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Protocol for Cryptosporidium Risk Communication for Drinking Water Utilities Mitch Small, Baruch Fischhoff, Claire Palmgren, Felicia Wu, Elizabeth Casman Center for Integrated Study of the Human Dimensions of Global Change, Carnegie Mellon University CIS oƒ HDGC Carnegie Mellon Sponsored by a grant from the American Water Works Association Research Foundation What is cryptosporidiosis? Acute gastrointestinal disease Caused in humans by an intracellular protozoan parasite, Cryptosporidium parvum Symptoms include explosive watery diarrhea, nausea, low-grade fever Self-limiting in otherwise healthy hosts Can be fatal in people with AIDS No cure currently available Small concentrations of Cryptosporidium are likely to be found in many drinkingwater source and finished waters. How should utilities report this information to avoid misunderstandings? • How can utilities communicate risk and uncertainty while maintaining customer confidence? • How can the utility be sure customers understand the information? Mental Models Methodology • Depicts an individual’s beliefs regarding a risk process and the options for addressing the risk • Identifies crucial gaps in information and misunderstandings by contrasting the mental model with an expert model Mental Models Protocol • Develop expert model of Cryptosporidium transmission • Interview public about Cryptosporidium risk • Develop lay public mental model of Cryptosporidium risk • Compare lay knowledge with expert model to identify significant gaps • Create structured questionnaire incorporating critical facts and gaps • Create communication instrument • Test success of communication • Iteratively refine communication CIS oƒ HDGC Carnegie Mellon Expert Model Contamination of Drinking Water Health Effects timestep = 1 week Consumption of treated water Utility treatment options Medical Awareness Averting behavior for public systems Routine testing results Health Department awareness Utility awareness Utility Communique Consumption of well water Tap test Averting behavior for private wells Well test Info sources Consumer awareness for public systems Consumer awareness for private wells Trigger Event Special studies Joint task force Media coverage Top Level Diagram: Awareness, Communication, and Behavior Present in surface water Contamination of Drinking Water timestep = 1 week Module Source of Cryptosporidium Government enforcement actions Present in utility intake Present in finished water Present at tap Distribution system contamination Source water type Well vulnerability Access to ground water Subsurface attenuation Present in ground water Present in private wells timestep = 1 week Proportion HIV+ Mortality Proportion on Public System Endemic rate HIV+ Endemic rate HIV - Epidemic Morbidity Other Sources Secondary Transmission Total Endemicity Herd Immunity Health Effects Module Outbreaks caused by Other Factors eaters exposed Person to Person and Zoonotic people exposed Sexual contact Animal Contact Foodborne prepared foods and meat swimmers exposed Recreational Water fresh fruits, vegetables and drinks Day Care Hospital and Nursing Home handler irrigation water feces wash water Other Sources Module lakes, ponds rivers, streams swimming pools, beaches Progress to date: •Completion of Expert Model •External Review of Expert Model •Review of existing communication instruments (brochures and websites) for content, form, and accessibility •Development of lay elicitation materials •Pre-testing of lay elicitation protocol •Completed plan for in-depth interviews CIS oƒ HDGC Carnegie Mellon
