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Irvin VL, Kile ML, Lucas-Woodruff C, Cude C, Anderson L, Baylog K, Hovell MF, Choun S, Kaplan RM. An overview of the Be Well Home Health Navigator Program to reduce contaminants in well water: Design and methods. Contemp Clin Trials 2024; 140:107497. [PMID: 38471641 PMCID: PMC11065571 DOI: 10.1016/j.cct.2024.107497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/23/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The Be Well Home Health Navigator Program is a prospective, randomized controlled trial (RCT) implemented to compare a community health navigator program to usual care program to reduce contaminants in drinking water. DESIGN AND SETTING This 4-year two-armed RCT will involve well owners in Oregon that have private drinking water wells that contain arsenic, nitrate, or lead above maximum contaminant levels. INTERVENTION The intervention leverages the trusted relationship between Cooperative Extension Service (CES) Community Educators and rural well owners to educate, assist and motivate to make decisions and set actionable steps to mitigate water contamination. In this study, CES will serve as home health navigators to deliver: 1) individualized feedback, 2) positive reinforcement, 3) teach-back moments, 4) decision-making skills, 5) navigation to resources, 6) self-management, and 7) repeated contact for shaping and maintenance of behaviors. Usual care includes information only with no access to individual meetings with CES. MEASURABLE OUTCOMES Pre-specified primary outcomes include 1) adoption of treatment to reduce exposure to arsenic, nitrate, or lead in water which may include switching to bottled water and 2) engagement with well stewardship behaviors assessed at baseline, and post-6 and 12 months follow-up. Water quality will be measured at baseline and 12-month through household water tests. Secondary outcomes include increased health literacy scores and risk perception assessed at baseline and 6-month surveys. IMPLICATIONS The results will demonstrate the efficacy of a domestic well water safety program to disseminate to other CES organizations. TRIAL REGISTRATION NUMBER NCT05395663.
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Affiliation(s)
| | - Molly L Kile
- Oregon State University, College of Health, Corvallis, OR, USA
| | | | | | - Lilly Anderson
- Oregon State University, College of Health, Corvallis, OR, USA
| | - Kara Baylog
- Oregon State University, Extension Service, Southern Oregon Research and Extension Center, OR, USA
| | | | - Soyoung Choun
- Oregon State University, College of Health, Corvallis, OR, USA
| | - Robert M Kaplan
- Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
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Asghar S, Atif M, Arshad S, Masood I, Hashmi A. Probing the parental cognizance of antibiotic resistance by using Health Belief Model: An exploratory study. Res Social Adm Pharm 2024; 20:28-35. [PMID: 37752028 DOI: 10.1016/j.sapharm.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To explore the determinants that innervate or avert the parents to use antibiotics responsibly for their children in Bahawalpur, Pakistan. Further, to assess the cognizance of Pakistani parents about antibiotic resistance. METHODS The Health Belief Model (HBM) was utilized to design this study. Parents who were using antibiotics for their children were taken as study participants. They were recruited purposively from various public and private healthcare settings and were asked to conveniently participate in the study. A total of 18 in-depth interviews were conducted at time and place convenient to the study participants. Data were transcribed, translated and analyzed by framework analysis in accordance with the constructs of Health Belief Model including perceived susceptibility, severity, benefit, barriers, self-efficacy and cues to action. RESULTS Within each HBM construct, responses of participants were analyzed, yielding 8 themes and 17 subthemes. Parents had a knowledge of antibiotics but considered their families to be at low risk of antibiotic resistance since their families were "low users" of antibiotics. Majority of the participants were not aware of the indications and risks of antibiotic use and perceived the antibiotics as a quick fix for every ailment. Communicating the risks of antibiotic resistance to parents and providing actionable solutions to tackle antibiotic resistance may address these perceptions. CONCLUSION Though parents revealed awareness about antibiotics, they continue to overestimate the value of antibiotics. Refocus of the antibiotic stewardship interventions are required and these campaigns are needed to be tailored to target their intended audience in a format that is appropriate to them.
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Affiliation(s)
- Saima Asghar
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.
| | - Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Saria Arshad
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Imran Masood
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Ayesha Hashmi
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
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Endres K, Zacher T, Richards F, Bear Robe L, Powers M, Yracheta J, Harvey D, Best LG, Red Cloud R, Black Bear A, Ristau S, Aurand D, Skinner L, Perin J, Cuny C, Gross M, Thomas ED, Rule A, Schwab K, Moulton LH, O'Leary M, Navas-Acien A, George CM. Behavioral determinants of arsenic-safe water use among Great Plains Indian Nation private well users: results from the Community-Led Strong Heart Water Study Arsenic Mitigation Program. Environ Health 2023; 22:42. [PMID: 37183246 PMCID: PMC10183246 DOI: 10.1186/s12940-023-00965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/11/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the behavioral determinants associated with exclusive use of arsenic-safe water in the community-led Strong Heart Water Study (SHWS) arsenic mitigation program. METHODS The SHWS is a randomized controlled trial of a community-led arsenic mitigation program designed to reduce arsenic exposure among private well users in American Indian Great Plains communities. All households received point-of-use (POU) arsenic filters installed at baseline and were followed for 2 years. Behavioral determinants selected were those targeted during the development of the SHWS program, and were assessed at baseline and follow-up. RESULTS Among participants, exclusive use of arsenic-safe water for drinking and cooking at follow-up was associated with higher self-efficacy for accessing local resources to learn about arsenic (OR: 5.19, 95% CI: 1.48-18.21) and higher self-efficacy to resolve challenges related to arsenic in water using local resources (OR: 3.11, 95% CI: 1.11-8.71). Higher commitment to use the POU arsenic filter faucet at baseline was also a significant predictor of exclusive arsenic-safe water use for drinking (OR: 32.57, 95% CI: 1.42-746.70) and cooking (OR: 15.90, 95% CI: 1.33-189.52) at follow-up. From baseline to follow-up, the SHWS program significantly increased perceived vulnerability to arsenic exposure, self-efficacy, descriptive norms, and injunctive norms. Changing one's arsenic filter cartridge after installation was associated with higher self-efficacy to obtain arsenic-safe water for drinking (OR: 6.22, 95% CI: 1.33-29.07) and cooking (OR: 10.65, 95% CI: 2.48-45.68) and higher perceived vulnerability of personal health effects (OR: 7.79, 95% CI: 1.17-51.98) from drinking arsenic-unsafe water. CONCLUSIONS The community-led SHWS program conducted a theory-driven approach for intervention development and evaluation that allowed for behavioral determinants to be identified that were associated with the use of arsenic safe water and changing one's arsenic filter cartridge. These results demonstrate that theory-driven, context-specific formative research can influence behavior change interventions to reduce water arsenic exposure. The SHWS can serve as a model for the design of theory-driven intervention approaches that engage communities to reduce arsenic exposure. TRIAL REGISTRATION The SHWS is registered with ClinicalTrials.gov (Identifier: NCT03725592).
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Affiliation(s)
- Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tracy Zacher
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | | | - Lisa Bear Robe
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Martha Powers
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Joseph Yracheta
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - David Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Indian Health Service, Rockville, MD, USA
| | - Lyle G Best
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | | | | | - Steve Ristau
- Mid Continent Testing Labs, Inc., Rapid City, SD, USA
| | - Dean Aurand
- Mid Continent Testing Labs, Inc., Rapid City, SD, USA
| | - Leslie Skinner
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christa Cuny
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Marie Gross
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Elizabeth D Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kellogg Schwab
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research, Inc., Eagle Butte, SD, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Munene A, Hall DC. Proximity of Water Wells to Public Water Testing Facilities in Alberta Using Drive Times. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221137437. [PMID: 36408333 PMCID: PMC9666857 DOI: 10.1177/11786302221137437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Approximately 10% of Albertans rely on well water for domestic purposes. The responsibility of water testing and stewardship is left to private well owners. Few well water owners conduct routine testing of their well water supplies. Drive times to public water testing facilities may be an important factor limiting a well owner's ability to conduct routine water testing. The objective of this study is to describe the proximity of water wells, using drive times, to public water testing facilities and describe the availability of facilities based on hours of operation. Using network analysis, we determined the proportion of a sample of wells within 3 estimated drive times of public water testing facilities. 5872 wells were included in the sample. One hundred and seven water testing facilities were mapped within the province. Of the 5872 wells mapped, 89% were located within 30 minutes of a water testing facility, 15% were located within 0 to 10 minutes of a water testing facility, 48% were located between 10 and 20 minutes of a water testing facility and 37% were located within 20 to 30 minutes of a water testing facility. Further analysis revealed that access to water testing facilities may be influenced by the hours of operation of the facilities.
