in this community (Group-3)
- Seeing how many women in the community are living and
struggling because you don’t see it every day, or it is isn’t
acknowledged (Group-1)
- Having my voice heard (Group-2)

In terms of how the group interview could have been better, all responses focused
around having more participants present as well as more of a variety of women. This signals
a need for more opportunities for women to gather and connect on issues impacting their
health and well-being.

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5.7 Conclusion
As indicated throughout the previous sections, there were several differences between
the individual and group interviews. It seemed that participants in the individual interviews
felt more comfortable talking about sensitive topics such as divides between women in the
community. Participants in the group interviews discussed many topics more deeply due to
the nature of group conversation and the opportunity to build on one another’s contributions.
Demographic differences between those who participated in individual and group interviews
may have also contributed to differences. This will be discussed in the following chapter.

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CHAPTER 6: DISCUSSION AND CONCLUSION
6.1 Introduction
This research was designed to explore issues affecting the health and well-being of
women in a rural, remote, and resource extraction-dependent community in northern BC.
Findings suggest that equitable access, perceptions of people and place, and leadership,
communication, and collaboration interact within the unique context of the community in
ways that both positively and negatively impact health and well-being. In this chapter, I
discuss and synthesize the different perspectives that influenced this thesis, drawing from
literature presented in Chapter 2, approaches discussed in Chapter 4, and findings reported in
Chapter 5. Insights into the strengths and limitations of using Appreciative Inquiry and
thoughts on participant recruitment are also included in this final chapter. The chapter
concludes with study limitations, and recommendations stemming from this thesis research.
6.2 Discussion and Synthesis
The following section presents combined insights in relation to research questions of
“What do women in a rural, remote, and resource-dependent community perceive as
contributing to their health and well-being?” and “Which factors are most prominently
identified by women as contributing to their health and well-being? (Social, ecological,
economic, etc.)”. This discussion and synthesis seek to further illustrate the
interrelationships among the themes of equity, place, resource extraction, and health and
well-being depicted in Figure 1 (pg.11) by discussing local women’s insights into equity
(6.2.1), place (6.2.2) and processes of change (6.2.3).

