April 17, 2015
Communicating with British Columbia’s Public about Water Issues:
Report based on interviews with BC’s Health Authorities’ water communicators and
focus groups with the public
Dr. Natalie Henrich (Center for Health Evaluation and Outcome Sciences, Providence Health)
Dr. Bev Holmes (Michael Smith Foundation for Health Research)
Introduction
As part of BC Public Health Microbiology and Reference Laboratory (BCPHMRL) Applied Metagenomics
of the Watershed Microbiome project, an exploratory study was undertaken to identify and understand
the communication strategies used by BC’s Health Authorities (HAs) for communicating directly with the
public about water issues. The HAs participate indirectly in communicating with the public via water
operators by providing content and messaging that gets passed onto the public by the operators. This
report focuses only on the HAs direct communications with the public. As a counterpart, focus groups
were conducted with members of the public in three of the HAs to identify the public’s preferences for
water communications (what they want to know; how they want to receive the information). This report
provides a descriptive analysis of the HAs communication practices (with respect to water) and how this
aligns with the public’s preferences.
Methods
In September and October 2012, phone interviews were conducted with representatives from each of
BC’s five regional HAs who communicate with the public about water issues (n=12 individuals).
Participants included managers or directors of environmental health officers, health protection, and
drinking water programs; medical health officers; and a water specialist. The semi-structured interviews
addressed:
 water situations or issues about which communications with the public occur,
 the content of communications with the public,
 the pathways by which information is communicated,
 what it means to communicate effectively and methods for effective communication, and
 what facilitates and challenges communicating with the public.
Eight focus groups were conducted with the public (n=72 individuals) in three of the HAs (VIHA, FH,
VCH). Led by an experienced qualitative researcher, the discussions addressed a set of semi-structured
questions, which included:
 what information they would like to receive and
 how they would like to receive information about water quality (pathways by which information
is shared and format).
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Interviews and focus group discussions were audio-recorded, transcribed and coded (in QSR NVivo, a
qualitative software analysis program) using theme codes (overarching issues) developed based on the
questions asked of participants and sub-theme codes (specific points that fit within an overarching
theme) derived from the content of the discussions. Themes were compared within and across focus
groups and HAs to identify differences and similarities across watersheds and HAs, and descriptively
analyzed. In order to protect confidentiality in describing the findings, results are attributed to the HA as
HA1, HA2, etc. and all respondents are referred to with the gender pronoun “he.”
Informed consent of the participants was obtained. The study protocol was approved by the University
of British Columbia, Vancouver, Canada, Behavioural Research Ethics Board.
Results
Part 1.What and how the HAs communicate with the public and how it aligns with public
preferences
Water issues that HAs communicate about with the public: HA representatives provided examples of
issues that require their direct communication with the public. These included communicating during
water-related emergencies or high risk situations, such as boil water advisories, arsenic in groundwater,
high water levels, beach closures, and flooding and landslides that may have impacted water quality as
well as non-crisis communications such as upgrades to water system infrastructure/treatment,
education about not drinking surface water, and safety tips for well users.
HA1 explained that communication around drinking water only occurs when there are problems (“We
seem to be in the bad news management game.”). The assumption is that drinking water is fine unless
the public hears otherwise. For recreational water, they promote and brag about positive test results
and the good quality of the water because recreational water quality is important for the local economy
vis-à-vis tourism and, unlike with drinking water, there is not an assumption that recreational water is
clean.
Content of messages: The following are examples of the content that was shared when communicating
about the aforementioned water issues. Not all HAs include the same information when reporting on
similar kinds of issues.
Arsenic in groundwater: HA1 and HA4 included results from the arsenic study, need for public to test
their water, need to treat water if levels found to be high; HA1 specified that when test results are sent
to the public it includes a fact sheet to assist in interpreting the results.
Boil water advisories: Messaging states that there is need to boil water and follow-up messages notify
the public when the situation is resolved. According to HA2 and HA4, advisories do not necessarily
include the reason for the advisory or the debates and issues that went into making the decision to issue
the advisory.
