Does the public receive and adhere to boil water advisory recommendations? A cross-sectional study in Newfoundland and Labrador, Canada
Jones-Bitton et al. BMC Public Health
Does the public receive and adhere to boil water advisory recommendations? A cross-sectional study in Newfoundland and Labrador, Canada
Andria Jones-Bitton 0
Diana L. Gustafson 2
Kelly Butt 2
Shannon E. Majowicz 1
0 Department of Population Medicine, University of Guelph , Guelph, ON N1G 2W1 , Canada
1 School of Public Health and Health Systems, University of Waterloo , BMH 2316, Waterloo, ON N2L 3G1 , Canada
2 Division of Community Health and Humanities, HSC 2834 Faculty of Medicine, Memorial University , St. John's, NL A1B 3V6 , Canada
Background: Highly publicized water supply problems highlight the importance of safe drinking water to the public. Boil water advisories (BWAs) are an important precautionary measure meant to protect public health by ensuring drinking water safety. Newfoundland and Labrador, Canada is a prime location for exploring public notification practices and adherence to recommendations as there were a total of 215 BWAs, affecting 6 % of the provincial population, in 145 communities between April 2006 and March 2007 when data for the present study were collected. Methods: Residents who received household water from a public water supply were randomly selected for a telephone interview. Collected data included participants' notification of boil water advisory, satisfaction with information provided, and their adherence to recommendations. Results: Most participants learned that a BWA had been issued or lifted in their community through radio, television, or word of mouth. BWAs were issued for a range of operational reasons. Almost all participants who had experienced a BWA reported wanting more information about the reasons a BWA had been issued. Low adherence to water use recommendations during a BWA was common. Conclusions: This study is first to report on public adherence to boil water advisory recommendations in Canada. The findings raise public health concerns, particularly given the high number of BWAs issued each year. Further studies in partnership with community stakeholders and government decision-makers responsible for overseeing public water systems are needed to assess the perceptions of BWAs, the reasons for non-adherence, and to identify information dissemination methods to increase information uptake and public adherence with acceptable uses of public drinking water during a BWA.
Boil water advisory; Public health communication; Water contamination; Guideline adherence; Drinking water
Background
Highly publicized water supply problems highlight the
importance of safe drinking water to the public. Canadian
examples include the Escherichia coli (E. coli) outbreak in
Walkerton, Ontario in May 2000, the Cryptosporidium
outbreak in North Battleford, Saskatchewan in April 2001,
and the evacuation of Kashechewan First Nation in Fall
2005, when E. coli was discovered in the drinking water
[
1–3
]. Less often published in the national press are
smaller scale water contamination events and boil water
advisories (BWAs), such as the years-long BWAs in many
Aboriginal communities of Canada [
4
]. BWAs are an
important precautionary measure meant to protect the
public health by ensuring drinking water safety; however,
they can also increase consumer anxiety and alter
perceptions about public drinking water [
5, 6
].
In Newfoundland and Labrador (NL), 42 % of the
approximately 500,000 residents live in rural areas, compared
to 20 % of Canada’s overall population [
7
]. This province’s
relatively small population is spread over a
disproportionately large land mass with approximately 535 public water
supply systems being maintained by communities [
8
]. Each
year, there are an average of 200 BWAs in effect in NL, and
long-term BWAs (lasting five or more years) are common
[
9
]. Little is known about how NL residents take up and
use information about BWAs or the extent to which they
adhere with BWA recommendations. This lack of
knowledge is also an issue nation-wide, as there are no published
studies on public adherence with BWA recommendations
in Canada.
In 2007, a mixed methods project funded by the
Newfoundland and Labrador Centre for Applied Health
Research and the Public Health Agency of Canada was
undertaken to investigate public perceptions of public
drinking water supplies in NL and adherence to water use
recommendations during BWAs. Given the paucity of
information of public adherence with BWAs in Canada, we
analysed data from this study, as an initial exploration of
BWAs in the province, to investigate: (1) how people
learned that a BWA had been issued, and lifted, in their
communities, (2) satisfaction with the information provided
about the BWA, and (3) public adherence to BWA
recommendations.
Methods
A cross-sectional study using computer-assisted telephone
interviewing was designed and conducted in March and
April 2007 with NL residents that received their
household water from a public water supply. The Human
Inves (...truncated)