As water supply in England increasingly faces threats of climate change, urbanisation and population growth, there is an imperative for household water users to be more resilient to extremes such as drought. However, since English water users have not traditionally been involved in drought management, there is need for in-depth understanding of perceptions and intentions towards drought management at a household scale to inform policy approaches. This paper fills this gap by investigating the perceptions and intentions of South West England households towards drought and drought coping. A theoretical framework developed through the lens of protection motivation theory and applying the trans-theoretical model, formed the basis of analysis of a survey administered in two communities in Exeter, England. Results indicated that despite low perceived likelihood and consequences of drought in their local area, participants were willing to implement household drought coping measures. Cluster analyses using a k-means clustering algorithm, found that participants were generally segmented in two typologies at different decision-stages. These decision-stages were defined by the variables perceived drought consequence, coping response efficacy, and behavioural intentions. Decision-stages were identified as contemplative and responsive decision-stages, illustrating willingness and participation in drought coping response at the household level. The importance of applying these psychological paradigms holds value for application in water company market research and policy decision-making in the context of targeted intervention strategies aimed at engendering drought resilient households.

The global literature on drought and health highlights a variety of health effects for people in developing countries where certain prevailing social, economic and environmental conditions increase their vulnerability especially with climate change. Despite increased focus on climate change, relatively less is known about the health-drought impacts in the developed country context. In the UK, where climate change–related risk of water shortages has been identified as a key area for action, there is need for better understanding of drought-health linkages. This paper assesses people’s narratives of drought on health and well-being in the UK using a source-receptor-impact framing. Stakeholder narratives indicate that drought can present perceived health and well-being effects through reduced water quantity, water quality, compromised hygiene and sanitation, food security, and air quality. Heatwave associated with drought was also identified as a source of health effects through heat and wildfire, and drought-related vectors. Drought was viewed as potentially attributing both negative and positive effects for physical and mental health, with emphasis on mental health. Health impacts were often complex and cross-sectoral in nature indicating the need for a management approach across several sectors that targets drought and health in risk assessment and adaptation planning processes. Two recurring themes in the UK narratives were the health consequences of drought for ‘at-risk’ groups and the need to target them, and that drought in a changing climate presented potential health implications for at-risk groups.

Drought in the United Kingdom is a “hidden” pervasive risk, defined and perceived in different ways by diverse stakeholders and sectors. Scientists and water managers distinguish meteorological, agricultural, hydrological, and socio-economic drought. Historically triggers in drought risk management have been demarcated solely in specialist hydrological science terms using indices and critical thresholds. This paper explores “drought thresholds” as a bridging concept for interdisciplinary science-narrative enquiry. The Eden catchment, Scotland acts as an exemplar, in a maritime country perceived as wet. The research forms part of creative experimentation in science-narrative methods played out in seven United Kingdom case-study catchments on hydro-meteorological gradients in the Drought Risk and You (DRY) project, with the agricultural Eden the most northerly. DRY explored how science and stories might be brought together to support better decision-making in United Kingdom drought risk management. This involved comparing specialist catchment-scale modelling of drought risk with evidence gathered from local narratives of drought perceptions/experiences. We develop the concept of thresholds to include perceptual triggers of drought awareness and impact within and between various sectors in the catchment (agriculture, business, health and wellbeing, public/communities, and natural and built environments). This process involved developing a framework for science-narrative drought “threshold thinking” that utilizes consideration of severity and scale, spatial and temporal aspects, framing in terms of enhancing or reducing factors internal and external to the catchment and new graphical methods. The paper discusses how this extended sense of thresholds might contribute to research and practice, involving different ways of linking drought severity and perception. This has potential to improve assessment of sectoral vulnerabilities, development of adaptive strategies of different stakeholders, and more tailored drought communication and messaging. Our findings indicate that drought risk presents many complexities within the catchment, given its cross-sectoral nature, rich sources of available water, variable prior drought experience among stakeholders, and different quantitative and perceptual impact thresholds across and within sectors. Fuzziness in identification of drought thresholds was multi-faceted for varied reasons. Results suggest that a management paradigm that integrates both traditional and non-traditional “fuzzy” threshold concepts across sectors should be integrated into current and future policy frameworks for drought risk management.

Background In the United States, many opioid treatment programs (OTPs) do not offer viral hepatitis (VH) or human immunodeficiency virus (HIV) testing despite high prevalence among OTP clients. We initiated an opt-out VH and HIV testing and linkage-to-care program within our OTP. Methods All OTP intakes are screened for VH and HIV and evaluated for rescreening annually. A patient navigator reviews laboratory results and provides counseling in the OTP clinic. The medical record is queried to identify individuals with previously diagnosed, untreated VH or HIV. Navigation support is provided for linkage or relinkage to VH or HIV care. Results Between March 2018 and Februrary 2019, 532 individuals were screened for hepatitis C virus (HCV), 180 tested HCV antibody positive (34%), and 108 were HCV-ribonucleic acid (RNA) positive (20%). Sixty individuals were identified with previously diagnosed, untreated HCV. Of all HCV RNA+, 49% reported current injection drug use (82 of 168). Ninety-five individuals were seen by an HCV specialist (57% of HCV RNA+), 72 started treatment (43%), and 69 (41%) completed treatment. Individuals with primary care providers were most likely to start treatment. Four individuals were diagnosed with hepatitis B; 0 were diagnosed with HIV. Conclusions The implementation of an OTP-based screening and navigation protocol has enabled significant gains in the identification and treatment of VH in this high prevalence setting.