Water system upgrades: HA3 and HA5 conduct public consultations/town hall meetings to discuss the
requirements for the system infrastructure, why these requirements exist, and the benefits to human
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health and the watershed from doing the upgrades; options and impacts from the upgrades are
discussed.
High water levels: In HA2, communication includes a description of the situation, what is being done in
response, and who to contact for more information.
Beach closures: In HA2, test results are converted into a scale of colours corresponding to water quality
and level of risk.
More broadly, when water quality test results are shared, HA2 said they provide the type of testing,
what they believe to be the cause of the problem, the believed solution (if known), and what they do
not know. With some exceptions, such as the example of the beach closure notification described
above, HAs typically post raw test results without an interpretation of their meaning. HA1 explained that
an interpretation of E. coli levels is not provided with the sharing of results and that the public can call
and ask for more information if they have questions about the meaning or implication of the results.
HA3 and HA5 said that their messaging focuses on the health impact or risk to the public and
information shared includes the level of risk, routes of exposures, and what people can do to protect
themselves.
How HAs currently communicate with the public: Much of the HAs’ communication with the public
occurs via the water operators, such as announcements of boil water advisories and in the water
operators’ annual reports. When communicating directly with the public, each HA has a website on
which it posts information. There is duplication of information shared by the water operators with the
information on the websites. For example, websites typically include boil water advisories and the water
operators’ annual report. By regulation, HAs are also required to post laboratory results. HA2 has a
separate HA beach webpage on which they post the scale that interprets the beach test results (green
(good), yellow (moderate), red (swimming not recommended); the colours map onto the contamination
levels).
Media is used in limited ways by the HAs. HA2 and HA 3 said that the media is often not interested in
running stories brought to them by the HA but that water issues are covered in the media when they
initiate the story and approach the HA for an interview. HA2 and HA 5 use media releases when there is
information they need to get out to the whole region and H1 uses media is urgent situations. HA5
specified that media is used most effectively when the HA provides a set message to be released
verbatim.
Four of the HAs have at least limited use of one-on-one communication with residents in their region.
These interactions are usually initiated by the public, and typically involves speaking by phone or in
person with a member of the public who has contacted the HA with a question. HA3 communicates
about water issues by going out and talking in public forums and small groups, like residents of a mobile
home park or members of a community association. This HA representative stressed the importance of
developing relationships with residents as a cornerstone of effective communication. HA4 uses public
forums in emergency situations. HA5 does not use public forums for communicating with the public
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because, according to this representative, a meeting of this sort would be the responsibility of water
operators or local government rather than the HA.
HA 3, 4 and 5 mentioned handing out information door-to-door during crisis situations and/or in small
water systems and HA1 described the use of targeted letters and brochures. HA3 uses a range of
methods for attracting attention to and reinforcing their messages by displaying the messages in many
locations such as on tents on main routes in and out of town, billboards, and intercept displays (like a
display at a the side of the road heading to a trail saying “please don’t drink the surface water” followed
by a sign-up sheet at the trail head saying “please sign here to confirm that you have enough water to
take with you for consumption and emergency reasons and that you will not drink the creek water”).
None of the HAs use social networking for water communications. Two HAs have considered using it;
HA1 said they do not know how to initiate the use of this medium and are unsure about its effectiveness
and HA4 said they may use it in the future for issues that require fast and wide dissemination. HA5 uses
social networking for communication in other programs but it has not been used as part of the water
program.
What the public wants to know about water quality: Participants in the focus groups were split on how
much information they want about water quality. A significant minority said they only want information
if there is a problem (“no news is good news”) and that during times of non-crisis information and
warnings should be limited because water quality is generally fine and too much information may make
people paranoid about using water for recreational purposes or drinking from tap. The remaining
participants expressed that it is very important to know about water quality in general, and specifically
that there should be more alert systems and sharing of information when contamination events are
occurring.