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6.2.1 Local women’s insights into equity
The women I interviewed for this thesis research continually identified equitable
access as a major factor impacting their health and well-being. Participants discussed the
need for more equitable access to healthcare, education and employment, and programs,
services and events. When women spoke of the challenges inherent in access, the word
“adequate” kept coming up. This suggests that women did not have unrealistic or grandiose
expectations when it comes to accessing services in a rural, remote and northern community,
but feel they need and deserve a satisfactory level and quality of services.
Both the 1977 Northern British Columbia Women's Task Force Report on Single
Industry Resource Communities and the 1979 Beyond the Pipeline research projects
(Women’s Research Centre) state the need for increased access to vital services such as
obstetrical and gynecological care, education and training, and childcare in northern BC. It is
noteworthy, and frustrating, to see that women are still asking for the same services today,
especially given the amount of evidence available for the health impacts associated with
resource extraction and development (Aalhus, 2018; Halseth et al., 2016). As the authors of
Beyond the Pipeline (1979) state, “Geographic isolation is not an acceptable justification for
inadequate goods and services” (p xv). While it may not be acceptable, it certainly persists.
It is promising, however, that in contrast to participants from the early research
projects introduced in Chapter 2, women who participated in this research project explicitly
identified lack of access as a health equity issue. A sense of agency permeated my
interactions with participants, in that they not only recognized and named the inequities they
perceived to be experiencing but discussed mechanisms to reduce such inequities. For
example, following the data collection period of this research, a facebook group was started
called Fort Nelson Residents for Maternity Support (Fort Nelson Residents for Maternity
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Support, 2018). The group states, “We would like to work together to achieve what is, in our
view, a basic human right- the right to give birth in our own community, and to have supports
for travelling out if staying in the community is not possible.” While this facebook group did
not arise directly from this thesis research, many of the women who participated in this
research are a part of this group.
The 2018 report, The Social Determinants of Health Impacts of Resource Extraction
and Development in Rural and Northern Communities: A Summary of Impacts and
Promising Practices for Assessment and Monitoring identifies intersectoral action and
research as necessary in order to further understand, prevent, and mitigate negative impacts
of resource development (Aalhus, 2018). Parkes (2015) raised similar themes in discussing
the “unhelpful divides between people and place, equity and ecosystems, society and nature”
(p. 213) that have continued to persist in health research and practice. Current environmental
assessment processes are not designed to identify equity issues that exist and arise due to
resources extraction and development in communities (Buse et al., 2018). There is a growing
body of evidence showing how women are more vulnerable to certain impacts of resource
development (Gislason et al., 2017). By developing and applying equity indicators for
research and service provision, such inequities can continue to be addressed.
Women living in rural, remote and northern communities are often tasked with the
responsibilities involved in not only maintaining their own health, but the health of their
families (Leipert et al., 2012). These responsibilities can prevent women from accessing
healthcare, education, employment. Many participants of this thesis research stated that they
have delayed traveling to medical appointments and accessing detoxification and
rehabilitation services because they are not able to find childcare. A lack of childcare makes
it extremely difficult, if not impossible, for women to attend school and access training
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opportunities. This lack of access prevents women from fully participating in the aspects of
the community that might directly positively impact their health and well-being.
Access to education and the associated sense of agency and empowerment it brings,
can be a mechanism for the prevention of gender-based violence (United Nations, 2016). As
research participants in this project stated, providing equitable access to education and
community development processes can also help to buffer the negative impacts of a “boom
and bust” cycle. This helps to challenge the prevalent notion that such negative impacts are
inevitable and unavoidable (Badenhorst et al., 2014).
In addition, Intersectionality can provide a useful lens through which to explore and
act on health inequities affecting women. Participants spoke to the divides among women in
the community and identified socio-economic position and ethnicity and two aspects of
identity that can divide women. Drawing attention to systems of power and oppression that
contribute to health inequities may contribute to a better understanding of inequities and help
to identify mechanisms to address them. As mentioned in Chapter 5, individual interview
participants did not mention challenges in accessing affordable housing, while group
interview participants did. This may be partly explained by the fact that individual interview
participants were women with varying degrees of training and education, who had gainful
and secure employment, and consequently better access to determinants of health such as
housing.
6.2.2 Local women’s insights into place
Women that participated in this research identified several factors that relate to place
and how perceptions of the community and environment positively and negatively impact
their health and well-being. Panelli (2001) explains that rural communities can be understood
through a diverse range of “meanings, practices and spaces that are constructed by local
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people” (p. 164). When discussing the impact of industry and the “boom and bust” cycle,
participants did not use the term “resource extraction” or “resource development”. Instead,
women used terms such as “work”, “the economy”, and “oil and gas”. This finding suggests
that terms used in technical and academic literature may not always resonate with those who
are experiencing the phenomena in question.
When asked about strengths of the community, women spoke of the strong sense of
community and how this “tight knit” nature is something that is unique and in contrast to
larger urban centers. Participants also identified the environment and landscape of the area as
valued systems that provide them with many health benefits. The expansiveness of
undeveloped land, fresh air, opportunities for leisure, recreation, and cultural practices were
all mentioned. The media coverage of Fort Nelson tells a much different story, and this was
discussed by participants. This speaks to the differences in perceptions of those inside and
outside of the community and how these differences can impact health and well-being.
Participants did not see their community as a place meant strictly for supplying energy to
those in other places.
As discussed in Chapter 2, a “rip and ship it” (Hemingway & Margolin, 2016, para 2)
conceptualization of remote resource extraction dependent communities by outsiders
contributes to the continued lack of funding and resources for such communities. Much of the
information on communities experiencing rapid and intensive resource development is
produced outside of the communities experiencing it, and by those with little to no
knowledge of community dynamics. It begs the question of who these research projects and
reports are benefitting? It is encouraging to see that agencies such as Northern Health’s
Office of Health and Resource Development has turned their attention to producing

