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Psychosocial Influences on Disaster Preparedness in San Francisco Recipients of Home Care

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Abstract

Disasters disproportionately impact certain segments of the population, including children, pregnant women, people living with disabilities and chronic conditions and those who are underserved and under-resourced. One of the most vulnerable groups includes the community-dwelling elderly. Post-disaster analyses indicate that these individuals have higher risk of disaster-related morbidity and mortality. They also have suboptimal levels of disaster preparedness in terms of their ability to shelter-in-place or evacuate to a shelter. The reasons for this have not been well characterized, although impaired health, financial limitations, and social isolation are believed to act as barriers to preparedness as well as to adaptability to changes in the environment both during and in the immediate aftermath of disasters. In order to identify strategies that address barriers to preparedness, we recently conducted a qualitative study of 50 elderly home care recipients living in San Francisco. Data were collected during in-home, in-person interviews using a semi-structured interview guide that included psychosocial constructs based on the social cognitive preparedness model and a new 13-item preparedness checklist. The mean preparedness score was 4.74 (max 13, range 1–11, SD. 2.11). Over 60 % of the participants reported that they had not made back-up plans for caregiver assistance during times of crisis, 74 % had not made plans for transportation to a shelter, 56 % lacked a back-up plan for electrical equipment in case of power outages, and 44 % had not prepared an emergency contacts list—the most basic element of preparedness. Impairments, disabilities, and resource limitations served as barriers to preparedness. Cognitive processes that underlie motivation and intentions for preparedness behaviors were lacking. There were limitations with respect to critical awareness of hazards (saliency), self-efficacy, outcome expectancy, and perceived responsibility. There was also a lack of trust in response agencies and authorities and a limited sense of community. Participants wanted to be prepared and welcomed training, but physical limitations kept many of them home bound. Training of home care aides, the provision of needed resources, and improved community outreach may be helpful in improving disaster outcomes in this vulnerable segment of the population.

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Reference

  1. Guha-Sapir D, Hoyois P, Below R, Centre for Research on the Epidemiology of Disasters (CRED). Annual disaster statistical review 2014: the numbers and trends. 2015; http://reliefweb.int/report/world/annual-disaster-statistical-review-2014-numbers-and-trends. Accessed 27 May 2016.

  2. Federal Emergency Management Agency. FEMA Disaster Declarations for 2015. https://www.fema.gov/disasters/grid/year/2015?field_disaster_type_term_tid_1=All. Accessed 20 May 2016.

  3. US Geological Survey. Natural disasters—forecasting economic and life losses. 2015; http://pubs.usgs.gov/fs/natural-disasters/. Accessed 26 May 2016.

  4. National Oceanic and Atmospheric Administration. Extreme events. https://www.ncdc.noaa.gov/climate-information/extreme-events. Accessed 26 May 2016.

  5. Federal Emergency Management Agency. Are you ready? An in-depth guide to citizen preparedness. 2004; https://www.fema.gov/pdf/areyouready/areyouready_full.pdf. Accessed 20 May 2016.

  6. Federal Emergency Management Agency. Build a kit—72 hours survival on your own. 2016; https://www.ready.gov/build-a-kit. Accessed 20 May 2016.

  7. Roth M. Everyone must be prepared for emergencies. 2015; https://www.fema.gov/blog/2015-04-29/everyone-must-be-prepared-emergencies. Accessed 10 May 2016.

  8. Strine TW, Neff LJ, Crawford S. Health-related quality of life domains and household preparedness for public health emergencies: behavioral risk factor surveillance system, 2006-2010. Disaster Med Public Health Prep. 2013; 7(02): 191–200.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Powell R, Gilbert S. The impact of hurricanes Katrina and Rita on people with disabilities: a look back and remaining challenges. Natl Council Disabil. 2006. http://files.eric.ed.gov/fulltext/ED496270.pdf. Accessed 27 May 2016.

  10. Ridgeway J. Katrina: A story of survival and Papa Joe’s new community. 2007; http://www.ici.umn.edu/products/impact/201/over1.html. Accessed 20 May 2016.

  11. Hemingway L, Priestley M. Natural hazards, human vulnerability and disabling societies: a disaster for disabled people? Rev Disabil Stud. 2014; 2(3).

  12. Gershon RRM, Magda LA, Riley HEM, Sherman MF. The World Trade Center evacuation study: factors associated with initiation and length of time for evacuation. Fire Mater. 2012; 36(5-6): 481–500.

    Article  CAS  Google Scholar 

  13. Lane K, Charles-Guzman K, Wheeler K, Abid Z, Graber N, Matte T. Health effects of coastal storms and flooding in urban areas: a review and vulnerability assessment. J Environ Public Health. 2013; 2013: 1–13.

  14. Fernandez LS, Byard D, Lin CC, Benson S, Barbera JA. Frail elderly as disaster victims: emergency management strategies. Prehosp Disaster Med. 2002; 17(2): 67–74.

    Article  PubMed  Google Scholar 

  15. Lane K, Wheeler K, Charles-Guzman K, et al. Extreme heat awareness and protective behaviors in New York City. J Urban Health. 2014; 91(3): 403–414.

