Abstract
Reducing disease from unsafe drinking-water is a key environmental health objective in rural Sub-Saharan Africa, where water management is largely community-based. The effectiveness of environmental health risk reporting to motivate sustained behaviour change is contested but as efforts to increase rural drinking-water monitoring proceed, it is timely to ask how water quality information feedback can improve water safety management. Using cross-sectional (1457 households) and longitudinal (167 participants) surveys, semi-structured interviews (73 participants), and water quality monitoring (79 sites), we assess water safety perceptions and evaluate an information intervention through which Escherichia coli monitoring results were shared with water managers over a 1.5-year period in rural Kitui County, Kenya. We integrate the extended parallel process model and the precaution adoption process model to frame risk information processing and stages of behaviour change. We highlight that responses to risk communications are determined by the specificity, framing, and repetition of messaging and the self-efficacy of information recipients. Poverty threatscapes and gender norms hinder behaviour change, particularly at the household-level; however, test results can motivate supply-level managers to implement hazard control measures—with effectiveness and sustainability dependent on infrastructure, training, and ongoing resourcing. Our results have implications for rural development efforts and environmental risk reporting in low-income settings.
Highlights
Introduction iationsRisk communications that describe a hazard with the purpose of motivating behaviour change are often conceptualized as fear appeals [1]
We conceptualize water quality results-reporting as a form of fear appeal and we investigate the potential effects of sharing water quality monitoring data with rural water users and lay water managers (LWMs)
Piped surface water supplies were rarely free of E. coli and the groundwater supplies had a broad range of E. coli, conductivity, and fluoride results—demonstrating that supply type is an inadequate proxy for water safety or acceptability
Summary
Risk communications that describe a hazard with the purpose of motivating behaviour change are often conceptualized as fear appeals [1]. They are used extensively for public health messaging and the fear appeals literature, which has developed over 7 decades, offers varied views on the persuasiveness and optimal design of appeals on a range of topics including the management of domestic and wider environmental exposures [1]. Access to information impacts perceptions of environmental health risks, including from drinkingwater [2], and information-based feedback loops are key determinants of behaviour in complex adaptive systems [3]. Research has evaluated the impact of risk communications on diverse issues, from preventing contraction of malaria [4] or human immunodeficiency virus (HIV) [5] to reducing neurotoxin-producing cyanobacterial blooms in water bodies [6].
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