Risk Communication and Factors Influencing Private Well Testing Behavior: A Systematic Scoping Review

Abstract

Unregulated private wells may be at risk for certain types of contamination associated with adverse health effects. Well water testing is a primary method to identify such risks, although testing rates are generally low. Risk communication is used as an intervention to promote private well testing behavior; however, little is known about whether these efforts are effective as well as the mechanisms that influence effectiveness. A systematic scoping review was conducted to evaluate the current evidence base for risk communication effectiveness and factors that influence well testing behavior. The review was conducted with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework. Data were synthesized using a health behavior model (Health Belief Model) to identify areas amenable to intervention and factors to consider when designing risk communication interventions. We identified a significant shortage of studies examining the effectiveness of risk communication interventions targeted to well testing behavior, with only two quasi-experimental studies identified. The review also identified seventeen studies that examined or described factors relating to well testing behavior. The two empirical studies suggest risk communication methods can be successful in motivating private well owners to test their water, while the remaining studies present considerations for developing effective, community-specific content.

Keywords: behavioral intervention; drinking water; health behavior; private wells; risk communication; well testing.

Figure 1

General components of the Health Belief Model (HBM). The HBM is a widely applied health behavior framework that can be used to explain and theorize areas to target in communication interventions. Source: Adapted from Glanz et al., 2015.

Figure 2

Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow diagram for the stages of selecting articles for inclusion. * One article addressed both risk communication interventions and factors affecting decisions to test private wells.

Figure 3

Counts and associations of modifying factors identified in the literature. Modifying factors are primarily demographic, structural, or socio-psychological variables that can influence behavior. Factors are presented in order from the most prevalent to least prevalent in the literature.

Figure 4

Counts and associations of individual beliefs identified in the literature. Individual beliefs that can influence behavior include factors related to perceived susceptibility to a harm, perceived seriousness of a harm, perceived self-efficacy, and perceived benefits and barriers to taking action. Factors are presented in order from the most prevalent to least prevalent in the literature.

Figure 5

Counts and associations of cues to action identified in the literature. Cues to action are internal or external events or phenomena that can trigger action. Factors are presented in order from the most prevalent to least prevalent in the literature.

Figure 6

Updated Health Belief Model (HBM) with synthesized data from the systematic scoping review. Source: Adapted from Glanz et al., 2015.