Compliance with water advisories after water outages in Norway

Abstract

Background: Water advisories, especially those concerning boiling drinking water, are widely used to reduce risks of infection from contaminants in the water supply. Since the effectiveness of boil water advisories (BWAs) depends on public compliance, monitoring the public response to such advisories is essential for protecting human health. However, assessments of public compliance with BWAs remain sparse. Thus, this study was aimed at investigating awareness and compliance among residents who had received BWAs in Baerum municipality in Norway. Method: We conducted a cross-sectional study among 2764 residents who had received water advisories by SMS in the municipality of Baerum between January and September 2017. We analysed data from two focus group discussions and an online survey sent to all residents who had received an advisory. We conducted descriptive analyses and calculated odds ratios (OR) using logistic regression to identify associations of compliance and awareness with demographic characteristics. Results: Of the 611 respondents, 67% reported that they had received a water advisory notification. Effective compliance rate with safe drinking water practices, either by storing clean drinking water or boiling tap water, after a water outage was 72% among those who remembered receiving a notification. Compliance with safe drinking water advisories was lower among men than women (OR 0.53, 95% CI 0.29-0.96), but was independent of age, education and household type. The main reason for respondents' non-compliance with safe water practices was that they perceived the water to be safe to drink after letting it flush through the tap until it became clear. Conclusions: Awareness of advisories was suboptimal among residents who had received notifications, but compliance was high. The present study highlights the need to improve the distribution, phrasing and content of water advisory notifications to achieve greater awareness and compliance. Future studies should include hard-to-reach groups with adequate data collection approaches and examine the use of BWAs in a national context to inform future policies on BWAs.