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Communicating Results of Drinking Water Tests From Private Wells: Designing Report-Back Materials to Facilitate Understanding
ciently to take appropriate action can still be a challenge (Chappells et al., 2014; Jones et al., 2006; Kreutzwiser et al., 2011). Increasingly, the reporting of sampling results to study participants is viewed as contributing to the development of environ- mental health literacy, which enables par- ticipants to make health-protective decisions (Brody et al., 2014; Gray, 2018; Morris et al., 2016; Severtson et al., 2006). Understanding well test results prepares participants to take steps to reduce harmful exposures (Ramirez- Andreotta et al., 2016), though awareness alone is not sucient for exposure reduction (Zheng & Flanagan, 2017). Within this context, the Well Empowered pilot study was conducted in North Caro- lina, a state where approximately 2.4 million people (25% of residents) access their drink- ing water from private wells (Dieter et al., 2018). Toxic metals from industry-derived and naturally occurring contamination have been identified in private wells across North Carolina (Sanders et al., 2012; Vengosh et al., 2016). After learning about the presence of such metals in local wells, residents in Stokes County reached out to the Univer- sity of North Carolina at Chapel Hill Super- Sarah Yelton, MS Institute for the Environment, University of North Carolina at Chapel Hill Andrew George, PhD Institute for the Environment, University of North Carolina at Chapel Hill Martha Scott Tomlinson, PhD Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Paige A. Bommarito, PhD Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Rebecca C. Fry, PhD Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill Kathleen M. Gray, MSPH, PhD Institute for the Environment, University of North Carolina at Chapel Hill
'786&(8 This evaluation assessed the eectiveness of graphic- based (i.e., pictorial) report-back materials in communicating the presence of toxic metals in private well water and soil samples. It also explored associations between recommendations in the report-back materials and appropriate actions to protect health taken by a subset of participants in an environmental monitoring pilot study. Overall, 39 residents of Stokes County, North Carolina, participated in the Well Empowered pilot study, which included water and soil testing and analysis. All participants received materials explaining the extent to which toxic metals were present in their well water and soil. A subset of participants ( n = 14) responded to a follow- up evaluation, which showed that many found at least one component of their test results “very easy to understand.” The existence of a federal standard for comparison appeared to influence participant recall of results, which was more accurate for contaminants with a federal maximum contaminant level. Our evaluation results suggest that a simple pictorial format, in combination with more detailed supporting text, can be useful in highlighting results that require action.
Introduction More than 42.5 million people in the U.S. rely on private wells for household water use (Dieter et al., 2018); over 20% of those wells contain one or more contaminants at concentrations exceeding health-based stan- dards (DeSimone et al., 2009). Yet no ongo- ing monitoring of private wells is required, meaning well users are responsible for test- ing wells and remediating contamination. Without testing, residents using private wells for drinking water could be unaware of con-
tamination. Barriers to testing include cost, convenience, and optimism bias (Fox et al., 2016; Zheng & Flanagan, 2017). Addition- ally, well users rely on sensory cues (e.g., taste, smell, discoloration) to determine if water is safe to drink, despite many contami- nants not being detectable by such cues (Fla- nagan et al., 2015; Jones et al., 2006). The promise of obtaining personal results about drinking water quality might incentivize par- ticipation in well testing studies (Segev et al., 2021), but understanding the results su-
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