    Article  PubMed  Google Scholar 

  16. Anderson GB, Bell ML. Lights out: impact of the August 2003 power outage on mortality in New York, NY. Epidemiology (Cambridge, Mass). 2012; 23(2): 189–193.

    Article  Google Scholar 

  17. Aldrich N, Benson WF. Disaster preparedness and the chronic disease needs of vulnerable older adults. Prev Chronic Dis. 2008; 5(1): A27.

    PubMed  Google Scholar 

  18. Center for Disease Control and Prevention. Prevalence of functional limitations among adults 60 years of age and over: United States, 1999–2002. 2006; http://www.cdc.gov/nchs/data/ad/ad375.pdf. Accessed 23 May 2016.

  19. US Department of Health & Human Services. The challenge of managing multiple chronic conditions. 2016; http://www.hhs.gov/ash/about-ash/multiple-chronic-conditions/about-mcc/the-challenge-of-managing-multiple-chronic-conditions/index.html. Accessed 20 May 2016.

  20. Portacolone E. The myth of independence for older Americans living alone in the Bay Area of San Francisco: a critical reflection. Ageing Soc. 2011; 31(05): 803–828.

    Article  Google Scholar 

  21. Estes CL, Biggs S, Phillipson C. Social theory, social policy and ageing. Berkshire, United Kingdom: Open University Press; 2004.

  22. AARP Public Policy Institute. Providing more long-term support and services at home: why it’s critical for health reform. 2009; http://www.aarp.org/health/health-care-reform/info-06-2009/fs_hcbs_hcr.html. Accessed May 26, 2016.

  23. Raveis VH. Subjective well-being of midlife and older women. In: Senie R, ed. Epidemiology of women’s health. Burlington: Jones & Bartlett Learning; 2014: 489–496.

    Google Scholar 

  24. Administration on aging. Profile of older Americans: 2014. 2015; http://www.aoa.gov/aging_statistics/Profile/2010/2.aspx. Accessed 10 May 2016.

  25. Center for Disease Control and Prevention. Long-term, home health, and hospice care planning guide for public health emergencies. 2016; http://www.cdc.gov/phpr/healthcare/planning2.htm. Accessed 23 May 2016.

  26. Raveis VH. Advances in cancer care impacting familial caregiving, Cancer Caregiving in the United States. New York, NY: Springer. 2012: 179–197.

  27. VanDevanter N, Kovner CT, Raveis VH, McCollum M, Keller R. Challenges of nurses’ deployment to other New York City hospitals in the aftermath of Hurricane Sandy. J Urban Health. 2014; 91(4): 603–614.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gershon RR, Rubin MS, Qureshi KA, Canton AN, Matzner FJ. Participatory action research methodology in disaster research: results from the World Trade Center evacuation study. Disaster Med Public Health Prep. 2008; 2(3): 142–149.

    Article  PubMed  Google Scholar 

  29. Khan AS. Public health preparedness and response in the USA since 9/11: a national health security imperative. Lancet. 2011; 378(9794): 953–956.

    Article  PubMed  Google Scholar 

  30. Davis T. A Failure of Initiative: final report for the select bipartisan committee to investigate the preparation for and response to hurricane Katrina (Report 109-377), House select bipartisan committee to investigate the preparation for and response to hurricane Katrina. Publius: The Journal of Federalism. Cary NC: Oxford Journals. 2006.

  31. Gershon RR, Kraus LE, Raveis VH, Sherman MF, Kailes JI. Emergency preparedness in a sample of persons with disabilities. Am J Disaster Med. 2013; 8(1): 35–47.

    Article  PubMed  Google Scholar 

  32. Gershon RRM, Qureshi KA, Stone PW, et al. Home health care challenges and avian influenza. Home Health Care Manag Pract. 2007; 20(1): 58–69.

    Article  Google Scholar 

  33. Baron S, McPhaul K, Phillips S, Gershon R, Lipscomb J. Protecting home health care workers: a challenge to pandemic influenza preparedness planning. Am J Public Health. 2009; 99(S2): S301–S307.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Paton D, Parkes B, Daly M, Smith L. Fighting the flu: developing sustained community resilience and preparedness. Health Promot Pract. 2008; 9(4 suppl): 45S–53S.

    Article  PubMed  Google Scholar 

  35. Ejeta LT, Ardalan A, Paton D. Application of behavioral theories to disaster and emergency health preparedness: a systematic review. PLoS Curr. 2015; 7.

  36. Paton D. Disaster preparedness: a social-cognitive perspective. Disaster Prev Manag. 2003; 12(3): 210–216.

    Article  Google Scholar 

  37. Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky performance status scale: an examination of its reliability and validity in a research setting. Cancer. 1984; 53(9): 2002–2007.

    Article  CAS  PubMed  Google Scholar 

  38. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000; 15(11): 1021–1027.

    Article  CAS  PubMed  Google Scholar 

  39. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006; 3(2): 77–101.

    Article  Google Scholar 

  40. SPSS Statistics Desktop, V22.0 [computer program]. 2013.

  41. Bethel JW, Foreman AN, Burke SC. Disaster preparedness among medically vulnerable populations. Am J Prev Med. 2011; 40(2): 139–143.

