A process for creating data report-back tools to improve equity in environmental health.

BACKGROUND: Although there is increasing interest in reporting results of environmental research efforts back to participants, evidence-based tools have not yet been applied to developed materials to ensure their accessibility in terms of literacy, numeracy, and data visualization demand. Additionally, there is not yet guidance as to how to formally assess the created materials to assure a match with the intended audience. METHODS: Relying on formative qualitative research with participants of an indoor air quality study in Dorchester, Massachusetts, we identified means of enhancing accessibility of indoor air quality data report-back materials for participants. Participants (n = 20) engaged in semi-structured interviews in which they described challenges they encountered with scientific and medical materials and outlined written and verbal communication techniques that would help facilitate engagement with and accessibility of environmental health report-back materials. We coupled these insights from participants with best practice guidelines for written materials by operationalizing health literacy tools to produce accessible audience-informed data report-back materials. RESULTS: The resulting data report-back materials had a 7th -grade reading level, and between a 4th -8th grade level of overall document complexity. The numeracy skills required to engage with the material were of the lowest demand, and we incorporated best practices for risk communication and facilitating understanding and actionability of the materials. Use of a rigorous assessment tool provides evidence of accessibility and appropriateness of the material for the audience. CONCLUSIONS: 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. Adapting health literacy tools to create and evaluate environmental data report-back materials is a novel and evidence-based means of ensuring their accessibility.

Characterizing the Environmental Health Literacy and Sensemaking of Indoor Air Quality of Research Participants.

This study is based on in-depth semi-structured interviews with the participants of an indoor air quality monitoring study. The purpose of the interviews was to capture participants' perceptions of indoor air quality and engage them in a discussion of those factors that influenced their behavior. Interview study participants (n = 20) noted the importance of family health concerns and their own sensory awareness of possible contaminants. They discussed their level of personal control over their home environment as well as their access to needed resources. This study is based on grounded theory and applies interpretivist epistemological methods. Study findings offer insights into how people perceive their home environment and what influences their decision making and action. Analyses indicate that perceived agency, risk perception, access to resources, and information all influenced participants' sense of ability to take action as well as their interest in taking action. These insights serve to challenge some of the current work in environmental health literacy which tends to focus on and measure an individual's knowledge or skills. Our analysis suggests that consideration be given to a number of factors that include perceived agency, access to resources, and the quality of information provided.

Air quality, Environment and Respiratory Outcomes in Bronchopulmonary Dysplasia, the AERO-BPD cohort study: design and adaptation during the SARS-CoV-2 pandemic.

INTRODUCTION: Almost half of all school-age children with bronchopulmonary dysplasia (BPD) have asthma-like symptoms and more suffer from lung function deficits. While air pollution and indoor respiratory irritants are known to affect high-risk populations of children, few studies have objectively evaluated environmental contributions to long-term respiratory morbidity in this population. This study aimed to examine the role of indoor environmental exposures on respiratory morbidity in children with BPD. METHODS AND ANALYSIS: The Air quality, Environment and Respiratory Ouctomes in BPD (AERO-BPD) study is a prospective, single-centre observational study that will enrol a unique cohort of 240 children with BPD and carefully characterise participants and their indoor home environmental exposures. Measures of indoor air quality constituents will assess the relationship of nitrogen dioxide (NO2), particulate matter (PM2.5), nitric oxide (NO), temperature and humidity, as well as dust concentrations of allergens, with concurrently measured respiratory symptoms and lung function.Adaptations to the research protocol due to the SARS-CoV-2 pandemic included remote home environment and participant assessments. ETHICS AND DISSEMINATION: Study protocol was approved by the Boston Children's Hospital Committee on Clinical Investigation. Dissemination will be in the form of peer-reviewed publications and participant information products. TRIAL REGISTRATION NUMBER: NCT04107701.

Reporting Results of a Community-Based In-Home Exposure Monitoring Study: Developing Methods and Materials.

BACKGROUND: Reporting exposure results to study participants provides information that can ideally be used to decrease harmful exposures, improve health, and prevent disease. In reality, we often do not fully understand how an environmental exposure contributes to disease. This is the case when reporting back indoor air exposures in the absence of regulations. OBJECTIVES: We reported nitrogen dioxide (NO2) and fine particulate matter (PM2.5) results back to individual participants of an in-home study in Chelsea, Massachusetts. We aimed to provide participants with information on the pollutant concentrations in their homes and in their community and to suggest strategies for decreasing in-home exposures. Our goals were to improve environmental health literacy and empower residents to take action on air quality issues in their community. The main objective of this paper is to describe how we developed our report back process and materials. METHODS: Our team of academic and community partners developed a two-part report back process. The first part included a mailing tailored to every home containing daily indoor and outdoor NO2 and PM2.5 concentrations, community averages, outdoor standards and guidelines, and results from other indoor air quality studies for comparison. The second part included a community meeting for participants. CONCLUSIONS: Our report back process and materials benefitted from the contributions of multiple diverse stakeholders. We recommend at least a two-part strategy for facilitating communication within the community and between community and academic researchers. The materials and methods can be easily adapted by other researchers to report back exposure results in other community-specific contexts.

A Mixed Methods Evaluation of Sharing Air Pollution Results with Study Participants via Report-Back Communication.

We implemented a concurrent triangulation mixed-methods evaluation of an air pollution data report-back to study participants in Chelsea, Massachusetts. We aimed to determine whether the report-back was effective in the following three ways: engagement, understandability, and actionability for the participants. We also evaluated participants' valuation of the report-back information and process. The evaluation involved both qualitative components, such as ethnographic observation, and quantitative components, such as closed-ended questionnaires and demographic data. The participants who engaged in the report-back process were significantly different from those who did not engage both in terms of their demographics, and in their indoor air pollutant concentrations. Participant understanding generally corresponded with the intended meaning of the research team, suggesting successful data communication. Additionally, many of the participants reported that they were inspired to take action in order to reduce their indoor air pollutant exposure as a result of the report-back process and information provided. These results identify areas of improvement for engagement, particularly regarding populations that may have higher exposures. This work outlines a framework with which to contextualize and evaluate the success of engagement with report-back efforts. Such evaluations can allow research teams to assess whether they are providing information that is equitably useful and actionable for all participants.