We used qualitative content analysis to evaluate the accuracy and comprehensiveness of online lead health education information provided to residents of the three cities. Our primary interest in this study was to elucidate ‘manifest content’, that is, to develop codes and categories that describe the actual content of education materials [30 (link)]. Due to the updated NHMRC advisory level for blood lead levels in May 2015, we re-checked the materials 2 months after this date to ensure any updates made to material would be captured in our assessment. We included information in the text and graphics from all of the direct webpages linked to each of each site, but for consistency, did not follow links that took the viewer off the main website.
Initially we determined the unit of analysis; [31 (link)] the online lead health education materials aimed at parents produced by Broken Hill Child and Family Health Centre, identified online as: Lead it’s in our hands; [17 ] Mount Isa’s Living with Lead Alliance, identified online as: Living safely with lead; [18 ] and Port Pirie’s Targeted lead abatement program [19 ].
We then used an open coding process to comprehensively identify categories and concepts that emerged from the data. From an initial list of open codes, we determined higher-order categorisations and groupings [31 (link)]. Based on our initial open coding, we identified three over-arching domains in which the content of the health education materials clustered: health effects of lead, exposure pathways, and strategies for reducing exposure. Because our primary objective was to assess the accuracy and completeness of the lead health education materials, we determined the best way to do this would be to compare the materials from the mining and/or smelting cities to best practice materials. We defined best practice health education materials as those based on current scientific evidence of health effects (e.g. no safe level of lead exposure identified in children, health effects of low-level lead, identification of vulnerable populations, and delineation of health effects across developmental stages), and those that most comprehensively addressed sources and pathways of exposure. Materials considered included those produced by the World Health Organization, Australian national and state governments, and US national and state governments. In addition the materials had to be in the English language, intended for parents/consumers rather than providers, and web-based.
For the first domain, the health effects of lead, we determined that the best practice materials were those developed by the CDC, due to their comprehensive consideration of lead’s health effects across developmental stages, consistency with recent scientific evidence, and focus on parent/caregiver education [32 ]. Consequently, we developed codes to capture the content of the CDC materials through open coding of the materials and then organised these codes into higher order categories.
For the second domain, pathways of exposure, we determined that best practice lead health education materials were those developed by the NHMRC [33 ], due to their comprehensive discussion of exposure pathways and their specificity to the Australian context. WHO [34 ] and CDC materials were ruled out as “best practice” because they provided only short descriptions of sources and pathways of exposure and did not go into detail about the mining/smelting context. Additionally, the NHMRC materials specifically address some pathways particular to Australia (e.g. rainwater collection for household use). Codes for this domain were developed in the same process described above for the first domain.
For the third domain, strategies for reducing exposure, we could not identify best practice materials specific to the mining/smelting context, therefore, we made the decision to develop an exhaustive list of codes, organised into categories, that would capture the advice provided to parents across the cities being assessed. This enabled us to to analyse the recommendations provided in each city, to compare each city to the others, and where possible, to compare the recommended strategies to the published literature.
Once the codes in each of the three domains were finalised the authors independently coded the health education materials. Then the codes applied by the authors were compared, and any areas of disagreement were discussed and reconciled.
Initially we determined the unit of analysis; [31 (link)] the online lead health education materials aimed at parents produced by Broken Hill Child and Family Health Centre, identified online as: Lead it’s in our hands; [17 ] Mount Isa’s Living with Lead Alliance, identified online as: Living safely with lead; [18 ] and Port Pirie’s Targeted lead abatement program [19 ].
We then used an open coding process to comprehensively identify categories and concepts that emerged from the data. From an initial list of open codes, we determined higher-order categorisations and groupings [31 (link)]. Based on our initial open coding, we identified three over-arching domains in which the content of the health education materials clustered: health effects of lead, exposure pathways, and strategies for reducing exposure. Because our primary objective was to assess the accuracy and completeness of the lead health education materials, we determined the best way to do this would be to compare the materials from the mining and/or smelting cities to best practice materials. We defined best practice health education materials as those based on current scientific evidence of health effects (e.g. no safe level of lead exposure identified in children, health effects of low-level lead, identification of vulnerable populations, and delineation of health effects across developmental stages), and those that most comprehensively addressed sources and pathways of exposure. Materials considered included those produced by the World Health Organization, Australian national and state governments, and US national and state governments. In addition the materials had to be in the English language, intended for parents/consumers rather than providers, and web-based.
For the first domain, the health effects of lead, we determined that the best practice materials were those developed by the CDC, due to their comprehensive consideration of lead’s health effects across developmental stages, consistency with recent scientific evidence, and focus on parent/caregiver education [32 ]. Consequently, we developed codes to capture the content of the CDC materials through open coding of the materials and then organised these codes into higher order categories.
For the second domain, pathways of exposure, we determined that best practice lead health education materials were those developed by the NHMRC [33 ], due to their comprehensive discussion of exposure pathways and their specificity to the Australian context. WHO [34 ] and CDC materials were ruled out as “best practice” because they provided only short descriptions of sources and pathways of exposure and did not go into detail about the mining/smelting context. Additionally, the NHMRC materials specifically address some pathways particular to Australia (e.g. rainwater collection for household use). Codes for this domain were developed in the same process described above for the first domain.
For the third domain, strategies for reducing exposure, we could not identify best practice materials specific to the mining/smelting context, therefore, we made the decision to develop an exhaustive list of codes, organised into categories, that would capture the advice provided to parents across the cities being assessed. This enabled us to to analyse the recommendations provided in each city, to compare each city to the others, and where possible, to compare the recommended strategies to the published literature.
Once the codes in each of the three domains were finalised the authors independently coded the health education materials. Then the codes applied by the authors were compared, and any areas of disagreement were discussed and reconciled.
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