Evaluation of water consumption preferences and water drinking behaviors of applicants to a university hospital general internal medicine polyclinics

Aim: This research aims to define the water consumption preferences, drinking behaviors, influencing factors, thoughts on tap water, and suggestions for its increased preference among individuals residing in Ankara who have applied to the General Internal Medicine Outpatient Clinics of Ankara University Faculty of Medicine. Materials and methods: The research was conducted in a descriptive manner between October 2022 and January 2023. The population consisted of individuals residing in Ankara who applied to the General Internal Medicine Outpatient Clinics of İbni Sina Hospital, Ankara University Faculty of Medicine. The minimum sample size was calculated as 231; however, the goal was to reach 300 participants, which was achieved (100%). Data were collected through a questionnaire comprising 59 questions, administered in the waiting area of the outpatient clinics, including the Three-Item First-Level Physical Activity Assessment (BBFAA). The study received approval from the Ankara University Faculty of Medicine Human Research Ethics Committee and obtained other necessary permissions. The data were analyzed using the SPSS 25.0 package program. Descriptive statistics such as mean, standard deviation, median, minimum and maximum values, frequencies, and percentages were calculated. Statistical analyses involved the application of Mann-Whitney U, Kruskal-Wallis, Chi-square tests, as well as Binary and Multivariable Logistic Regression analyses. Results: The 300 participants had an average age of 41.85 ± 14.01, with 51.7% being female, 63.6% married, and 39% having completed high school or university education. About 70.7% were employed, with 12.7% being healthcare workers. Approximately 17.4% of participants assessed their economic situation as poor or very poor. The average household size was 3.0 ± 1.35 individuals. According to the BBFAA scores, 39.7% of participants were categorized as "sedentary." Regarding habits, 39% smoked, 18.7% consumed alcohol, and 46% reported having a chronic illness. Only 13% used tap water at home, while the most common choice for drinking water, at 67%, was packaged water. Outside the home, the frequency of consuming packaged water was 94.3%. The average monthly expenditure per person on non-tap water was calculated as 63.06 ± 39.83 Turkish Lira. Within the past year, 15.3% of participants had changed their water consumption preferences, with 39% of those citing the financial burden of the previous source as the reason. Preferences for tap water consumption at home were significantly higher among men (p=0.007), the 50-59 age group (p=0.003), and those with an educational level of middle school or below (p=0.028). The preference for water purification devices was more common in households with four or more occupants (p=0.003). Among those who changed their preferred brand within the last year, this was more frequent among packaged water consumers compared to those using water purification devices (p=0.004). Moreover, individuals who rated their economic status as poor or very poor were more likely to change brands compared to those with moderate or better economic statuses (p=0.038). Multivariable logistic regression analysis identified gender, age groups, education levels, household size, and economic status as influential factors for drinking water preferences (p<0.05). Inadequate fluid intake was more frequent among individuals aged 50-59 and 60 years or older (p=0.002), those with a middle school or lower education level (p=0.004), unemployed individuals (p=0.001), non-healthcare workers (p=0.008), sedentary individuals (p<0.001), those with chronic illnesses (p=0.008), and those with hypertension (p=0.001). The inability to consume sufficient water at the workplace was more common among healthcare workers compared to other groups (p=0.009). Binary logistic regression analysis indicated that the frequency of adequate fluid intake was five times higher in active individuals compared to sedentary ones (95% CI 1.541-16.009, p=0.007). Conclusions: The majority of the participants in this study preferred packaged water both at home and outside. Participants who used packaged water tended to choose more affordable options due to financial reasons. Female gender, higher educational levels, and younger age were found to influence the avoidance of tap water. Being a healthcare worker was found to affect the inability to consume sufficient water at the workplace, although they were in a better situation regarding daily adequate fluid intake compared to other employees. Low educational levels, advanced age, unemployment, the presence of hypertension, and sedentary lifestyle were associated with inadequate fluid intake. The need for non-tap water sources should be eliminated due to the financial burden and risks it poses to individual health and environmental health, and tap water should be promoted. Public education initiatives for a healthier lifestyle should advocate and facilitate adequate fluid intake. The community's water consumption preferences should continue to be investigated, and municipalities and relevant ministries should undertake necessary efforts to ensure access to a sufficient amount of clean and healthy drinking water solely through tap water. Key Words: Water consumption preference, water drinking behavior, mains water, packaged water, water purifier