Nor Any Drop to Drink: Creating a Community-Based Assessment Tool to Address 1,4-Dioxane Water Contamination

1,4-Dioxane (DX), a synthetic organic chemical solvent prevalent in water systems, has been monitored by the U.S. Environmental Protection Agency (EPA) as a possible carcinogen since 2013. Delegation of risk tolerance levels to states has resulted in varying exposure standards across the U.S., concerning DX-impacted communities. This study employed a community-based participatory research (CBPR) to design a survey that identifies DX-impacted communities' concerns and preferred risk management strategies.

CBPR survey design drew on descriptions of two DX-impacted communities in Michigan and North Carolina to target key issues and outcomes. An addendum to the survey was designed to gather expert reviewer feedback and face-validate the draft survey using mixed methods. Snowball sampling increased the expert-reviewer sample size (N = 29). Targeted reliability statistics were applied to eight Likert-scale evaluation questions.

Thematic scoring of responses highlighted requests for tools that may prompt timelier and more effective control of related health risks. Cronbach's alpha coefficient (0.93) showed high internal consistency regarding the respondents' expression of the validity of the survey.

Experts supported advancing the survey's criterion testing in one DX-impacted community. This design approach may be used by public health nursing teams to amplify community voices, integrate contextual evidence with epidemiology, strengthen advocacy, and guide multisector collaboration regarding DX-related health risks.