Determinants of Safe Water Access: Household Water Use and Demand for Defluoridation in High-Fluoride Groundwater Exposure Areas

Abstract

Fluoride contamination in groundwater is a significant health concern because long-term exposure can lead to fluorosis. Understanding household behavior and risk perception in high-fluoride regions is critical for developing mitigation strategies. In this study, 205 residents in a groundwater fluoride-exposure area in Chiang Mai, Thailand, were interviewed about their fluoride knowledge, water-use patterns, and need for fluoride-removal drinking water systems. The results revealed that respondents had limited knowledge and awareness of fluoride-associated health risks and exhibited significant demand for defluoridation systems. Bottled water was reported as the primary source of drinking water for daily consumption; however, households still relied on tap and groundwater, thereby risking prolonged fluoride exposure. Applying the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) framework effectively pinpointed essential factors for intervention design. The risk factor indicated variation in risk perception between living environments and water treatment methods. Meanwhile, social norms and personal attitudes were closely linked within this community-oriented context. Binary logistic regression analysis showed that age had a greater impact on determining the need for defluoridation systems than the psychological constructs. These findings highlight the need for tailored interventions considering demographics, community infrastructure, and education to reduce fluoride exposure and ensure access to safe drinking water.