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knowledge translation materials that are designed for the needs of specific communities
(Northern Health Office of Health and Resource Development, 2018).
Women living in rural and remote communities have long been characterized as
“hardy” and “resourceful”, often in comparison to their southern counterparts (Leipert et al.,
2005; Young, 1980). Participants in this research project echoed such sentiments by defining
local women as “strong” and “resilient”, and the ones holding the community together during
challenging times. While initially this can be seen as a testament to northern women and is
indeed something such women should take pride in, it has also become a justification for
continued health inequities. Past research has found that women in remote northern
communities develop creative solutions to maintain their health and well-being (LeBreton,
2005), not because they want to but because they have to. While resiliency and innovation
are indeed positive attributes, women in remote northern communities should not
automatically be excepted to display such attributes when they want access to things such as
healthcare and education.
Rather than seeing the place in which rural women live as simply a “container” (p.
281) for their experience, Little and Panelli (2003) explain that research on geography and
gender must recognize “the rural” as an active participant in the perception of identity and
place. It was clear that women in the community of Fort Nelson are proud of the local and
traditional knowledges and cultures in the area. Participants voiced a desire to revitalize
cultural practices as a way of maintaining and promoting their health. Many women
advocated for a focus on tourism in order to decrease the community’s reliance on resource
extraction and development. This links well with current research on environmental violence
and how traditional cultural practices are crucial aspects of mediating negative impacts
caused by resource extraction (Women’s Earth Alliance & Native Youth Sexual Health
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Network, 2016). Viewing ecological determinants of health (earth, air, water, etc.) as
potential sources of health and well-being as opposed to potential sources of contamination
and disease (Parkes, 2016) can influence the ways in which people engage with their
environment.
6.2.3 Local women’s insights into processes of change
Women that participated in this research identified leadership, communication, and
collaboration as factors that strongly influence their health and well-being. As mentioned in
Chapter 5, these factors came up mostly during the Destiny and Design stage of the
Appreciative Inquiry Cycle (see Figure 5) when participants were asked what actions were
needed to improve their health and well-being. In this way leadership, communication, and
collaboration can be seen as potential processes of change. Similar to findings regarding
equitable access, women felt that strong leadership and effective communication are not only
preferable, but their right as members of the community. Democratizing the research process
by making opportunities for involvement more accessible to those in communities can help to
design more equitable and effective interventions that improve health and well-being (Buse
et al., 2018; Oestreicher et al., 2018).
Sharing insights from her research in New Zealand, Parkes (2015) advocates for the
participation of a diverse range of stakeholders in order to provide a deeper understanding of
health, ecosystem, and equity issues. The community-university partnership developed in this
participatory action research process “built capacity for improved coordination, future
partnerships, and multiple axes of integration, without compromising local communities’
sense of autonomy” (Parkes, 2015, p. 191). The Mobilizing Strength research project
presented in Chapter 2 is a great example of such a partnership (LeBreton, 2005). By
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focusing on and building capacity within local young women, not just as a positive
implication but as a main goal, research projects can lead to sustainable and effective
outcomes that improve the health and well-being of communities.
As mentioned in Chapter 3, the Northern Rockies Regional Community Health Plan
finalized in March 2018 is an expression of multi-stakeholder engagement and collaboration
occurring in the community. This is the first time that the municipality, Northern Health, and
Fort Nelson First Nation have committed to working together to address the health and wellbeing of the community. Continued opportunities for the consultation and involvement of
residents is currently underway.
The creation of Women North Network (WNN) in 2000 was a response to bridging the
geographical divide that separates women in remote northern communities. Findings from
this research project shows that distance exists not only between communities but within
them as well. Participants in this research noted divisions existed among women of different
ethnicities, income brackets, and social standing. Literature points to the roles that resource
extraction and development can play in this fragmentation (Women’s Earth Alliance &
Native Youth Sexual Health Network, 2016). Differences of opinion on the need for and the
impacts of resource extraction can cause tensions within a small community, with residents
often occupying several different roles, making advocating for or against resource
development extremely complex. Participants in my project identified the need for local
women to connect and share mutual experiences as a way to confront these tensions.
Resource extraction and development has been identified as an expression of
colonialism, racism and patriarchy (Women’s Earth Alliance & Native Youth Sexual Health

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Network, 2016). While participants did not explicitly make this link, they did identify the
acknowledgement and use of traditional and local knowledges and cultures as a mechanism
to maintain and improve their health in the current context. This suggests that attending to
local history and current ramifications of colonialism, racism and patriarchy can be a way to
mediate the negative impacts of resource extraction and development.
In their book The Reconciliation Manifesto: Recovering the Land, Rebuilding the
Economy (2017), Arthur Manuel and Grand Chief Ronald Derrickson use examples of
resource extraction and development to illustrate how Canadian governments are attempting
to reconcile with Indigenous Peoples without addressing the colonial structures that are
central to the relationship. The authors contend that:
Many Canadians want to see Reconciliation between the settlers and Indigenous
peoples. But that cannot be forced. Reconciliation has to pass first through truth. And
we still have not had enough of that from this government or from Canada as a whole.
(Manuel & Derrickson, 2017, p. 56).
There were several references made to Reconciliation by research participants, with
one participant suggesting that the “whole damn town” should read The Truth and
Reconciliation Commission Report (Ind-3). Participants spoke of divisions in the community
between Indigenous and non-Indigenous women and how these negatively impact the health
of the whole community. The findings suggest that participants are experiencing impacts of
colonization but do not clearly see the connections between resource extraction, colonialism,
and Indigenous-settler relations. Drawing attention to this connection in a supportive,
respectful, and inclusive way may help to begin a dialogue among community members on
the lasting impacts of colonization.
The connections between resource extraction, colonialism, and Indigenous-settler
relations is one example of the ways in which this research links what could be perceived as
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separate issues. Reflecting on research question 2, “Which factors are most prominently
identified by women as contributing to their health and well-being (Social, ecological,
economic, etc.)”, I now see that this question was structured in a way that works against the
integration of multiple knowledges, disciplines, and sectors to improve health and wellbeing. This question encourages the continuation of siloed approaches to addressing the
health impacts of resource extraction and development. No one area of focus or category
(social, ecological, economic, etc.) can solely solve challenges that communities such as Fort
Nelson are facing. If I were to redesign the research questions I would focus more on the
relationships and connections between such factors, rather than focus on prominence.
6.3 Methodological Insights
The following section discusses methodological insights gained through the research
process. Section 6.3.1 answers the third research question of “What are the strengths and
limitations of using an appreciative inquiry approach to research involving women’s
perceptions of health and well-being?” Recruitment of participants and reflections on the
research design are also discussed.
6.3.1 Strengths and limitations of using Appreciative Inquiry
The post group interview questionnaire asked participants to what extent they agreed
with the statement, “Using the Appreciative Inquiry 4D cycle prompted useful discussion
around women’s health and well-being”. Women that participated in individual interviews
were asked if they could envision using the 4D cycle in their role as service providers.
Individual participants expressed that while this was not an approach they were familiar with
(strength/asset based), they could indeed see themselves using it in their respective practice.

