The system of stakeholders impacting water heater selection decisions in the U.S. is complex, with numerous actors and key players engaging with varying degrees of information asymmetry. The limited availability of decision-making tools could lead to unintended consequences of water and energy saving decisions on public health, such as the growth of opportunistic pathogens in water systems. We use a qualitative meta-synthesis to identify key stakeholders, map interactions among these stakeholders, identify decisions, roles, and influences, and inventory potential interventions. This study identifies and characterizes the important attributes of the residential water heater stakeholder system (leverage points) that influence the selection of water heating technologies. The ultimate desired outcome of the work is to facilitate the selection of water heating components and design configurations that meet occupant objectives and constraints while limiting the potential for health and safety risks due to scalding or opportunistic pathogens. This effort identifies a clear need for decision-making support tools for selecting residential water heaters, one that takes a whole-systems perspective in the water heater stakeholder system and takes advantage of key leverage points for effective intervention.

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