Home Health Navigator Program for Pollution Exposure

Overseen By Veronica L Irvin, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Oregon State University

Disqualifiers: Non-Oregon residents, Non-homeowners, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

98 Participants Needed

Trial Summary

What is the purpose of this trial?

Approximately 34 million Americans rely on private wells to supply their drinking water. Private wells are excluded from the Safe Drinking Water Act. Consequently, people who use private wells have not benefited from pollution prevention activities mandated by this law. This is a public health concern because toxic chemicals such as arsenic, nitrate, and lead are frequently detected in drinking water provided by private wells at concentrations that exceed the Safe Drinking Water Act's maximum contaminant levels. Chronic exposure to toxics in drinking water increase the risk of several chronic diseases. Several states in the U.S. have implemented or are proposing legislative policies to require testing and treatment of private wells and it is critical that public health agencies offer a program to aid homeowners with adherence to these new policies. Subsequently, there is a need to determine if individual-level interventions would be more effective for promoting behaviors that would reduce, mitigate, or eliminate exposure to contaminated well water. Lay health care workers may be able to provide cost-effective counseling to promote environmental health decision making among homeowners that have contaminated wells. This study will involve a community efficacy trial that brings together university-based researchers, State and Local agencies, and Extension Services. The community efficacy trial will be implemented by community health navigators via the Extension service. Specifically, it will involve a randomized controlled trial in Oregon to test the acceptability, fidelity, scalability and efficacy of 2 different intervention arms to reduce harmful toxicant exposures through the adoption of appropriate well water treatment. Upon completion, it will will produce a private well safety intervention program that has been tested and modified through empirical research. By capturing the costs and retaining the most efficacious intervention components, our cooperative approach has a better chance of scalability into practice across multiple stakeholders (i.e. Extension services, state health agencies). This information has the potential to reduce health disparities in rural America that are related to a household's source of drinking water.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Community health worker in the Home Health Navigator Program for Pollution Exposure?

Research shows that community health worker programs can improve health outcomes by helping patients access primary care, enhancing communication during hospital discharge, and reducing hospital readmissions. These programs have also been effective in managing conditions like asthma and improving cancer screening rates, suggesting they can be beneficial in addressing pollution exposure as well. ^{1 2 3 4 5}

Is the Home Health Navigator Program for Pollution Exposure safe for humans?

Community health worker programs, like the Home Health Navigator Program, have been used safely in various settings to support vulnerable populations, such as those with chronic illnesses or at risk of infant mortality. These programs focus on providing health education, referrals, and social support, and are generally considered safe when implemented with proper training and resources. ^{6 7 8 9 10}

How does the Home Health Navigator Program for Pollution Exposure treatment differ from other treatments?

The Home Health Navigator Program for Pollution Exposure is unique because it uses specially-trained community health workers to provide personalized support and education to individuals, focusing on reducing exposure to environmental pollutants. This approach is distinct from traditional medical treatments as it emphasizes community-based, culturally sensitive interventions to address social determinants of health and improve overall well-being. ^{3 7 11 12 13}

Research Team

Molly Kile, ScD

Principal Investigator

Oregon State University

Veronica Irvin, PhD

Principal Investigator

Oregon State University

Eligibility Criteria

This trial is for homeowners over 21 in Jackson County, OR, who use a private well as their main drinking water source and plan to stay in their home for at least the next year. They must be able to fill out a questionnaire in English or Spanish.

Inclusion Criteria

Currently live in the home with the private well and intend to live in the home for at least 12 months from now

I am at least 21 years old.

Be a homeowner with a private well

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive a free well water test kit and materials from the Oregon Health Authority. Health navigators meet with homeowners to assist in decision-making and promote environmental health.

12 months

3 visits (in-person or virtual)

Follow-up

Participants are monitored for changes in well stewardship behaviors and health outcomes through surveys and water testing.

12 months

Treatment Details

Interventions

• Community health worker

Trial Overview The study tests if community health workers can effectively counsel homeowners on reducing exposure to arsenic, nitrate, and lead from private wells. It's a randomized controlled trial comparing two intervention methods for promoting safe water practices.

