Health Stream Literature Summary - Issue 56 - December 2009

Perceptions of drinking water quality and risk and its effect on behaviour: A cross-national study.
Doria MdF, Pidgeon N and Hunter PR. (2009) Science of the Total Environment, 407:5455-5464.

A mixed-methods approach was used with quantitative (survey) and qualitative (focus groups) methods to compare perceptions and water uses in UK and Portugal. A survey was mailed to 500 people randomly selected from phone directories in each country. The survey was backed up by a telephone call between 3 weeks and 4 months after the mail survey. The response rate was approximately 41% in both countries (n= 203 in the UK and n= 204 in Portugal). The survey consisted of a questionnaire about water related perceptions and behaviours. Respondent's agreement with several statements was measured using a Likert-type scale from 'completely disagree' (1) to 'completely agree' (7). The variables that explained cross-national differences were identified using a univariate generalised linear model (GLM) approach. Structural equation models (SEM) were also used and tested with empirical data and extended to included additional variables.

Three focus group sessions were conducted in each country and participants were recruited in Norwich (UK) and Lisbon (PT) using street adverts and leaflets. There were eight people invited to attend each session. The moderator introduced the discussion items which were derived from the survey items. Focus group results were analysed for patterns that support, contradict, or extend the theoretical patterns described by the quantitative models. The majority of UK participants (80%) used tap water as their main type of drinking water at home, but less than half of Portuguese participants did so. Water flavour was found to have a strong influence on perceived water quality. Perceptions of risk and context also influenced perceived quality but the strength of these relationships varied depending on the country. Perceived water quality was also influenced by trust in water companies. The perception of risks associated with tap water was moderately explained by flavour, memorability, context and negative information from friends. The influence of flavour on risk perception and other organoleptic variables was evident in the quantitative research however this relationship was disputed during the focus groups. It is possible that the association between organoleptics and risk is intuitively used and may be questioned when people have time to think about it in a focus group situation. There were also other inconsistencies between the quantitative and qualitative results; the direct association of chlorine with risks which was apparent in the quantitative research was challenged in the focus groups, with some participants stating that chlorine taste and/or odour revealed water safety. Also in the survey results lead had a significant effect on risk perception however this was not evident in the focus groups. Trust in water suppliers appeared to be largely influenced by the same factors that influence risk perception, namely by water flavour, colour, memorability and interpersonal information from friends and family. This was consistent with focus group results which suggested that trust in water companies is characterised by the absence of aesthetic, health and supply problems. Quantitative research showed a considerably high level of trust in water companies.

Flavour was found to be the most relevant variable and explained consumption more than perceived water quality. Tap water consumption was moderately influenced by satisfaction with flavour and weakly influenced by risk perception. The main factors identified in this study as affecting bottled water consumption correspond mostly to those found in other countries such as Canada, France and the US. There were several similarities and differences found in the way tap water quality and risks are perceived in Portugal and the UK. There were no significant differences found at the p less than 0.001 level in relation to the magnitude of perceived water quality, risk, flavour, odour, trust in water companies, hardness, lead, chlorine and memorability. On average, UK and Portuguese participants did not consider concentrations of tap water chlorine and lead to be excessive and did not regard their water as too hard. Focus group results indicated that UK participants seemed to be more critical about chemicals in drinking water than Portuguese participants. These differences may result from cultural attitudes towards drinking water and may have implications for the public acceptability of European-wide standards for drinking water. Differences were also found regarding the influence of different variables on perception of quality and risk including colour, pressure, interpersonal information and tap/bottled water consumption.

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