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Affiliation(s)
- Abraham Munene
- Faculty of Nursing, University of
Alberta, Edmonton, AB, Canada
| | - David C. Hall
- Faculty of Veterinary Medicine,
University of Calgary, Calgary, AB, Canada
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Kankya C, Okello J, Wambi R, Ninsiima LR, Tubihemukama M, Kulabako CT, Asaba R, Baguma JN, Munyeme M, Muleme J. Utilization of health belief model in comprehending diarrheal disease dynamics: a case of cryptosporidiosis in Uganda. BMC Public Health 2022; 22:2008. [PMID: 36324178 PMCID: PMC9628109 DOI: 10.1186/s12889-022-14413-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Diarrheal diseases contribute greatly to the reported global childhood mortality and morbidity with related social, economic consequences. This study was conducted to analyze the utilization of the Health Belief Model (HBM) theory to comprehend diarrheal disease dynamics in Uganda. METHODS Our study utilized a qualitative cross-sectional design among adult livestock farmers in selected farming communities. A total of 80 individuals were recruited and interviewed through Focus Discussion Groups (FDGs) (n = 6) and Key Informant Interviews (KIIs) (n = 8) to evaluate diarrheal disease dynamics. The scope of dynamics included but not limited to exposure risks, knowledge, and attitudes. Our results were presented using the five (5) constructs of the HBM. RESULTS Perceived susceptibility; communities believed that both humans and their animals are at high risk of different kinds of diarrheal infections. The farmers believed that majority of these diarrhea infections are hard to treat especially among animals. Perceived severity; farmers believed that diarrheal diseases are characterized by loss of weight, fever, emaciation, dry eyes, severe prolonged diarrhea and sudden death. Perceived barriers; limited knowledge and misconceptions about the diarrheal infections were great inhibitors to successful disease prevention and control. Self-efficacy; farmers had fear of laxity that interventions being suggested and put in place to curb diarrheal diseases such as cryptosporidiosis would wither away with time thus endemicity of the problem in the community. Modifying factors and cues to action; most of the farmers treat animals by themselves based on; probability, traditional knowledge and previous experience. CONCLUSION Sustained public health interventional activities should therefore be undertaken by both human and animal health sectors with maximum community involvement. Communities suggested the need to increase preventive measures and promote household hygiene efforts to always wash hands with soap and running water in order to reduce the burden of diarrhea diseases such as cryptosporidiosis.
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Affiliation(s)
- Clovice Kankya
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda
| | - Justine Okello
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda
| | - Rogers Wambi
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda ,grid.416252.60000 0000 9634 2734Department of Clinical Laboratory, Mulago National Referral Hospital, P.O Box 7051, Kampala, Uganda
| | - Lesley Rose Ninsiima
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O BOX 7072, Kampala, Uganda
| | - Methodius Tubihemukama
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda
| | - Christine Tricia Kulabako
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda
| | - Richard Asaba
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548School of Women and Gender Studies, Makerere University, P.O BOX 7062, Kampala, Uganda
| | - James Natweta Baguma
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O BOX 7072, Kampala, Uganda
| | - Musso Munyeme
- grid.12984.360000 0000 8914 5257Department of Disease control, School of Veterinary Medicine, University of Zambia, P.O BOX 32379, Lusaka, Zambia
| | - James Muleme
- grid.11194.3c0000 0004 0620 0548Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O BOX 7062, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Department of Disease Control and Environmental Health, School of Public Health, Makerere University, P.O BOX 7072, Kampala, Uganda
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Anthonj C, Setty KE, Ferrero G, A Yaya AM, Mingoti Poague KIH, Marsh AJ, Augustijn EW. Do health risk perceptions motivate water - and health-related behaviour? A systematic literature review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 819:152902. [PMID: 34998758 DOI: 10.1016/j.scitotenv.2021.152902] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 05/26/2023]
Abstract
Health-related risk perceptions are important determinants of health behaviours and components of behaviour change theories. What someone thinks or feels will motivate or hinder their intention or hesitancy to implement a certain behaviour. Thus, a perceived potential risk to our health and well-being can influence our health-promoting and/or health-seeking behaviour. We aimed to review and synthesize available peer-reviewed literature to better understand the links between water and health-related risk perceptions and behaviours. We conducted the first systematic review of peer-reviewed literature on risk perceptions and behaviours in the context of water and health, published between 2000 and 2021. A total of 187 publications met the inclusion criteria. We extracted data relating to study characteristics and categorized our results according to the major themes emerging from the literature, namely drinking water, sanitation, hygiene and wasterelated topics, health risk factors, diseases and mental health implications, and preventative measures. Our review shows that the literature has grown over the past twenty years, reporting information from different countries belonging to different income groups around the globe, conducted in various settings and contexts, among different target populations, from various disciplinary angles, using different methods, theories and approaches. Our review provides evidence of health risk perceptions determining behaviour particularly related to drinking water sources and water safety. Evidence on disease prevention, health seeking, variations and changes in perception and behaviour over space, geography, socioeconomic differences and time, and the relevance of cultural context is provided. Our review shows that risk perception studies are vital for WASH governance in terms of policy, raising awareness, education and behaviour change. In order to make risk perception and behaviour studies even more relevant to effective public health planning and health messaging, future research needs to increasingly focus on early culturally sensitive interventions and changes in perceptions and behaviours over time.
