Publication Date
Spring 5-28-2025
Item Type
Text
Executive Summary
In Washington State, around 18.5% of individuals aged 12 and older, about 1.4 million people, struggle with substance use each year (Substance Abuse and Mental Health Services Administration, 2023). Many also face housing instability and limited access to basic health needs like clean drinking water. Our agency supports Seattle residents in recovery, and during our initial assessment, we identified inadequate hydration as a common concern. As a team of seven nursing students, we developed a community health project to improve self-reported hydration among this population. This paper outlines our process from assessment to intervention and our efforts to support healthier hydration habits in a vulnerable community.
Background
Access to drinking water involves more than just its physical presence, as it also depends on the time and effort required to obtain it. Research shows that when individuals spend more time and energy collecting water, their overall consumption decreases (Cassivi et al., 2018). In contrast, when clean water is readily accessible through public fountains, rest stops, or other community resources, people are more likely to stay adequately hydrated (Cassivi et al., 2018). Water is vital to human health, playing a key role in regulating body temperature, aiding digestion, transporting nutrients, and supporting cellular function (Liska et al., 2019). Even mild dehydration can impair cognition, cause fatigue, and lower alertness. Adults are advised to consume 2-3 liters of fluids daily, depending on activity level and climate (Taylor & Tripathi, 2025). All of these factors contributed to why we believe it would be important for our group to focus on improving hydration.
Assessment
We conducted our assessment using two complementary methods: a windshield survey and a written survey distributed to agency members. The windshield survey identified the Urban Rest Stop as a key community asset, a facility offering clean, safe hygiene services like restrooms, showers, and laundry for unsheltered individuals and families. Just a four-minute walk from our agency, it plays a vital role in supporting vulnerable populations. We also recognized that for our intervention to be effective, building rapport, trust, and strong relationships with agency members and staff was essential. Through ongoing engagement and open communication, we successfully established these connections, laying a strong foundation for our work. The written survey revealed a clear gap between hydration awareness and actual intake. Of the 28 respondents, 22 reported drinking fewer than five cups of water per day, with seven consuming only zero to two cups daily. This is concerning compared to the recommended 11 cups for women and 15 for men (Mayo Clinic, 2022). While 91% of members acknowledged the importance of water for health, 63% admitted they don’t drink enough. Notably, 53% said that having a reusable water bottle would help increase their intake, highlighting a clear opportunity for targeted intervention.
Planning and Outcomes Identification
Guided by our community assessment and the identified nursing diagnoses, the intervention was designed to improve water intake among agency members by focusing on education, accessibility, and motivation. Our objectives included increasing awareness of recommended hydration levels, improving access to clean drinking water, and encouraging consistent use of reusable water bottles. Short-term outcomes focused on members' ability to locate free water refill stations and report increased water intake. Long-term outcomes aimed to promote sustained hydration behaviors, such as meeting or approaching recommended daily water consumption, maintaining awareness of hydration needs, and routinely using reusable water bottles. These outcomes were chosen to support lasting behavioral change and self-management, ultimately promoting health and well-being in a population experiencing systemic barriers.
Implementation
To address the hydration gap identified during the assessment phase, we implemented a multi-component intervention focused on education, accessibility, and behavioral support. We created an informative pamphlet that included the recommended daily water intake, situations when to increase intake, and mapped out water refill stations offering free, clean water in the Seattle area. We distributed these pamphlets to the members at our agency and directly engaged with them all to discuss the importance of drinking enough water for overall health and well-being, and to answer any hydration-related questions. To reduce barriers and encourage sustained hydration habits, we provided free reusable water bottles along with decorative stickers, allowing individuals to personalize their bottles and increase engagement. We chose to implement the use of reusable water bottles as a practical and sustainable strategy to improve self-reported hydration within this community. Many community members face barriers to consistent hydration, including limited access to clean drinking water and a lack of personal water containers. By distributing reusable water bottles, we aimed to reduce these barriers, promote daily water intake, and encourage healthy hydration habits.
Evaluation
Based on 20 post-survey responses, we found that members of the agency who participated in the education and water bottle program increased their fluid intake by 65%. Notably, nearly 80% of respondents reported drinking more than six cups of water per day, a significant improvement compared to the pre-survey, in which only about 15% met that level of hydration. Additionally, 90% of participants stated that having a water bottle helped them drink more water throughout the day. While there was only a modest 10% increase in the number of members who believed they drank enough water daily, 75% of respondents indicated that water was their primary source of hydration, with the remaining 25% citing coffee or soda as their main fluids.
Conclusion
Overall, our project successfully met its primary goal of increasing water intake among agency members through the distribution of reusable water bottles and hydration education. While the project had a strong impact, one limitation we faced was the inability to collect post-survey responses from all members who received a water bottle. This was primarily due to limited time spent at the agency site and inconsistent member attendance, which affected follow-up participation. Through our implementation, we found that this program could be sustainable, observing the effectiveness of reusable water bottles on daily hydration levels. Looking ahead, future projects could build on this foundation by incorporating hydration tracking tools, interactive educational activities, and stronger follow-up methods to improve participation and sustain engagement.
References
Cassivi, A., Johnston, R., Waygood, E. O. D., & Dorea, C. C. (2018). Access to drinking water: Time matters. Journal of Water and Health, 16(4), 661- 666. https://doi.org/10.2166/wh.2018.009
Lawman, H. G., Grossman, S., Lofton, X., Tasian, G., & Patel, A. I. (2020). Hydrate philly: An intervention to increase water access and appeal in recreation centers. Preventing Chronic Disease, 17, E15. https://doi.org/10.5888/pcd17.190277
Liska, D., Mah, E., Brisbois, T., Barrios, P. L., Baker, L. B., & Spriet, L. L. (2019). Narrative review of hydration and selected health outcomes in the general population. Nutrients, 11(1), 70. https://www.mdpi.com/2072-6643/11/1/70
Mayo Foundation for Medical Education and Research. (2022). How much water do you need to stay healthy?. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256
Substance Abuse and Mental Health Services Administration. (2023). National Survey on Drug Use and Health: Model-based prevalence estimates (50 states and the District of Columbia). U.S. Department of Health and Human Services. https://www.samhsa.gov/data/sites/default/files/reports/rpt56188/2023-nsduh-sae-state-tables_0/2023-nsduh-sae-state-tabs-washington.pdf
Taylor, K., & Tripathi, A. K. (2025). Adult dehydration. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK555956/
Recommended Citation
Short, Erica; Dill, Adam; Bradley, Ali; Gao, Kaito; Hanks, Jennifer; Muhammad, Hayat; and Ngo, Mai, "Improving Self-Reported Hydration Using Refillable Bottles and Clean Water Access" (2025). Nursing Leadership in Community Engagement Projects. 61.
https://digitalcommons.spu.edu/shs_nlce/61
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