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Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program

Author

Listed:
  • Darcy M. Anderson

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Annabelle Black Bear

    (Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA)

  • Tracy Zacher

    (Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA)

  • Kelly Endres

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Ronald Saxton

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Francine Richards

    (Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA)

  • Lisa Bear Robe

    (Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA)

  • David Harvey

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
    Indian Health Service, Rockville, MD 20857, USA)

  • Lyle G. Best

    (Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA)

  • Reno Red Cloud

    (Environmental Resource Department, Oglala Sioux Tribe, Pine Ridge, SD 57770, USA)

  • Elizabeth D. Thomas

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Joel Gittelsohn

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

  • Marcia O’Leary

    (Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA)

  • Ana Navas-Acien

    (Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, NY 10032, USA)

  • Christine Marie George

    (Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA)

Abstract

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.

Suggested Citation

  • Darcy M. Anderson & Annabelle Black Bear & Tracy Zacher & Kelly Endres & Ronald Saxton & Francine Richards & Lisa Bear Robe & David Harvey & Lyle G. Best & Reno Red Cloud & Elizabeth D. Thomas & Joel , 2023. "Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program," IJERPH, MDPI, vol. 20(3), pages 1-24, February.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:3:p:2681-:d:1055488
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    References listed on IDEAS

    as
    1. Karen Setty & Ryan Cronk & Shannan George & Darcy Anderson & Għanja O’Flaherty & Jamie Bartram, 2019. "Adapting Translational Research Methods to Water, Sanitation, and Hygiene," IJERPH, MDPI, vol. 16(20), pages 1-31, October.
    2. W. Douglass Shaw & Mark Walker & Marnee Benson, 2005. "Treating and Drinking Well Water in the Presence of Health Risks from Arsenic Contamination: Results from a U.S. Hot Spot," Risk Analysis, John Wiley & Sons, vol. 25(6), pages 1531-1543, December.
    3. Shiloh Deitz & Katie Meehan, 2019. "Plumbing Poverty: Mapping Hot Spots of Racial and Geographic Inequality in U.S. Household Water Insecurity," Annals of the American Association of Geographers, Taylor & Francis Journals, vol. 109(4), pages 1092-1109, July.
    4. Jeffrey W. Koch, 2019. "Racial Minorities’ Trust in Government and Government Decisionmakers," Social Science Quarterly, Southwestern Social Science Association, vol. 100(1), pages 19-37, February.
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