Two-year follow-up on an environmental health literacy software intervention for Anishinaabe Native Americans.

Fish consumption comprises an important part of what the Anishinaabe (Great Lakes Native Americans) call "" which translates roughly to "living in a good way." Industrial activity leading to the accumulation of persistent contaminants in fish disrupts . Our team of academic and Anishinaabe scientists co-developed a fish consumption advisory for the Anishinaabe using software that can be accessed via mobile phones and the internet. The software, Gigiigoo'inaan ("our fish") is designed to improve environmental health literacy using culturally congruent messaging and aesthetics. In 2021, we conducted a randomized control trial to test changes in environmental health literacy including fish consumption behaviors. The software was determined to improve confidence whilst maintaining contaminant intakes within advisory (i.e., "safe") limits. In 2022 and 2023, we updated the software and conducted user follow-up surveys using email recruitment captured by the software on personal devices. During the 2022 follow-up of software users, 90 respondents indicated significant increases of engagement (80.9%), utility (88.8%), and confidence (91.1%) relative to the original control trial. During the 2023 follow-up, after the additional update, those gains increased even further: engagement (98.4%), utility (97.3%), and confidence (97.3%). Iterations of community-engaged software development was associated with improved environmental health literacy metrics across software updates.