TY - JOUR
T1 - Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities
T2 - A Qualitative Evaluation of the Strong Heart Water Study Program
AU - Anderson, Darcy M.
AU - Bear, Annabelle Black
AU - Zacher, Tracy
AU - Endres, Kelly
AU - Saxton, Ronald
AU - Richards, Francine
AU - Robe, Lisa Bear
AU - Harvey, David
AU - Best, Lyle G.
AU - Cloud, Reno Red
AU - Thomas, Elizabeth D.
AU - Gittelsohn, Joel
AU - O’Leary, Marcia
AU - Navas Acien, Ana
AU - George, Christine Marie
N1 - Funding Information:
The research was supported by the National Institute of Environmental Health Sciences, National Institutes of Health of the United States (Grant R01ES025135). ANA, TZ, and MO are supported by P42ES033719 from the National Institute of Environmental Health Sciences, National Institutes of Health of the United States.
Funding Information:
Policy and funding structures at the implementer level were barriers to a sustainable and affordable supply of arsenic filter cartridges. The installation of the filter devices for this program was funded by the IHS. However, federal regulations dictate that IHS funding can be used to establish water services but not to subsequently operate and maintain them. While some implementers were concerned about sustainability, these policies limited the actions they could take. Other implementers perceived the SHWS program to be a temporary solution, with the long-term goal of connecting households to the municipal water supply. However, formative research for the SHWS program indicated that some households may be reluctant to connect to the municipal supply, in part because of preferences regarding the temperature and taste of drinking water and the potential cost and perceived reliability of the municipal water supply [].
Publisher Copyright:
© 2023 by the authors.
PY - 2023/2
Y1 - 2023/2
N2 - Arsenic is a naturally occurring toxicant in groundwater, which increases cancer and cardiovascular disease risk. American Indian populations are disproportionately exposed to arsenic in drinking water. The Strong Heart Water Study (SHWS), through a community-centered approach for intervention development and implementation, delivered an arsenic mitigation program for private well users in American Indian communities. The SHWS program comprised community-led water arsenic testing, point-of-use arsenic filter installation, and a mobile health program to promote sustained filter use and maintenance (i.e., changing the filter cartridge). Half of enrolled households received additional in-person behavior change communication and videos. Our objectives for this study were to assess successes, barriers, and facilitators in the implementation, use, and maintenance of the program among implementers and recipients. We conducted 45 semi-structured interviews with implementers and SHWS program recipients. We analyzed barriers and facilitators using the Consolidated Framework for Implementation Research and the Risks, Attitudes, Norms, Abilities, and Self-regulation model. At the implementer level, facilitators included building rapport and trust between implementers and participating households. Barriers included the remoteness of households, coordinating with community plumbers for arsenic filter installation, and difficulty securing a local supplier for replacement filter cartridges. At the recipient level, facilitators included knowledge of the arsenic health risks, perceived effectiveness of the filter, and visual cues to promote habit formation. Barriers included attitudes towards water taste and temperature and inability to procure or install replacement filter cartridges. This study offers insights into the successes and challenges of implementing an arsenic mitigation program tailored to American Indian households, which can inform future programs in partnership with these and potentially similar affected communities. Our study suggests that building credibility and trust between implementers and participants is important for the success of arsenic mitigation programs.
AB - Arsenic is a naturally occurring toxicant in groundwater, which increases cancer and cardiovascular disease risk. American Indian populations are disproportionately exposed to arsenic in drinking water. The Strong Heart Water Study (SHWS), through a community-centered approach for intervention development and implementation, delivered an arsenic mitigation program for private well users in American Indian communities. The SHWS program comprised community-led water arsenic testing, point-of-use arsenic filter installation, and a mobile health program to promote sustained filter use and maintenance (i.e., changing the filter cartridge). Half of enrolled households received additional in-person behavior change communication and videos. Our objectives for this study were to assess successes, barriers, and facilitators in the implementation, use, and maintenance of the program among implementers and recipients. We conducted 45 semi-structured interviews with implementers and SHWS program recipients. We analyzed barriers and facilitators using the Consolidated Framework for Implementation Research and the Risks, Attitudes, Norms, Abilities, and Self-regulation model. At the implementer level, facilitators included building rapport and trust between implementers and participating households. Barriers included the remoteness of households, coordinating with community plumbers for arsenic filter installation, and difficulty securing a local supplier for replacement filter cartridges. At the recipient level, facilitators included knowledge of the arsenic health risks, perceived effectiveness of the filter, and visual cues to promote habit formation. Barriers included attitudes towards water taste and temperature and inability to procure or install replacement filter cartridges. This study offers insights into the successes and challenges of implementing an arsenic mitigation program tailored to American Indian households, which can inform future programs in partnership with these and potentially similar affected communities. Our study suggests that building credibility and trust between implementers and participants is important for the success of arsenic mitigation programs.
KW - RANAS model
KW - arsenic
KW - consolidated framework for implementation research (CFIR)
KW - drinking water
KW - process evaluation
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U2 - 10.3390/ijerph20032681
DO - 10.3390/ijerph20032681
M3 - Article
C2 - 36768048
AN - SCOPUS:85147822734
SN - 1661-7827
VL - 20
JO - International journal of environmental research and public health
JF - International journal of environmental research and public health
IS - 3
M1 - 2681
ER -