A needs assessment among stakeholders regarding the enhancement of a risk assessment tool for waterborne infectious diseases in the context of climate change

Abstract

Climate change has an impact on waterborne pathogen concentrations in surface water, possibly resulting in an increased risk of diseases caused by these pathogens. Schijven et al. (2013) developed a climate change QMRA (cc-QMRA) tool which calculated relative infection risk per person per year for specific water- and foodborne pathogens and exposure sources. Building on the tool by Schijven et al., this study focuses on identifying key areas of improvement based on stakeholder input, aiming to enhance its use and relevance. This needs assessment was conducted through the analysis of a questionnaire that was distributed among professionals working on water quality and/or climate change adaptation measures. The questionnaire was distributed through e-mail and LinkedIn. We asked questions about respondents’ background characteristics; their familiarity with (quantitative microbial) risk assessment tools; priority pathogens; priority exposure sources and their desires regarding technical functionalities of the cc-QMRA tool. A total of 58 professionals replied to the questionnaire. The findings revealed that stakeholders perceived norovirus, E. coli, hepatitis A virus, Salmonella, rotavirus, and Legionella as the most significant pathogens. The current cc-QMRA tool already encompasses certain exposure sources and pathogens. Thus, the pathogens E. coli, rotavirus and Legionella and exposure source of flooding should be added to the cc-QMRA tool. Most respondents mentioned that they thought the cc-QMRA tool could be beneficial to their area of work. Stakeholders identified many technical functionalities that they would like to see in the tool or that they thought would be beneficial to include in the cc-QMRA tool. Some differences were observed between respondents working in policy and respondents working in research. Respondents working in policy often prioritized usability and practical outputs, whereas researchers value detailed data analysis and customizable features. To address the differing needs of stakeholder groups, a hybrid approach could be implemented. Further research should focus on approaching respondents from lower- and middle-income countries as well as complementing the prioritization of exposure sources and pathogens by other key factors, such as the burden of disease. Lastly, it is also recommended to test the updated tool in collaboration with end-users to ensure its usability and relevance across different contexts. This could be conducted during workshops or focus group sessions during which the end-users test the cc-QMRA tool based on case studies.