For those who want information, the highest priority is receiving information on the risk associated with
using water (recreationally and for consumption). In the FH and VIHA groups a small number of people
want information on why tap water tastes like chlorine and if this is indicative of high levels of treatment
in response to contaminants (“And so it makes you wonder, well, then if—[chlorine is] in there for a
reason so what are they killing, right?”), and similarly, why tap water smells bad (does this indicate poor
water quality?).
In the VIHA and VCH groups people want information about where to find information about water
quality and water treatment.
The primary reason that the public was not interested in getting information about water is that they
perceive the quality of their water to be excellent and consequently they do not see a reason to concern
themselves with the issue. This is also coupled with a lack of awareness of some water hazards that do
pose a threat to human health, such as the risks associated with exposure to fecal contaminants.
How the public wants to receive information: When the public receives information about water
quality, they want the information provided in a way that explains what the results mean for human
health and the implications for using the water (i.e., Is it safe to swim in it? Is it safe to drink?). The
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public does not find raw test scores useful and they do not need to know about levels of specific
microbes. Rather, people want scales of water quality similar to the fire risk level displayed in parks or
the air quality and UV indexes.
Focus group participants in VCH and VIHA would like to see water quality information on the weather
channel just like air quality and UV information is provided. The VIHA participants were also enthusiastic
about accessing information from a credible website (assuming that the information is being posted in a
way that is easy to understand), with more limited support for websites in FH and VCH. Participants
from FH and VCH like getting information from mainstream media, especially during a crisis. However,
participants from VCH clarified that they want the media to report on sources the public perceives as
credible, preferring that the content comes from scientists rather than the water operators. More
broadly, in the VIHA and VCH groups a preference was voiced to receive information from professors
and scientists, who are perceived as unbiased and knowledgeable, as opposed to people working in the
industry who are seen as less trustworthy.
Part 2. Outcomes and strategies for effective communication
Outcomes of effective communication: HA representatives described several goals or outcomes of
effective communication:
 The public will have confidence in how the situation is being handled.
 The public will understand the risks they face or how the issue affects them.
 If a behavior is promoted by the HA then people will do that behaviour (e.g., boil water; don’t
swim at closed beach; bring in water samples for testing).
 People’s knowledge about the issue at hand will increase.
 The public’s and the media’s interest about the issue at hand will increase.
 Relationships and credibility between the HAs and the public will be established or improved.
 Improvements in health will occur.
In one HA, the representative said that behaviour change should not be an expected short-term
outcome of effective communication. He explained that people will only begin to change their
behaviours based on the recommendations of the HAs after they have come to trust the HAs. People’s
willingness to listen to and consider the messages presented by the HAs is a realistic short-term goal of
effective communication but behaviour change will occur in the longer-term after trust and
relationships have been established.
The HA representatives identified evaluation of communication as challenging. Consequently, they
found that they were unable to assess whether or not their communications have been effective. HA1
said that the expected outcome of effective communication is behaviour consistent with the messaging
but he doesn’t know what people do with information provided by the HA. While he can assess what
percentage of mail outs were delivered (i.e., not returned because of wrong address, etc.), he doesn’t
have a way to determine whether or not people read the documents or if they are doing the
recommended behaviours. He identified improved health as an outcome (and an indicator that
behaviour changes had occurred) but he said the HA lacks baseline data on water-related illnesses and a
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means for measuring changes in these illnesses. HA4 expressed the same challenge in evaluating if
communications led to behaviour change. HA5 described a challenge in determining what caused an
outcome to occur or not, explaining that their website appears to be ineffective because of the low
number of visitors to the site. However, he doesn’t know if the lack of visitors is a consequence of a
shortcoming on the part of the HA (e.g., people don’t know about the website; website doesn’t provide
useful information) or if people just don’t want much information about water issues and the low traffic
reflects the low level of interest.
Strategies for effective communication: The HA representatives provided many recommendations on
how messages can be effectively communicated. The recommendations are not used by all the HAs and
some are not used even by the people who made the recommendations. However, the following are
each recognized by at least one representative as something that ideally should be incorporated into a
communication strategy.