Participant Groups

Group I: Arm 2: Health navigator Experimental Treatment 1 Intervention

People will receive a free well water test kit that is delivered by mail and the results from this water test. They will also be mailed material that is provided by the Oregon Health Authority's Domestic Well Stewardship Program which is the Water Well Owner's Handbook(in English or Spanish) and contaminant guides. In addition, a trained health navigator will meet with the homeowner three times to assist the homeowner's decision-making. Activities include: i) Interpreting results, ii) Improving health literacy and numeracy through teach-back moments, iii) Assessment of household risk for contaminants from well and septic, iv) Assessment of risk to family members, pets, livestock, etc v) Coaching to resolve ambivalence or lack of motivation and other barriers using elicit-provide-elicit motivational interviewing; vi) Assistance with decision-making and weighing financial options, and vii) Goal-setting and action plans.

Group II: Arm 1: Usual practice Active Control 1 Intervention

People will receive a free well water test kit that is delivered by mail and the results from this water test. They will also be mailed material that is provided by the Oregon Health Authority's Domestic Well Stewardship Program which is the Water Well Owner's Handbook(in English or Spanish) and contaminant guides.

Who Is Running the Clinical Trial?

Oregon State University

Lead Sponsor

Trials

51

Recruited

8,300+

National Institute of Environmental Health Sciences (NIEHS)

Collaborator

Trials

294

Recruited

1,233,000+

Oregon Health Authority

Collaborator

Trials

4

Recruited

24,100+

Oregon Health Authority

Collaborator

Trials

4

Recruited

24,100+

Findings from Research

The community health worker (CHW) program helped 1600 frequent emergency department users in Buffalo, New York, achieve 43% of their health-related objectives, primarily focused on connecting clients to community resources and primary care.

Success in achieving these objectives was linked to higher client engagement with CHW services, indicating that improving access to resources and addressing systemic barriers could enhance the program's effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community Health Workers: Addressing Client Objectives Among Frequent Emergency Department Users. Kwan, BM., Rockwood, A., Bandle, B., et al.[2019]

A tailored community health worker (CHW) intervention significantly improved posthospital outcomes for low-socioeconomic status patients, increasing timely primary care follow-up from 47.9% to 60.0% and enhancing the quality of discharge communication.

The intervention also led to better mental health improvements and patient activation, while reducing the likelihood of multiple 30-day readmissions, indicating that CHWs can effectively address socioeconomic and behavioral factors affecting recovery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. Kangovi, S., Mitra, N., Grande, D., et al.[2018]

A 15-hour training course significantly improved the asthma medication instruction abilities of 11 immigrant Mexican community health workers (CHWs), with median correct technique scores rising from 25% to 69% for metered dose inhalers and from 0% to 64% for spacers after training.

Post-training evaluations showed that all CHWs demonstrated adequate understanding of medication delivery techniques, indicating that with proper training, CHWs can effectively help families manage asthma medications.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of an asthma medication training program for immigrant Mexican community health workers. Martin, MA., Mosnaim, GS., Rojas, D., et al.[2011]

References

1. United States pubmed.ncbi.nlm.nih.gov

Community Health Workers: Addressing Client Objectives Among Frequent Emergency Department Users. [2019]

2. United States pubmed.ncbi.nlm.nih.gov

Effect of weatherization combined with community health worker in-home education on asthma control. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Community health workers and environmental interventions for children with asthma: a systematic review. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Use of Community Health Workers and Patient Navigators to Improve Cancer Outcomes Among Patients Served by Federally Qualified Health Centers: A Systematic Literature Review. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. [2018]

6. United States pubmed.ncbi.nlm.nih.gov

Safety and Health Support for Home Care Workers: The COMPASS Randomized Controlled Trial. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

The Evolution of an Innovative Community-Engaged Health Navigator Program to Address Social Determinants of Health. [2017]

8. United States pubmed.ncbi.nlm.nih.gov

A Community Health Worker Home Visit Program: Facilitators and Barriers of Program Implementation. [2021]

9. England pubmed.ncbi.nlm.nih.gov

An Analysis of the Availability of Health Education Materials for Migrant and Seasonal Farmworkers. [2023]

10. United States pubmed.ncbi.nlm.nih.gov

Evaluation of an asthma medication training program for immigrant Mexican community health workers. [2011]

11. England pubmed.ncbi.nlm.nih.gov

An evaluation of the asthma intervention of the New York State Healthy Neighborhoods Program. [2019]

12. England pubmed.ncbi.nlm.nih.gov

Community health workers providing asthma education. [2022]

13. Switzerland pubmed.ncbi.nlm.nih.gov

Recruitment, Training, and Roles of the Bilingual, Bicultural Navegantes: Developing a Specialized Workforce of Community Health Workers to Serve a Low-Income, Spanish-Speaking Population in Rhode Island. [2021]