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Seventeen of the twenty-six women that completed the post group interview questionnaire
stated that they strongly agreed with the above statement and nine stated that they agreed.
As a researcher I found the 4D cycle useful in designing both interview guides and
the interview protocols. I did not ask individual interview participants the same questions
included in the post group interview questionnaire. This was an oversight on my part, but on
reflection I feel that I was able to get a good sense of how the individual interviews went due
to the rapport built with the participants and the more intimate nature of an individual
interview (see Section 4.4.2). In the future I would consider a way for all participants to share
feedback on how they felt the data collection process went, by providing an online
anonymous questionnaire for example.
In terms of limitations of using an Appreciative Inquiry approach, participants stated
that they would have liked having a larger and more diverse group of women take part in the
group interviews. Appreciative Inquiry is often used with large groups, whether in business,
government, or healthcare. Larger and more diverse groups of women may have provided
more diverse findings, but the larger groups may have also limited what participants were
willing to share with each other.
6.3.2 Participant recruitment
Reflecting on participant recruitment, a more concerted effort to engage women not
accessing services from one of the community organizations could have strengthened
findings. Although it was emphasized that participating in the research would not impact
access to current services, it cannot be guaranteed that participants did not feel pressure to
tailor their responses in a way that they felt would ensure continued access. By recruiting a

95

group of participants not associated with an organization and holding an interview in a
neutral space I may have been able to gather a more diverse range of experiences.
In discussing collaboration between researchers and gatekeepers, Wanat (2008) draws
a distinction between the facilitation of access and the act of cooperation. Providing a
researcher with access to participants can take many different forms, for example posting a
bulletin advertising the research or providing in kind resources such as the use of facilities.
The community partners of this thesis research were instrumental in helping me to recruit
participants and provided both program time and space to hold the group interviews.
6.3.3 Limitations of research design
The experiences of women shared here and communicated in this research is not
definitive of women in all remote, northern communities. With this in mind, findings
presented in this thesis must be interpreted contextually and parallels to other communities
made cautiously. However, by providing information on the study context and history of the
community, aspects of the analysis, findings, and recommendations may be transferrable to
other communities (Nowell et al., 2017).
My positionality as both a trainee researcher and a woman from the community
inevitably influenced the research process and what women chose to share with me. While
there were instances in which women expressed they were more willing to participate
because I was leading the research, there were quite possibly women who did not participate
for the same reason. In situations where the researcher is known to participants it can be
beneficial to involve researchers that are not known in the community (Reid et al., 2017).
Having another researcher involved in this project could have reduced this potential bias.

96

In addition to conducting the research presented in this thesis, I have also been
employed throughout my Master’s degree. This was necessary for financial reasons and
resulted in less time dedicated to this research than would have been ideal. However, my
employment has proven invaluable in providing me with additional knowledge and
experience related to women’s health and well-being in rural, remote and northern
communities. Being involved as a research assistant on several projects related to the health
impacts of resource extraction introduced me to several emerging pieces of literature.
Similarly, being involved in several community-based organizations in a volunteer capacity
has widened my perspective and experience of issues impacting women in northern BC.
6.5 Recommendations and Implications
There are several recommendations stemming from this research directed to service
providers, those in leadership positions, and researchers. In terms of service providers, it is
clear that increased collaboration is one mechanism to maintain and improve women’s
health. Participants spoke of overlapping mandates, conflicting programs times, and divisions
among women as challenges in accessing services. The establishment of a group for service
providers to meet and connect would be beneficial. An additional strong recommendation is
the need for childcare in the community. Several participants discussed having childcare
available in spaces that women are already utilizing, such as the local recreation centre and
the community college. By investing in the quality and availability of childcare, more women
would be able to access healthcare and education.
Following the group interviews, a staff member from one of the community
organizations wrote me to tell me that several of the women who had participated in the
group interview had asked to be on the organization’s Board of Directors. This suggests that
97

the group interview experience may have motivated them to become more involved in the
services and supports they access. In my newly acquired position of Implementation Lead for
the community’s Health Plan, my research findings have helped to further inform the priority
areas. Relationships built during the research process may help to facilitate the opportunity
for women to become involved in the Community Health Plan’s implementation and
evaluation.
In terms of recommendations for those in positions of leadership, this research
indicates that that continual and effective communication between those in the community is
key. Participants expressed that “no news is not good news”, and they want to be informed of
work going on behind the scenes that impacts their livelihoods and overall health and wellbeing. More informal and accessible ways for women to receive information could help
women feel more connected to their community. Improvements in the ways that municipal
and health related information is disseminated could include things such as considering
varying literacy levels, having both print and electronic information widely available, and
providing opportunities for those with children to attend events where information is
presented.
In terms of future research, a more extensive exploration of the ways that gender, place
and resource extraction and development impact women in rural, remote and northern
communities is warranted. Given that this research was conducted by a trainee researcher,
findings are both an expression of my learning and an interpretation the findings. More
attention paid to the intersections of categories of women’s ethnicity, income and age may
reveal the ways that such diversity impacts health. Research projects that focus on building
capacity within communities should be prioritized.