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Communicate openly and transparently, including what you do not know.
Create/share messages with varying levels of details to meet the needs of different people.
Modify the content of messages to target the background knowledge of different audiences.
Present the same message in different formats (e.g., signs, pamphlets, prompts along the
highway, humourous messages, town hall meetings).
Provide opportunities for two-way communication (dialogue between the public and the HAs);
provide ways for the public to ask questions
Convert test results into a scale of risk/water quality; provide descriptors with test results that
explain how information relates to health.
Do not include information that people can’t interpret or that can be misinterpreted; provide
clear and concise messages.
Use concise language; avoid jargon.
Messages should state the key message, the core issues, background, and re-statement of the
key message. Repeat the main message several times.
Keep messages practical. Focus on the health implications and any actions people should take.
Part 3. What facilitates and challenges communicating with the public
Facilitators to communication: HA representatives made the following recommendations for getting
messages to the public efficiently and in a way that increases the likelihood that the messages will be
accepted:
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Using the media:
 Have well-established contacts in the media and, ideally, personal relationships with
members of the media.
 Train supervisors on talking to the media (e.g., how to get key message across; how to
redirect/reframe questions to cover what the HA wants expressed)
 Use the media as a conduit for putting out a message. Provide a media release that can
be repeated verbatim.
Interacting with the public:
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Establish trust and relationships with the public prior to putting out messages and/or
engaging in a meeting with the public. For example, meet ahead of the start of a town
hall meeting to drink coffee together and chat informally.
 Relate to the public; connect with them (e.g., “I know how you feel. I felt the same way.
But what I found was...”).
Coordination:
 Have messages supported across different levels (e.g., coordinated news release and
message dispersed at local levels)
 Establish relationships with water operators before communications are needed so that
HA and operators can coordinate their messages and provide consistency to the public
 Create emergency response plans in advance of an emergency.
Challenges to communication: HA representatives identified many challenges that make it difficult to
communicate effectively with the public:
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Getting messages to the target audience:
 Difficult to get messages to people scattered across rural areas or in hard to reach areas.
 Finding pathways for sharing information when the media isn’t interested in running the
story.
 Getting people to use the HA website; challenges of access and lack of interest
 Having correct addresses to use for mail-outs.
Inducing people to be receptive to communications:
 Getting people who live in isolated communities to be receptive to messages; people
who choose to be isolated generally do not want government interventions
 Communicating with populations with whom no relationship/trust exists
 Motivating people to act on the messages and change their behaviours; getting people
to translate knowledge into action.
 Getting people to read mail-out brochures
 Overcoming people’s lack of interest in water quality issues; people who don’t
understand the importance of having the information that is being communicated
Avoiding confusion in communications:
 Balancing the messages that water is generally good but still need to test water or flush
taps, etc.
 Confusion when message needs to vary by water system (e.g., different levels of
advisories for different water systems within the same region plus one region-wide
advisory).
 Confusion from water advisories because unable to tell the public definitively that the
water is or is not safe.
 Confusion and/or too much information when need to communicate about multiple
issues at the same time
 Determining the right level of detail to include in messages; how much information to
provide on website; need to find balance between giving enough information but not
creating misunderstandings
 Providing context for test results; helping the public understand that results relate to
specific times and conditions; sharing test results in a way that people can understand
how it impacts them
Achieving consistency in messaging:
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Lack of coordination in messaging by water operators and HAs; operators sometimes
put up boil water notices without notifying the HA (impacts credibility because
operators and HA look disorganized)
 Getting the media to present information the way the HA wants it presented; message
gets distorted when interviews are edited
 Managing messages put out by private interest groups.
