A collaborative multimedia campaign leveraging online patient portal messaging to promote environmental health in Hunterdon County, New Jersey

Background:

Most private wells have never been tested for arsenic, even in areas of high natural prevalence like Hunterdon County, New Jersey, where over 16% of private wells exceed the state standard for drinking water in tests required during real estate transactions. Households with pregnancies and young children are a priority group for water screening due to their increased vulnerability to adverse health impacts from arsenic exposure.

Program background:

Hunterdon Healthcare partnered with Columbia University and the New Jersey Departments of Health and Environmental Protection to offer patients with private wells free drinking water tests for arsenic and lead. A limited practice-based effort was undertaken to promote free tests to clinic-patients, which included presentations to medical providers on arsenic prevalence and risks, and informational brochures and posters in exam and waiting rooms. Additionally, an Earth Day well testing campaign the following year leveraged social media, news media, and billboards to raise awareness about arsenic to the wider community and was timed to coincide with an offer for free arsenic testing sent to over 10,000 patients through the Hunterdon Healthcare online portal, the first time the patient portal was used for large-scale population health outreach. Leveraging this innovative channel allowed targeting messages to vulnerable populations based on demographics and residence in known high-risk arsenic areas.

Evaluation Methods and Results:

About 20% of portal messages were opened; however, without patient data on home water supply, messages could not be restricted to only those who drink from private well water, thus the final rate of uptake is unknown. Most portal recipients who submitted water samples reported children in the home (92%) and 9% cited current or imminent pregnancies. In total, 457 test kits were requested online over a nearly 3-month period, both from patient portal requests and through the wider community offer to households with children, with 70% returned to date. 10% of the water samples tested were found to exceed the NJ drinking standard for arsenic, 5 µg/L. In comparison, 117 water samples were collected over 18+ months of limited practice-based distribution, where > 16% of those wells exceed 5 µg/L arsenic, reflecting the selection of clinics in particularly high-risk areas. The majority of testing participants had never tested their private well water for arsenic before.

Conclusions:

This project successfully targeted a well testing offer based on geographical risk and biological vulnerability to arsenic in drinking water, across multiple communication channels, including an innovative approach to leverage an online healthcare patient portal. This multi-media campaign generated more water tests in a shorter period of time than the limited practice-based outreach approach, where motivating doctor-patient conversations around drinking water proved challenging.

Implications for research and/or practice:

This project demonstrates the potential of public health collaborations between state agencies, academic researchers, and health care professionals, as well as the utility of increasingly common patient communication platforms. Changes to the Electronic Health Records used during clinic visits to include well water supply can allow for more specific targeting of patients at risk in the future.