98

6.6 Conclusion
This thesis research found that the health and well-being of women in Fort Nelson,
BC was impacted by several interconnecting factors, including equitable access, perceptions
of people and place, and leadership, communication, and collaboration. Engaging with local
women to conduct the research has been an incredible experience and increased my
knowledge, skills, and experience as both a trainee researcher and a health practitioner.
Findings suggest that more integrative approaches are needed to address the health impacts
that exist at the intersection of gender, place, and resource extraction. Commitment to
equitable and meaningful participation in research and local decision making can improve the
health and well-being of women, their families, communities, and the land on which they
live.

99

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APPENDICES

APPENDIX A: Letter of support from Fort Nelson Community Literacy Society
APPENDIX B: Letter of support from Fort Nelson Aboriginal Friendship Society
APPENDIX C: Letter of support from Northern Lights College
APPENDIX D: Letter of support from the Northern Rockies Aboriginal Women
Society
APPENDIX E: Project Information Sheet for Group Participants
APPENDIX F: Project Information Sheet for Individual Participants
APPENDIX G: Consent Form for Group Participants
APPENDIX H: Consent Form for Individual Participants
APPENDIX I: UNBC Research Ethic Board Approval letter (E2017.0103.001.00)
APPENDIX J: Recruitment Poster
APPENDIX K: Group Interview Guide
APPENDIX L: Individual Interview Guide
APPENDIX M: Demographic Questionnaire
APPENDIX N: Post Group Interview Evaluation

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118
119
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Appendix
M:
Support
four
Community
Organizations
APPENDIX
A: Letter
ofLetters
supportoffrom
Fortfrom
Nelson
Community
Literacy
Society

F o r t N e l s o n C o m m u n i t y L it e r a c y S o c ie t y
#17 Landmark Plaza, 4903-51st Ave W, Box 91, Fort Nelson, BC V0C 1R0
PHONE: 250-774-4415 FAX: 250-774-4416
EMAIL: coordinator@fncls.com WEBSITE: www.fncls.com

Seanah Roper
Fort Nelson Community Literacy Society
4903 51 Avenue W #17
Fort Nelson, BC V0C 1R0
November 16, 2016
Shayna Dolan
c/o Dr. Margot Parkes
University of Northern British Columbia
3333 University Way
Prince George, BC V2N 4Z9
To Whom It May Concern:

Re: Background to proposed Master’s Thesis Research and Request for Support
The Fort Nelson Community Literacy Society (FNCLS) is pleased to support the proposed research of UNBC Master
of Community Health Sciences student Shayna Dolan which is titled “Women’s Perceptions of Health & Well-being
in a rural, remote, and resource-dependent community: Strengths and Opportunities”. Shayna and I began
communicating about her proposed research in June of 2015.
FNCLS provides free services and programs to the Fort Nelson area. Some specific target demographics we serve
include individuals with multiple life and literacy barriers, immigrants and newcomers to Canada and members of
the Aboriginal population. Our core programs include Adult Literacy, Family Literacy and English as a Second
Language and Settlement Assistance. We also hold term contracts to run an in-town Aboriginal Engagement
Program, an Adult Education Program at Prophet River First Nation, a Youth Tutoring Program and a Public Legal
Education Program. Working with many vulnerable women in the community, we acknowledge the importance of
these research findings for our program delivery and community engagement. Women’s Health plays a large role
in literacy work, as the two are often interrelated.
FNCLS is committed to working with Shayna to recruit participants for a focus group and to hold a focus group onsite at our Learning Centre. This will be an in-kind contribution to the project.
Please don’t hesitate to contact me if you have any questions and require any further information.
All the best,

Seanah Roper, Executive Director, FNCLS

115

APPENDIX B: Letter of support from Fort Nelson Aboriginal Friendship Society

116

APPENDIX C: Letter of support from Northern Lights College

117

APPENDIX D: Letter of support from the Northern Rockies Aboriginal Women
Society

118

APPENDIX E: Project Information Sheet for Group Participants

Project Information Sheet for Group Participants
Women’s Perceptions of Health and Well-being in a rural, remote, and resource-dependent community:
Strengths and Opportunities
Researcher:
Shayna Dolan, B.T.R.
Community Health Sciences Graduate Program
University of Northern British Columbia
3333 University Way, Prince George, BC, V2N4Z9
778-886-0098 (cell) or dolans@unbc.ca
Supervisors:
Dr. Margot Parkes, MBChB, MAS, PhD
School of Health Sciences, Associate Professor,
University of Northern British Columbia
3333 University Way, Prince George, BC, V2N4Z9
250-960-6813 or margot.parkes@unbc.ca