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Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | - Karen E Setty
- ICF, Durham, NC, USA; The Aquaya Institute, P.O. Box 1603, San Anselmo, CA 94979, USA
| | - Giuliana Ferrero
- WASH consulting, Delft, the Netherlands; IHE Delft Institute for Water Education, Delft, the Netherlands
| | - Al-Mounawara A Yaya
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Alan J Marsh
- Department of Medicine, Division of Gastroenterology and Hepatology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ellen-Wien Augustijn
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands
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Gray KM, Triana V, Lindsey M, Richmond B, Hoover AG, Wiesen C. Knowledge and Beliefs Associated with Environmental Health Literacy: A Case Study Focused on Toxic Metals Contamination of Well Water. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9298. [PMID: 34501888 PMCID: PMC8430820 DOI: 10.3390/ijerph18179298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022]
Abstract
Environmental health literacy (EHL) is developing as a framework that can inform educational interventions designed to facilitate individual and collective action to protect health, yet EHL measurement poses several challenges. While some studies have measured environmental health knowledge resulting from interventions, few have incorporated skills and self-efficacy. In this study, a process-focused EHL instrument was developed, using the Newest Vital Sign (NVS) health literacy instrument as a model and tailoring it for the context of private well contamination with toxic metals. Forty-seven (47) participants, including undergraduate students and residents of communities with contaminated well water, piloted a prototype EHL instrument alongside NVS. Results suggested a moderate degree of correlation between NVS and the EHL prototype, and significant differences in scores were observed between students and residents. Responses to a self-efficacy survey, tailored for drinking water contaminated with arsenic, revealed significant differences between students and residents on items related to cost and distance. In response to open-ended questions, participants identified a range of potential environmental contaminants in drinking water and deemed varied information sources as reliable. This study highlights differences in knowledge and self-efficacy among students and residents and raises questions about the adequacy of EHL assessments that mimic formal education approaches.
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Affiliation(s)
- Kathleen M. Gray
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Victoria Triana
- Institute for the Environment, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Marti Lindsey
- Southwest Environmental Health Sciences Center, University of Arizona, Tucson, AZ 85721, USA; (M.L.); (B.R.)
| | - Benjamin Richmond
- Southwest Environmental Health Sciences Center, University of Arizona, Tucson, AZ 85721, USA; (M.L.); (B.R.)
| | - Anna Goodman Hoover
- Department of Preventive Medicine & Environmental Health, University of Kentucky, Lexington, KY 40536, USA;
| | - Chris Wiesen
- Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
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Murray CJ, Olson AL, Palmer EL, Yang Q, Amos CI, Johnson DJ, Karagas MR. Private well water testing promotion in pediatric preventive care: A randomized intervention study. Prev Med Rep 2020; 20:101209. [PMID: 33072497 PMCID: PMC7548982 DOI: 10.1016/j.pmedr.2020.101209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 11/16/2022] Open
Abstract
Over 43 million U.S. residents rely on private unregulated wells for their drinking water, raising public health concerns, particularly in regions like northern New England where widespread groundwater arsenic contamination is now recognized. Children are particularly vulnerable to adverse health effects from arsenic exposure. Despite AAP Guidelines, approaches to engage pediatric clinicians in promoting private well testing have not been previously described. We sought to determine the most effective practice approaches to achieve successful well water testing in routine pediatric care. 12 primary care clinics were block randomized to one of four study arms. Two intervention variables were assessed: (1) test results access (parent only vs. parent and clinic) and (2) follow up approaches (yes/no). Parents of children under 12 months using a private well were eligible. Prepaid water tests were provided. Primary outcome was parental water test completion. Eleven clinics successfully implemented processes identifying well users. 240 testing kits were dispensed. Completion rates averaged 29% (range 10 to 61%). The study arm with both clinic results access and staff follow up system was 2.3 times more likely to achieve test completion than other arms (95% CI 1.12-4.86, p = .03). Kit distribution by clinicians versus nursing staff, irrespective of study arm, had 2.4 times greater completion (95% CI 1.13-5.11, p = .02). Systematic drinking water source screening can be improved in pediatric care. Higher testing completion was found in practices randomized to reminders and structured follow up versus single visit discussion, but clinician involvement was the most predictive factor.
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Affiliation(s)
- Carolyn J. Murray
- Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, 74 College Street, Hanover, NH 03755, USA
| | - Ardis L. Olson
- Dartmouth CO-OP Primary Care Research Network, Dartmouth Geisel School of Medicine, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Ellen L. Palmer
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Qian Yang
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Christopher I. Amos
- Department of Biomedical Data Science, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Deborah J. Johnson
- Dartmouth CO-OP Primary Care Research Network, Dartmouth Geisel School of Medicine, 46 Centerra Parkway, Lebanon, NH 03766, USA
| | - Margaret R. Karagas
- Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
- Department of Epidemiology, Dartmouth Geisel School of Medicine, 1 Medical Center Drive, Lebanon, NH 03756, USA
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