Alaska Native Tribal Health Consortium, Anchorage, Alaska
The Alaska Native Tribal Health Consortium, Anchorage, Alaska, proposes a water-quality project to to develop, pilot, evaluate, and disseminate a water-use promotion program to reduce occurrence of sanitation-related waterborne diseases among Alaska Natives in the Yukon-Kuskokwin Delta region.
- Developing a pilot water-use promotion program adapted from successful approaches from abroad,
- Piloting the approach in three Alaska Native villages scheduled to receive first-time modern water service within the project period,
- Evaluating and modifying the approach if needed, and
- Providing information and resources for Alaskan environmental health professionals so that similar activities can be conducted in other villages
In Year 1, we placed a priority on determining the specific knowledge, attitudes, and practices surrounding treated water use in our three project villages. This information will serve as a basis for future water-use promotion activities. We attempted to conduct structured interviews with all heads of households. One hundred eighty-eight households are in our three villages (73 in Village A, 44 in Village B, and 71 in Village C). Structured interviews were conducted in 169 households (90%). In addition to structured interviews, households in the three villages were asked to complete a monthly water-use diary. Water-use diaries have been completed by 122 of 188 households (65%); this activity is ongoing.
Preliminary results from the structured interviews show that 45% of respondents primarily drink untreated water and 50% did not believe it was possible to get sick from drinking untreated water. Persons in households using untreated water were asked to explain this preference. Responses can generally be placed into one of six categories [a substantial portion of responses involved an aversion to chlorine]:
- preference for “natural” things;
- untreated water tastes better/treated water tastes bad;
- untreated water is free;
- health/safety concerns with treated water;
- convenience (rain water can be collected near home; treated water must be brought in from a centralized point);
- and culture/tradition.
Data obtained from monthly water-use logs shows that domestic water use among residents who must carry treated water from a remote point used an average of 1.8 gallons per person each day (all uses). In contrast, the World Health Organization (WHO) has associated water use less than 13.2 gallons per person each with a high level of health concern.
As expected, discussing issues such as handwashing, bathing, and in-home cleaning must be approached with great sensitivity. We have expended a great deal of time and effort exploring techniques to promote disease-preventing practices without offending or demeaning local residents. One well-received approach is to promote “proper water use.” We might inform residents of the health risks associated with using less than the WHO-recommended 13.2 gallons of treated water per day. Residents understand the importance of practices such as handwashing, bathing, household cleaning, and drinking treated water, so it is not necessary to explain those practices.
Another promising approach to overcoming the sensitivity surrounding proper water use is to give residents credit for knowledge of the issues, and then following this with a specific and targeted message. For example, we might say “You know that handwashing is important, but do you know that washing hands before touching or holding a baby can help prevent respiratory infections?” This technique has been well received.
Lastly, the basis of our project is to conduct water-use promotion activities in three communities receiving in-home water services for the first time. This ties our project activities to the provision of water infrastructure. Construction in the Arctic is difficult and unpredictable. Although construction in one community is ahead of schedule, construction in remaining two has been delayed. To compensate, we are working to add a fourth project village that may replace one of the others in case of prolonged delays.
In Year 2, we will transition from development to implementation. This phase will involve delivery of the water-use promotion plan developed in Year 1. Water-use educational and promotional activities will be conducted in the three project villages and will target families who receive in-home water service. Our approach is based on principles of the Social Ecological Model and will focus on behavioral change at the individual, community, and policy levels.
Examples of our promotional activities include
- water-use orientation for households receiving in-home water service;
- school-based educational activities demonstrating the safety of treated water;
- distribution of a simplified, culturally appropriate supplement to the EPA-required Consumer Confidence Report;
- education for new mothers about in-home water use to protect their infants from illness; and
- monthly home visits by village-based project coordinators to reinforce key messages on proper water use.