Dawn Hemingway, BA, MSc, MSW
School of Social Work Chair, Associate Professor
University of Northern British Columbia
3333 University Way, Prince George, BC, V2N4Z9
250-960-5494 or Dawn.Hemingway@unbc.ca

What is this? What is the purpose of this research?
You are invited to participate in a master’s research project that will explore women’s perceptions of health and
well-being in Fort Nelson. By talking about the things that help to make women healthy in the community we
can help to keep and improve those things and explore other things that women still want and need. This
research uses an approach called “Appreciative Inquiry”. This approach focuses on the strengths, the “good”
things happening on our community. After gathering this information, I plan to work with organizations in Fort
Nelson that serve women to make programs and services even better.
What will the participant do?
As a participant, you will take part in a focus group that will last approximately 1.5 hours. During the focus
group we will explore the factors that women see to be impacting their health and well-being. As a group,
participants will be guided through an appreciative inquiry cycle that explores the strengths of the community,
hopes and dreams for the future, and action that can be taken to keep and improve women’s health and wellbeing. Before starting the focus group I will ask participants to fill out a short questionnaire asking their age,
ethnicity and how long they have lived in Fort Nelson. Your name is not going to be written on the paper so it
can be anonymous. After the focus group I will ask participants to fill out a short evaluation of how the focus
group went. If you are interested in getting a written summary of the focus group you will be asked to leave
your name and contact information. If you do not wish to leave contact information I can leave a copy of the
summary at the service organization for you. This summary will be ready approximately 1 month after the focus
group.
Are there potential benefits or risks to participating?
There are benefits to participating in this focus group. Your thoughts and ideas will contribute valuable
information that can be used to shape local services and supports for women and their families. Women in
northern rural communities often feel isolated. A focus group can be an opportunity to gain support from other
women dealing with similar issues.
There are no direct risks from participating in a focus group for this research. If at any point you feel
uncomfortable, upset, or want to stop please let me know and we can arrange for a break. If you want to leave

119

the focus group, you are absolutely able to do so. But, since there will be multiple women present at the focus
group I cannot erase your contributions from the audio recording.
Information from the study will be shared with participants in a few different ways. You can receive a written
summary like mentioned above. I will also be giving a presentation at the organization that you participated in
the focus group at. I will also hold a meeting open to anyone interested to talk about the study and provide some
recommendations.
**Your participation in this focus group is entirely voluntary**
How will confidentiality be addressed?
The focus group will be digitally audio recorded and the researcher (Shayna Dolan) will take notes during the
focus group. Names will not be included on my written version of the audio recording but since several women
will be at the focus group I can’t guarantee that your identity will be kept confidential. Before the start of the
focus group we will talk about privacy and confidentiality and everyone will be asked to not use names or share
any specific information outside of the focus group. All paper forms filled out by participants will be kept
separately from the audio recordings for further security. All paper records will be directly transported from the
data collection site to a locked filing cabinet until such time that they are physically transported to the
University of Northern British Columbia by the researcher. Directly following each focus group, the audio
recordings will be downloaded onto a computer with file encryptions. The recordings will then be erased from
the recorders. Data will be backed up on a portable storage device using a file encryption program. Any
information sent to project supervisors electronically will be done using end to end email encryption. All paper
and electronic research data will be destroyed after 5 years. Study findings may be presented at conferences,
meetings and published in journal articles and books. However, participant names and identifiers will not be
used in any published or oral presentations of the research.
Questions?
If you have any questions or concerns surrounding this project, please contact myself, Shayna Dolan at 778886-0098 (cell) or email dolans@unbc.ca. My supervisors can be reached using the contact information below:
• Dr. Margot Parkes 250-960-6813 or by email at margot.parkes@unbc.ca.
• Dawn Hemingway 250-960-5694 or by email at Dawn.Hemingway@unbc.ca
For any concerns or complaints, please contact the UNBC Research Ethics Board at
250.960.6735 or reb@unbc.ca.
THANK YOU FOR YOUR TIME

120

APPENDIX F: Project Information Sheet for Individual Participants

Project Information Sheet for Individual Participants
Women’s Perceptions of Health and Well-being in a rural, remote, and resource-dependent community:
Strengths and Opportunities
Researcher:
Shayna Dolan, B.T.R.
Community Health Sciences Graduate Program
University of Northern British Columbia
3333 University Way, Prince George, BC, V2N4Z9
778-886-0098 (cell) or dolans@unbc.ca
Supervisors:
Dr. Margot Parkes, MBChB, MAS, PhD
School of Health Sciences, Associate Professor,
University of Northern British Columbia
3333 University Way, Prince George, BC, V2N4Z9
250-960-6813 or margot.parkes@unbc.ca

