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

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 Gittelsohn, Marcia O’Leary, Ana Navas-Acien and Christine Marie George ()
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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
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

IJERPH, 2023, vol. 20, issue 3, 1-24

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.

Keywords: arsenic; drinking water; process evaluation; consolidated framework for implementation research (CFIR); RANAS model (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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