title: Disaster Impact on Impoverished Area of US: An Inter-Professional Mixed Method Study.
abstract: Introduction In the foothills of the Cumberland Mountains, in central Appalachia (a region that spans 13 states in the US), sits an economically distressed and rural community of the United States. Once a thriving coal-mining area, this region now is reported as one of the hardest places to live in the US. Southeastern Kentucky, located in a remote, rocky, mountainous area surrounded by rivers and valleys and prone to flooding, experienced a major flood in Spring 2013 causing significant damage to homes and critical infrastructure. Purpose Aims of the study were to: (1) identify and better understand the contextual variables compounding the impact of a disaster event that occurred in Spring 2013; (2) identify ways participants managed antecedent circumstances, risk, and protective factors to cope with disaster up to 12 months post-event; and (3) further determine implications for community-focused interventions that may enhance recovery for vulnerable populations to promote greater outcomes of adaptation, wellness, and readiness.
  
  
  METHODS
  Using an ethnographic mixed-methods approach, an inter-collaborative team conducted face-to-face interviews with (N=12) Appalachian residents about their disaster experience, documented observations and visual assessment of need on an observation tool, and used photography depicting structural and environmental conditions. A Health and Emergency Preparedness Assessment Survey Tool was used to collect demographic, health, housing, environment, and disaster readiness assessment data. Community stakeholders facilitated purposeful sampling through coordination of scheduled home visits.
  
  
  RESULTS
  Triangulation of all data sources provided evidence that the community had unique coping strategies related to faith and spirituality, cultural values and heritage, and social support to manage antecedent circumstances, risk, and protective factors during times of adversity that, in turn, enhanced resilience up to 12 months post-disaster. The community was found to have an innate capacity to persevere and utilize resources to manage and transcend adversity and restore equilibrium, which reflected components of resilience that deserve greater recognition and appreciation.
  
  
  CONCLUSIONS
  Resilience is a foundational concept for disaster science. A model of resilience for the rural Appalachia community was developed to visually depict the encompassing element of community-based interventions that may enhance coping strategies, mitigate risk factors, integrate protective factors, and strengthen access. Community-based interventions are recommended to strengthen resilience, yielding improved outcomes of adaptation, health and wellness, and disaster readiness. Banks LH , Davenport LA , Hayes MH , McArthur MA , Toro SN , King CE , Vazirani HM . Disaster impact on impoverished area of US: an inter-professional mixed method study. Prehosp Disaster Med. 2016;31(6):583-592.
authors.affiliation: University of Tennessee,College of Nursing,Knoxville,TennesseeUSA.
authors.forename: Linda H
authors.initials: LH
authors.lastname: Banks
authors.affiliation: University of Tennessee,College of Nursing,Knoxville,TennesseeUSA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Davenport
authors.affiliation: University of Tennessee,College of Nursing,Knoxville,TennesseeUSA.
authors.forename: Meghan H
authors.initials: MH
authors.lastname: Hayes
authors.affiliation: University of Tennessee,College of Nursing,Knoxville,TennesseeUSA.
authors.forename: Moriah A
authors.initials: MA
authors.lastname: McArthur
authors.affiliation: University of Tennessee,College of Nursing,Knoxville,TennesseeUSA.
authors.forename: Stacey N
authors.initials: SN
authors.lastname: Toro
authors.affiliation: University of Tennessee,College of Nursing,Knoxville,TennesseeUSA.
authors.forename: Cameron E
authors.initials: CE
authors.lastname: King
authors.affiliation: University of Tennessee,College of Nursing,Knoxville,TennesseeUSA.
authors.forename: Hazel M
authors.initials: HM
authors.lastname: Vazirani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004189:Disaster Planning; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007629:Kentucky; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D036301:Qualitative Research; D035862:Vulnerable Populations; D055815:Young Adult
keywords:  CASPER Community Assessment for Public Health Emergency Response;  IPCP inter-professional collaborative practice;  UT University of Tennessee; disaster; flooding; resilience; rural Appalachia; vulnerability