Dawn Hemingway, BA, MSc, MSW
School of Social Work Chair, Associate Professor
University of Northern British Columbia
3333 University Way, Prince George, BC, V2N4Z9
250-960-5494 or Dawn.Hemingway@unbc.ca

What is this? What is the purpose of this research?
You are invited to participate in a master’s research project that will explore women’s perceptions of health and
well-being in Fort Nelson. By talking about the things that help to make women healthy in the community we
can help to keep and improve those things and explore other things that women still want and need. This
research uses an approach called “Appreciative Inquiry”. This approach focuses on the strengths, the “good”
things happening on our community. After gathering this information, I plan to work with organizations in Fort
Nelson that serve women to make programs and services even better.
What will the participant do?
As a participant, you will take part in a 1:1 semi-structured interview that will last approximately 1 hour. During
the interview we will talk about the factors that women perceive to impact their health and well-being. You will
be guided through an appreciative inquiry cycle that explores the strengths of the community, hopes and dreams
for the future, and action that can be taken to maintain and improve women’s health and well-being. Following
the interview participants will be asked a few questions about their experience of using the appreciative inquiry
approach. The participant is free to skip any question they do not feel comfortable answering.
Are there potential benefits or risks to participating?
There are benefits to participating in this focus group. Your thoughts and ideas will contribute valuable
information that can be used to shape local services and supports for women and their families. Women in
northern rural communities often feel isolated. A focus group can be an opportunity to gain support from other
women dealing with similar issues.
There are no direct risks from participating in a focus group for this research. If at any point you feel
uncomfortable, upset, or want to stop please let me know and we can arrange for a break. If you want to end the
interview at any time, you are absolutely able to do so. Following the interview, I will transcribe the audio
recording and email a copy to you to review. At this point you are welcome to elaborate on, add to, or remove
anything you wish.
Information from the study will be shared with participants in a few different ways. You will receive a transcript
of the audio recording, as mentioned above. Presentations will be made to each of the participating

121

organizations and I will also hold a meeting open to anyone interested to talk about the study and provide some
recommendations.
**Your participation in this interview is entirely voluntary**
How will confidentiality be addressed?
The interview will be digitally audio recorded and the researcher (Shayna Dolan) will take notes during the
duration of the interview. Your name will not be included on my written version of the audio recording, but due
to the small population of the community I can’t guarantee that your identity will be kept confidential. All paper
records will be directly transported from the data collection site to a locked filing cabinet until such time that
they are physically transported to the University of Northern British Columbia by the researcher. Directly
following each focus group, the audio recordings will be downloaded onto a computer with file encryptions.
The recordings will then be erased from the recorders. Data will be backed up on a portable storage device using
a file encryption program. Any information sent to project supervisors electronically will be done using end to
end email encryption. All paper and electronic research data will be destroyed after 5 years. Study findings may
be presented at conferences, meetings and published in journal articles and books. However, participant names
and identifiers will not be used in any published or oral presentations of the research.
Questions?
If you have any questions or concerns surrounding this project, please do not hesitate to contact myself, Shayna
Dolan at 778-886-0098 (cell) or email dolans@unbc.ca. My supervisors can be reached using the contact
information below:
Dr. Margot Parkes 250-960-6813 or by email at margot.parkes@unbc.ca.
Dawn Hemingway 250-960-5694 or by email at Dawn.Hemingway@unbc.ca
For any concerns or complaints, please contact the UNBC Research Ethics Board at
250.960.6735 or reb@unbc.ca.
THANK YOU FOR YOUR TIME

122

APPENDIX G: Consent Form for Group Participants

Consent Form for Group Participants
Women’s Perceptions of Health and Well-being in a rural, remote, and resource-dependent community:
Strengths and Opportunities
To be completed by the research participant:
YES
I have been given a copy of the attached Information Sheet
I understand the reason and purpose for this project and what my role is as a participant
I agree to my voice being recorded during the focus group
I agree it is okay for Shayna Dolan to use the recorded information from the focus group,
including direct quotations for her master's thesis. Study findings may be presented at
conferences, meetings and published in journal articles and books. However, participant names
and identifiers will not be used in any published or oral presentations of the research.
I have been given the opportunity to ask question/express concerns with Shayna Dolan
I know I may leave the focus group at any time.
I understand there is little risk in me participating in this project, however there are chances of
risk which are listed below:
1. I understand that there is a chance I may feel uncomfortable or upset during the focus group,
but that supports are available and I may leave the focus group at any time, however any data I
have provided will not be removed from the data materials.
2. I understand that participants will be asked to keep the names of participants and specific
personal details private, but that in a group setting it is impossible to guarantee these details
will not be shared outside of the focus group.
3. I understand that Shayna Dolan will have to report to police if I threaten to hurt someone,
including myself, or if I report child abuse.
I agree to volunteer in this research
I have been explained the details of Shayna Dolan’s research as it pertains to my role as a volunteer participant
and I believe I understand what is being asked of me.
______________________________________
Volunteer participant signature and date
I have explained the nature of this research to the volunteer participant and believe they understand.
______________________________________
Shayna Dolan and date

