Effectiveness and scalability of a home health navigator program to reduce environmental hazards - 1 Abstract
2 Approximately 34 million Americans rely on private wells to supply their drinking water. Private wells are
3 excluded from the Safe Drinking Water Act. Consequently, people who use private wells have not benefited
4 from pollution prevention activities mandated by this law. This is a public health concern because toxic
5 chemicals such as arsenic, nitrate, and lead are frequently detected in drinking water provided by private wells
6 at concentrations that exceed the Safe Drinking Water Act's maximum contaminant levels. Chronic exposure to
7 toxics in drinking water increase the risk of several chronic diseases. Several states in the U.S. have
8 implemented or are proposing legislative policies to require testing and treatment of private wells. As the
9 numbers of states implementing these policies increase, it is critical that public health agencies offer a program
10 to aid homeowners with adherence to these new policies, specifically in the domains of understanding water
11 test results and choosing appropriate remediation solutions. Previous programs increased well testing and
12 knowledge of hazards, yet the majority of private well users still did not test their well water or remediate
13 detected hazards. Subsequently, there is a need to determine if individual-level interventions would be more
14 effective for promoting behaviors that would reduce, mitigate, or eliminate exposure to contaminated well
15 water. Lay health care workers are effective in clinical settings with improving the outcomes and management
16 of chronic diseases, and may be able to provide cost-effective counseling to promote environmental health
17 decision making among homeowners that have contaminated wells. Thus, we propose to conduct a community
18 efficacy trial that brings together university-based researchers, State and Local agencies, and Extension
19 Services. Together, we propose a community efficacy trial implemented by community health navigators via the
20 Extension service. Specifically, we will conduct a randomized controlled trial in one rural county in Oregon to
21 test the acceptability, fidelity, scalability and efficacy of 3 different intervention arms to reduce harmful
22 toxicant exposures through the adoption of appropriate well water treatment. Upon completion, we will
23 produce a private well safety intervention program that has been tested and modified through empirical
24 research. By capturing the costs and retaining the most efficacious intervention components, our cooperative
25 approach has a better chance of scalability into practice across multiple stakeholders (i.e. Extension services,
26 state health agencies). This information has the potential to reduce health disparities in rural America that are
27 related to a household's source of drinking water.