Providing appropriate content:
 Determining what the public wants to know; no process for getting this information
 Communicating a message to a varied audience; creating a “one size fits all” message
Discussion
Several key findings emerged from the interviews with the HA representatives and the focus groups with
members of the public. The HAs primarily communicate with the public about water issues when there
is a crisis or risky situation but rarely communicate for the sake of general information sharing (like how
and why water is treated) or to engage around on-going issues (like the use or non-use of chlorine and
fluoride). While this may seem to be a shortcoming of the communication strategy, it is consistent with
the preferences of the public who are most interested in getting information during crisis situations.
There are two situations in which the current approach of focusing communications on high risk
situations are problematic. First, there is a subset of the public who would like to be able to seek out
useful information about water quality and cannot currently find a place to get this information. While
each HA posts water quality test results on their websites, the public wants results converted to a scale
that reflects quality and/or risk to human health from different kinds of exposure to the water. Most
people were also unaware that the HAs post water quality information. The HAs can meet the public’s
needs for water quality information by both increasing awareness of their websites and providing test
results with context and interpretation. Second, one of the reasons for the public’s low interest in water
interests is their perception that water quality is excellent and shortcomings in their knowledge about
what constitutes poor water quality the risks associated with it. If the HAs are able to improve the
public’s understanding of the health issues associated with water quality (such as the risks to human
health from exposure to fecal contaminants) then there may be more overall interest in receiving and
acting on messages disseminated by the HAs. As identified by some HA representatives, the challenge
will be finding the balance between raising awareness of water quality issues while protecting the
public’s belief that water quality is good.
The HAs find it challenging to get information into the hands of the public. The techniques being used to
share information are fairly traditional. Incorporating new technologies and social networking mediums
for dissemination of information may be an effective way to reach larger audiences. For example,
messages can be sent out via Twitter or the HAs can create an app (application) that provides water
quality scales for local beaches or other useful information. The advantage of these mediums is that
people opt in to receive information ensuring that people who are interested can get information when
they want it. However, people can also be encouraged to sign up to receive notifications in the event of
a water crisis. In such a situation, messages can be rapidly disseminated information to large numbers of
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people by pushing information out via mediums such as email or text messages. Technology can also be
used to facilitate two-way communication between the HAs and the public. At present, most dialogue
between the public and the HAs occurs by telephone when the public reaches out to the HAs for
information. With technology, the public can participate in virtual town hall meetings, such as the ones
conducted over the phone by politicians in which large numbers of the public phone in at the same time
to listen to a speaker and ask questions. These kinds of interactions may help the HAs build trust and
relationships with the public in advance of a crisis situation at which time having pre-established trust
will improve the effectiveness of communications and increase the likelihood that recommended
behaviours are adopted.
Lastly, the HAs have clear ideas of the expected outcomes of effective communication but evaluation of
communications is largely absent. Without evaluation, there is no way of knowing if the messages and
communication strategies being used by each HA are effective and this knowledge is critical for
determining if changes need to be made to the way in which communication occurs. Several challenges
in evaluating communications were identified by HA representatives. These challenges are not
insurmountable and can be overcome with the use of a trained evaluator to conduct the evaluation or
work with the HA in developing an evaluation plan (including indicators and methods for collecting the
needed data). The evaluation strategy should be developed at the same time as the communication
strategy with regular feedback provided to the HA so that real-time modifications can be made to
communications, as needed, rather than waiting until the end of the communication campaign to find
out what should have been done differently. Evaluation will require resources but the benefits of
improving the effectiveness of communications should be worth the costs.
Summary
The HAs are well aware of the challenges in communicating with the public as well as many techniques
and strategies that could be used to facilitate communications. They are also focusing their
communications on crisis or high risk situations, which is consistent with the public’s reported
preferences for receiving information. For those members of the public who do want more information,
the HAs can use their websites more effectively by promoting them and posting information in ways
that are more understandable and usable by the public. Despite the public’s generally low interest in
receiving information about water issues, outreach may be necessary to provide people with the
baseline knowledge needed for recognizing the importance of receiving water information. New
technologies can be useful tools in getting information into the hands of the public and providing them
with easy ways to access information.