Impact of a boil water advisory on in-home water and food handling practices: A qualitative study

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Lacroix, Bonnie J.

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University of Guelph

Abstract

Boil water advisories (BWAs) are issued when municipal drinking water supplies are found to be contaminated with microbial pathogens. This event case study describes how a BWA in 2000 influenced in-home consumer practices in a small Canadian rural community with high rates of morbidity and mortality during a waterborne outbreak. Fifty-eight adult respondents answered opened-ended questions in focus groups or telephone interviews relating to a 198-day BWA. Responses from a purposive sample are presented. A home pathogen control framework systematically positioned self-reported handling practices of three groups (Mothers, Seniors, and Others) for assessment. Mothers reported using bottled water for all in-home activities, including bathing children, out of fear that boiling would not render the tap water safe. Older respondents had problems coping as evidenced by using potentially risky dishwashing practices, needing more time to change practices, reporting difficulties transporting water within the home, choosing to avoid purchasing fresh food for the duration of the event, and failing to recognize that Seniors are as much at risk for illness or complications as are young children. Seventy-two per cent of Others took two or more days to comply with the initial recommendations. Only males stated the BWA was not problematic. Issues requiring attention include: the need to provide multiple compelling messages repeatedly in more than one format targeted to specific at-risk groups; the need for messages to be prescriptive, practical, salient and timely for residents to change practices that reduce or eliminate crosscontamination and exposure; and a requirement that messages must be correct the first time they are presented. Respondents in this study were mostly well educated and experienced in handling food in the home but were unable to implement a full home pathogen control plan. Less well educated individuals or those with cognitive deficits would likely experience greater difficulty in managing the BWA. Changes in food purchasing and consumption patterns in a BWA of long duration could have serious nutritional implications for at-risk populations. The results are of greatest use to those preparing advisory messages for the general public or food and health professionals working with individuals during a waterborne outbreak.

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Keywords

boil water advisories, municipal drinking water supplie, contamination, microbial pathogens, in-home consumer practices, Canadian rural community, morbidity, mortality, waterborne outbreak

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