Intervention effect on treatment.

This study sought to identify the psychosocial influences on the practice of well stewardship behaviors (water testing, water treatment, and well maintenance) in rural Georgia, USA. Three interventions (education, the provision of household water treatment systems [HWTS], and both education and HWTS) were evaluated using a four-group, randomized controlled trial. A total of 64 private well owners completed a pretest measuring psychosocial factors and stewardship behaviors before receiving an intervention. Following a 104-day waiting period, participants completed a posttest and interviews were conducted to identify the barriers and facilitators to use (S1 File). Pretest results showed that 34% of well owners have ever tested their water and that only 25% treat their water before consumption. The education-only intervention showed no influence on stewardship behaviors, resulted in no new water tests and had no impact on psychosocial factors. The HWTS-only intervention had no significant effect on testing and treatment behaviors, though it had a significant effect on abilities (R2 = .87, p< 0.05) and self-regulation (R2 = 1.0, p<0.01). The intervention of both education and HWTS had no effect on testing and no significant effect on treatment behaviors, though had a significant effect on abilities (R2 = .84, p<0.05) and self-regulation (R2 = .93, p<0.05). This study identified three barriers to the use of HWTS: beliefs, knowledge, and functionality. Two factors (piece of mind and ease of use) were identified as facilitators to the use of HWTS. The results of this study indicate that providing water treatment systems does not guarantee use and that current educational efforts provided by state and local health departments may be ineffective.本研究旨在探明美国佐治亚州农村地区私人水井管理行为（包括水质检测、水处理及水井维护）实践的社会心理影响因素。研究采用四组随机对照试验（randomized controlled trial），对三类干预措施展开评估：单纯教育干预、家庭水处理系统（Household Water Treatment Systems，HWTS）供给干预，以及教育与HWTS联合干预。共计64名私人水井所有者参与研究，在接受干预前完成了涵盖社会心理因素与水井管理行为的前测。经过104天的等待周期后，参与者完成后测，并开展访谈以探明HWTS使用的障碍与促进因素（详见附件S1文件）。 前测结果显示，34%的水井所有者曾进行过水质检测，仅25%的所有者在饮水前会对水质进行处理。单纯教育干预对水井管理行为无显著影响，未促成新增水质检测行为，且对社会心理相关因素无作用。仅提供HWTS的干预组对水质检测与水处理行为无显著影响，但可显著提升个体能力（R²=0.87，p<0.05）与自我调节能力（R²=1.0，p<0.01）。教育与HWTS联合干预对水质检测无影响，对水处理行为亦无显著作用，但可显著提升个体能力（R²=0.84，p<0.05）与自我调节能力（R²=0.93，p<0.05）。 本研究明确了HWTS使用的三类障碍：认知信念、知识储备与系统功能。另有两项因素被认定为HWTS使用的促进因素：安心感与操作便捷性。研究结果表明，仅提供水处理系统无法确保其被实际使用，且当前州级与地方卫生部门开展的教育宣传工作或未达预期效果。