title: Psychosocial Influences on Disaster Preparedness in San Francisco Recipients of Home Care.
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.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, 94118, USA. robyn.gershon@ucsf.edu.|Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 280, San Francisco, CA, 94118, USA. robyn.gershon@ucsf.edu.
authors.forename: Robyn R
authors.initials: RR
authors.lastname: Gershon
authors.affiliation: Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, CA, 94118, USA.|Institute for the Study of Societal Issues, University of California, Berkeley, Berkeley, CA, 94720, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Portacolone
authors.affiliation: Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, San Francisco, CA, 94118, USA.
authors.forename: Ezinne M
authors.initials: EM
authors.lastname: Nwankwo
authors.affiliation: Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 280, San Francisco, CA, 94118, USA.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhi
authors.affiliation: School of Nursing and Dental Hygiene, University of Hawaii at Manoa, 2528 McCarthy Mall, Webster Hall, Honolulu, HI, 96822, USA.
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Qureshi
authors.affiliation: Psychosocial Research Unit on Health, Aging and the Community, New York University, 137 East 25th St, 5th Fl, New York, NY, 10010-2314, USA.
authors.forename: Victoria H
authors.initials: VH
authors.lastname: Raveis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000523:psychology*; D004189:Disaster Planning; D005260:Female; D006699:Home Care Services; D006801:Humans; D057187:Independent Living; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D036301:Qualitative Research; D012495:San Francisco; D020377:Self Efficacy; D012959:Socioeconomic Factors
keywords: Disaster preparedness; Home care; Psychosocial