Expanding the Purview of Environmental Data Report-back and Environmental Health Literacy

Abstract

Access to information and resources is not equitably distributed (1–5). These inequities have been associated with adverse health outcomes (6–9). Enhancing access to personal health data and information via data democratization has been touted as a means of addressing information and health inequities (10–13). Within the field of environmental health, there is increasing interest in return of research results (i.e., data report-back) to participants of exposure assessment studies as a method of data democratization (11,14–18). Returning environmental health results back to participants provides access to information that may not otherwise be available to them. It can provide insight regarding hazardous exposures and suggestions for health-protective behaviors. However, making environmental health data available does not necessarily mean that the data are accessible. Research regarding impact of environmental data report-backs has largely focused on knowledge gain and actionable outcomes. Both have been housed under the overarching skillset labeled, ‘Environmental Health Literacy’ (EHL). Little research has evaluated the impact of data report-back on domains beyond these two components of EHL, missing opportunities to identify areas for improvement regarding message creation and distribution. The objective of this dissertation is to explore existing EHL for a specific environmental exposure, indoor air quality, and to augment existing methods for creating and assessing accessible environmental health data report-backs. First, we build upon suggested evaluation metrics (namely, participant valuation) by introducing assessments of reach, understandability, and actionability of a data report-back effort. We found that there were significant demographic differences in terms of who engaged in the report back process and determine that additional methods are necessary to evaluate impact of environmental health data messaging. Next, we engage in interpretivist grounded theory to inductively explore the ways in which participants (n= 20) of an indoor air quality study attend and make sense of their home’s indoor air quality (IAQ). Our findings suggest that family health concerns and sensory awareness of indoor air contaminants were primary motivators for participants to spend time making sense of indoor air quality, and that certain intervening conditions (such as perceived self-efficacy, risk perception, and accessibility of environmental health information) influenced participants’ ability and interest to take action to address their home’s indoor air quality. These findings present challenges to existing conceptualizations of EHL on two fronts: that is an attribute of an individual and that the proposed continuum between knowledge and action is a reasonable metric for evaluating EHL. Finally, we combine formative research with best practice guidelines for written materials from evidence-driven health literacy tools and health communication theory to produce accessible audience-informed data report-back materials. We outline a process for developing and evaluating environmental health data reports that are tailored to inspire risk-reduction actions, and are demonstrably accessible in terms of their literacy, numeracy, and data visualization demand.