Navigating the Waters of Community Water Fluoridation: An Environmental Assessment Steers the Way

Theoretical Background and research questions/hypothesis:  Although community water fluoridation (CWF) was named one of 10 great public health achievements of the 20^th century by the Centers for Disease Control and Prevention (CDC), educating the public about its benefits and safety continues to be challenging. For more than 65 years, CWF has been used throughout the U.S. to prevent tooth decay and improve oral health. In 2010, nearly 74 percent of the U.S. population had access to fluoridated tap water from their community water system. A Healthy People 2020 objective is to increase the percentage to 79.6 percent. CDC contracted with Hager Sharp to develop a National Communications Plan to support CWF. To develop the plan, valuable information and insights about the complex issue of CWF was gathered; therefore, an environmental assessment was conducted to inform the plan. The assessment’s goals were to:

• Construct a snapshot of the current landscape around CWF in the United States;
• Provide insight for selection and/or segmenting of target audiences; and
• Inform communication goals, objectives, and strategies (within the constraints of time and agency resources).

Methods:  To meet the goals of the environmental assessment and ultimately provide relevant and timely communication recommendations to CDC, Hager Sharp implemented the following methods:

1. Online search
2. Media audit
3. Partner website audit
4. Fluoride campaign/program website audit
5. External subject matter expert interviews
6. Internal stakeholder interviews
7. Literature review
8. Existing materials review

Results:  Specific findings from each method were captured and overall themes were constructed. The main findings included:

• Those who do not want CWF are using online resources extensively, consistently and quickly to share information, and be first “out of the gate”
• Many large health organizations support CWF, but there is not a sole “leader”
• CWF is a difficult topic to understand and communicate
• CWF is a localized issue with national roots
• Water engineers and water operators are an important audience
• Local spokespeople can be very effective
• Media coverage tends to be local/ community-based

Conclusions: 

In the end, the findings informed the following recommendations:

• Make it easy. Provide a single, one-stop shop of resources and information for the most important target audiences.
• Partner, partner, partner. Develop a systematic, centralized partnership structure with role delineation.
• Focus on the issue first. Lead with need and talk about why oral health is important.
• Tell a story in “kitchen table language.”

Implications for research and/or practice:  CWF is a complex, community-driven public health issue. By determining where CDC fits into the overall educational efforts about the benefits and safety of CWF, partners can further define their own role. In addition, the findings support further audience segmentation and research and stakeholder discussions. Other public health issues can learn from this process, approach, and findings.