title: The impact of adaptive capacity on disaster response and recovery: evidence supporting core community capabilities.
abstract: BACKGROUND
  The aim of this study was to determine if a relationship exists between the development of adaptive capacity and disaster response and recovery outcomes. Hospitals and health care systems are a critical element in community planning for all phases of the disaster cycle. There is a lack of research, however, to validate the relationship between the development of these capabilities and improved response and recovery outcomes. Hypothesis/Problem Two hypotheses were formulated to address the research question. The first hypothesis argued that counties or parishes that developed adaptive capacity through pre-event planning, community engagement, training, and the use of national response frameworks would have improved response and recovery performance outcomes. The second hypothesis argued that adaptive capacity, along with response and recovery performance outcomes, predicts the trajectory of recovery progression.
  
  
  METHODS
  This study employed a quantitative cross-sectional survey methodology and existing community demographic data to explore the development of adaptive capacity and its ability to predict disaster response and recovery outcomes in communities affected by major disaster in 2011. A total of 333 counties and parishes were included in the final sample, providing a 95% confidence interval with a 5% margin of error. Data were analyzed using both descriptive and inferential statistics. Multiple, hierarchical, and robust regression were used to find the best fitting model. Multi-level modeling with random intercepts was used to control for the nesting effects associated with county, state, and the Federal Emergency Management Agency (FEMA) region sampling.
  
  
  RESULTS
  Descriptive results provide a baseline assessment of adaptive capacity development at the community level. While controlling for other variables, hypothesis testing revealed that pre-event planning, community engagement, full-scale exercises, and use of national frameworks predicated overall response and recovery performance outcomes (R 2 = .43; F 13,303 = 13.34; P < .001). In terms of recovery progression, pre-event planning, overall response and recovery performance outcome, total time of disruption, and percent of people below poverty were significant (R 2 = .15; F14,302 = 4.53; P < .001).
  
  
  CONCLUSIONS
  Establishment of empirical data provides communities with reinforcement to continue resilience-building activities at the local level. However, findings from this study suggest that only full-scale exercises were significant in improving response and recovery outcomes. Implications for re-evaluation of disaster training warrant further exploration.
authors.affiliation: Mount Aloysius College,Cresson,Pennsylvania USA.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Zukowski
mesh_terms: D057191:Capacity Building / Q000458:organization & administration*; D003153:Community Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D004189:Disaster Planning / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D006801:Humans; D009111:Local Government; D015980:Public Health Practice; D011795:Surveys and Questionnaires; D014481:United States