Mixed methods (qualitative and quantitative) in environmental epidemiology : an industrial area study, France

Abstract

Background and aim The Lacq industrial area has been the site of numerous chemical activities over the past 60 years. To assess the impact of these activities on the local population health, the French national public health agency has developed a sequenced and participative approach, combining qualitative and quantitative studies. Methods A qualitative local context study, based on 39 semi-directive interviews with different categories of local stakeholders and residents, was first conducted to identify the perceptions and expectations of local actors regarding the links between health and the environment around the industrial site. Two geographical epidemiological studies were then launched to describe mortality and morbidity (cancers, acute and chronic diseases) near the industrial area. Not clinically assessed health outcomes (irritation symptoms, anxiety), quality of life and their link with environmental disturbances will be assessed with an ongoing individual perceived health survey. Results Social demand, analyzed in the local context study, led to the integration of diseases of concern (e.g. digestive cancers, thyroid disorders), reported by local residents and health professionals, in the mortality and morbidity studies. Furthermore, people’s mistrust of authorities and desire for more transparency on the scientific process were taken into account and participatory citizen workshops were set up to co-create the perceived health survey questionnaire. The mortality study reported non-cancerous respiratory and circulatory excess death rates. Those pathologies will be thoroughly explored in both morbidity (health care system use) and perceived health (irritations, discomfort) surveys for a more comprehensive overview of the population health, closer to their life experience. Conclusion This innovative approach, mixed and participative, developed around Lacq industrial area shows the benefit of sequential mixed methods design in environmental health. It enables to better respond to social demand and to overcome blind spots of health surveillance around industrial areas. Keywords Health, Industrial pollution, mixed methods,