    Article  PubMed  Google Scholar 

  42. Smith DL, Notaro SJ. Personal emergency preparedness for people with disabilities from the 2006-2007 behavioral risk factor surveillance system. Disabil Health J. 2009; 2(2): 104–94.

    Article  Google Scholar 

  43. Gargano LM, Caramanica K, Sisco S, Brackbill RM, Stellman SD. Exposure to the World Trade Center disaster and 9/11-related post-traumatic stress disorder and household disaster preparedness. Disaster Med Public Health Prep. 2015; 9(6): 625–633.

    Article  PubMed  Google Scholar 

  44. Lawton MP, Nahemow L. Ecology and the aging process. 1973.

    Book  Google Scholar 

  45. Ballantyne M, Paton D, Johnston D, Kozuch M, Daly M. Information on volcanic and earthquake hazards: the impact on awareness and preparation. 2000. Institute of Geological & Nuclear Sciences. Lower Hutt, New Zealand.

  46. Paton D, Johnston D. Disasters and communities: vulnerability, resilience and preparedness. Disaster Prev Manag. 2001; 10(4): 270–277.

    Article  Google Scholar 

  47. Abramson CM. The End Game. Cambridge, Boston MA: Harvard University Press; 2015.

  48. Klinenberg E. Dying alone the social production of urban isolation. Ethnography. 2001; 2(4): 501–531.

    Article  Google Scholar 

  49. Portacolone E. Precariousness among older adults living alone in San Francisco: an ethnography. San Francisco, CA: Sociology, University of California; 2011.

  50. Baltes MM. The many faces of dependency in old age. Cambridge, United Kingdom: Cambridge University Press; 1996.

  51. Carmel S, Raveis VH, O’Rourke N, Tovel H. Health, coping and subjective well-being: results of a longitudinal study of elderly Israelis. Aging Ment Health. 2016; 1: 1–8.

    Google Scholar 

  52. Roush RE, Tyson SK. Geriatric emergency preparedness and response workshops: an evaluation of knowledge, attitudes, intentions, and self-efficacy of participants. Disaster Med Public Health Prep. 2012; 6(04): 385–392.

    Article  PubMed  Google Scholar 

  53. US Department of Homeland Security. Disaster planning guide for home health care providers. http://assuranceaz.com/wp-content/uploads/Disaster-Planning-Guide_Home_Health_DHS.pdf. Accessed 26 May 2016.

  54. American Red Cross. Disaster preparedness for seniors by seniors. 2007; http://www.redcross.org/images/MEDIA_CustomProductCatalog/m46400104_Disaster_Preparedness_for_Srs-English.revised_7-09.pdf. Accessed 26 May 2016.

  55. The National Association for Home Care & Hospice. Emergency preparedness packet for home health agencies. 2008; http://www.nahc.org/assets/1/7/ep_binder.pdf. Accessed 26 May 2016.

  56. Agency for Healthcare Research and Quality. Public Health emergency preparedness. 2004; http://archive.ahrq.gov/prep/. Accessed 26 May 2016.

  57. Goldman L, Finkelstein R, Schäfer P, Pugh T, The New York Academy of Medicine. Resilient communities: empowering older adults in disasters and daily life. 2015; http://www.agefriendlynyc.org/docs/Resilient_Communities_Report_Final.pdf. Accessed 27 May 2016.

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Acknowledgement

This research was funded by the National Institute of Nursing Research, National Institutes of Health through grant no. 5R21NR014017. We are grateful to the study participants, their homecare providers, and the San Francisco In-Home Support Services Public Authority (Donna Calame and Patrick Hoctel). We are also thankful to Thomas Chin, Response Coordinator, San Francisco Department of Emergency Management, and Teri Dowling, Community Engagement Specialist, Emergency Preparedness and Response, Population Health Division, San Francisco Department of Public Health, for their review of our initial interview guide.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, 94118, USA

    Robyn R. Gershon

  2. Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 280, San Francisco, CA, 94118, USA

    Robyn R. Gershon & Qi Zhi

  3. Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, 94118, USA

    Elena Portacolone

  4. Institute for the Study of Societal Issues, University of California, Berkeley, Berkeley, CA, 94720, USA

    Elena Portacolone

  5. Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA, 94118, USA

    Ezinne M. Nwankwo

  6. School of Nursing and Dental Hygiene, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall, Honolulu, HI, 96822, USA

    Kristine A. Qureshi

  7. Psychosocial Research Unit on Health, Aging and the Community, New York University, 137 East 25th St, 5th Fl, New York, NY, 10010-2314, USA

    Victoria H. Raveis

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  1. Robyn R. Gershon
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  2. Elena Portacolone
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Correspondence to Robyn R. Gershon.

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Gershon, R.R., Portacolone, E., Nwankwo, E.M. et al. Psychosocial Influences on Disaster Preparedness in San Francisco Recipients of Home Care. J Urban Health 94, 606–618 (2017). https://doi.org/10.1007/s11524-016-0104-3

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