123

NO

APPENDIX H: Consent Form for Individual Participants

Consent Form for Individual Participants
Women’s Perceptions of Health and Well-being in a rural, remote, and resource-dependent community:
Strengths and Opportunities
To be completed by the research participant:
YES
I have been given a copy of the attached Information Sheet
I understand the reason and purpose for this project and what my role is as a participant
I agree to my voice being recorded during a one-on-one, semi structured interview
I agree it is okay for Shayna Dolan to use the recorded information from the focus group,
including direct quotations for her master's thesis. Study findings may be presented at
conferences, meetings and published in journal articles and books. However, participant names
and identifiers will not be used in any published or oral presentations of the research.
I have been given the opportunity to ask question/express concerns with Shayna Dolan
I know I may leave the interview or drop out of the project at any time.
I understand there is little risk in me participating in this project, however there are chances of
risk which are listed below:
1. I understand that there is a chance I may feel uncomfortable or upset during the interview, but
that supports are available and I may leave the interview at any time and I can choose whether
the data I have provided will be used.
2. I understand that my name will not be included on transcripts or final materials, however due
to the small population of the community my anonymity cannot be guaranteed.
3. I understand that Shayna Dolan will have to report to police if I threaten to hurt someone,
including myself, or if I report child abuse.
I agree to volunteer in this research
I have been explained the details of Shayna Dolan’s research as it pertains to my role as a volunteer participant
and I believe I understand what is being asked of me.
______________________________________
Volunteer participant signature and date
I have explained the nature of this research to the volunteer participant and believe they understand.
______________________________________
Shayna Dolan and date

124

NO

APPENDIX I: UNBC Research Ethic Board Approval letter (E2017.0103.001.00)

125

Appendix
H:J:Recruitment
Poster to be posted at each of the four organizations
APPENDIX
Recruitment Poster

126

APPENDIX K: Group Interview Guide

Group
Guide
Appendix
F: Interview
Focus Group
Guide
Women’s Perceptions of Health and Well-being in a rural, remote, and resource-dependent community:
Strengths and Opportunities
Set up:
I will arrive an hour prior to the start of the focus group to set up the room. Chairs will be set up in a ushape I will have chart paper posted outlining the 4-D appreciative inquiry process. Food and beverages
will be available. I will have the information letters and consent forms readily available.
Prior to starting focus group:
Participants will be asked to be seated and I will discuss the project, the information letter and provide
an overview of the consent form. I will distribute the $10 IGA gift cards and voice my appreciation for
their time. Participants will have the opportunity to voice any questions or concerns they have. 10
minutes will be given for participants to complete the consent form and return to me. I will notify
participants that a list of community services and supports are included with the information letter and
more copies are available.
Prior to beginning the focus group participants will be asked to fill out a short anonymous demographic
questionnaire and return to me (see Appendix I). If participants would like to receive a summary of the
focus group they will be given an opportunity to fill out their preferred contact information (see
Appendix N). This summary will be drafted approximately 1 month after the focus group.
Introduction to focus group:
Participants will be reminded that the focus group will be audio recorded but that no names will be
used in the transcription. I will also remind participants that they can leave at any time but that due to
multiple participants being involved their contributions to the focus group cannot be erased. I will
explain to participants that due to the group setting I cannot guarantee that information shared in the
focus group will not be re-shared outside of the group. I will acknowledge that participants may wish to
share themes and topics from the focus group with others but respectfully ask that they do not share
names and specific details outside of the focus group. I will allow time for a circle of introductions.
I will provide a brief explanation of appreciative inquiry and the 4-D process. Participants will be given
an opportunity to ask any questions they may have. Participants will be reminded that they are being
audio recorded and asked to speak one at a time if possible so that their responses can be accurately
captured.
Focus Group:
Participants will be directed to the overarching question of the research, which is:
What do women in a rural, remote, and resource-dependent community perceive as contributing to
their health and well-being?

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APPENDIX L: Individual Interview Guide

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APPENDIX M: Demographic Questionnaire

Appendix I: Focus Group Participant Demographic Questionnaire

**DO NOT PUT YOUR NAME OR ANY IDENTIFIYING MARKS ON THIS PAPER**
Focus Group #______(ask Shayna)
Date:______________
Age _________
Ethnicity ______________ (for example: Caucasian, First Nations, Filipino, South Asian, Chinese, etc.)
Years spent living in Fort Nelson ________

Please fold and return to Shayna

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APPENDIX N: Post Group Interview Evaluation

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