Using the Precaution Adoption Process model to describe a disaster preparedness intervention among low-income Latinos

Promoting Disposal of Left-Over Opioids After Surgery in Rural Communities: A Qualitative Description Study

BACKGROUND

Patients rarely dispose of left-over opioids after surgery. Disposal serves as a primary prevention against misuse, overdose, and diversion. However, current interventions promoting disposal have mixed efficacy. Increasing disposal in rural communities could prevent or reduce the harms caused by prescription opioids.

AIMS

Identify barriers and facilitators to disposal in the rural communities of the United States Mountain West region.

METHODS

We conducted a qualitative description study with 30 participants from Arizona, Idaho, Montana, Nevada, Oregon, Utah, and Wyoming. We used a phronetic iterative approach combining inductive content and thematic analysis with deductive interpretation through the Precaution Adoption Process Model (PAPM).

RESULTS

We identified four broad themes: (a) awareness, engagement, and education; (b) low perceived risk associated with nondisposal; (c) deciding to keep left-over opioids for future use; and (d) converting decisions into action. Most participants were aware of the importance of disposal but perceived the risks of nondisposal as low. Participants kept opioids for future use due to uncertainty about their recovery and future treatments, breakdowns in the patient-provider relationship, chronic illness or pain, or potential future injury. The rural context, particularly convenience, cost, and environmental contamination, contributes to decisional burden.

CONCLUSIONS

We identified PAPM stage-specific barriers to disposal of left-over opioids. Future interventions should account for where patients are along the spectrum of deciding to dispose or not dispose as well as promoting harm-reduction strategies for those who choose not to dispose.

Facing flood disaster: A cluster randomized trial assessing communities' knowledge, skills and preparedness utilizing a health model intervention

Floods occur when a body of water overflows and submerges normally dry terrain. Tropical cyclones or tsunamis cause flooding. Health and safety are jeopardized during a flood. As a result, proactive flood mitigation measures are required. This study aimed to increase flood disaster preparedness among Selangor communities in Malaysia by implementing a Health Belief Model-Based Intervention (HEBI). Selangor's six districts were involved in a single-blinded cluster randomized controlled trial Community-wide implementation of a Health Belief Model-Based Intervention (HEBI). A self-administered questionnaire was used. The intervention group received a HEBI module, while the control group received a health talk on non-communicable disease. The baseline variables were compared. Immediate and six-month post-intervention impacts on outcome indicators were assessed. 284 responses with a 100% response rate. At the baseline, there were no significant differences in ethnicity, monthly household income, or past disaster experience between groups (p>0.05). There were significant differences between-group for intervention on knowledge, skills, preparedness (p<0.001), Perceived Benefit Score (p = 0.02), Perceived Barrier Score (p = 0.03), and Cues to Action (p = 0.04). GEE analysis showed receiving the HEBI module had effectively improved knowledge, skills, preparedness, Perceived Benefit Score, Perceived Barrier Score, and Cues to Action in the intervention group after controlling the covariate. Finally, community flood preparedness ensured that every crisis decision had the least impact on humans. The HEBI module improved community flood preparedness by increasing knowledge, skill, preparedness, perceived benefit, perceived barrier, and action cues. As a result, the community should be aware of this module. Clinical trial registration: The trial registry name is Thai Clinical Trials Registry, trial number TCTR20200202002.

A Systematic Review on an Optimal Dose of Disaster Preparedness Intervention Utilizing Health Belief Model Theory

Disaster preparedness is an issue that receives little attention in the community. Communities must take preventative measures to overcome obstacles and improve community preparedness. This review identifies the optimal dose of disaster preparedness intervention in the community. A systematic literature search was conducted to examine a study about the optimal dose of disaster preparedness intervention developed for implementation at a community level. A scoping review based on the PRISMA diagram was conducted from four databases. A combination of keywords was adapted for each database. Inclusion and exclusion criteria were applied. A total of eight articles were synthesized based on the intervention dose of disaster preparedness among community interventions. The summarized studies provided evidence that the optimal dose for disaster preparedness intervention in the community can be prevented with an educational intervention program with a minimal dosage of intervention. The Health Belief Model Theory was the most often cited theory by researchers. The best dose for disaster preparedness intervention in a community can be mitigated with a single dose of education. Nonetheless, we cannot disregard alternative disaster preparedness theories because each has its advantages and disadvantages.

Wastewater System Inflow/Infiltration and Residential Pluvial Flood Damage Mitigation in Canada

Pluvial flooding in urban areas is one of the most significant drivers of disaster loss in Canada. Damages during pluvial flood events are associated with overwhelmed urban drainage (stormwater and wastewater) systems. During the period from 2013 to 2021, Canadian property and casualty insurers reported approximately CAD 2 billion in personal property (residential) pluvial sewer backup claims during flood catastrophes. There has been growing interest in managing pluvial urban flood risk, notably through newly funded national programs focused on climate change adaptation. These programs have included the development of new guidelines and standards focused on managing the underlying factors contributing to urban and basement flooding. Inflow and infiltration (I/I) has received limited attention in the pluvial flood literature, however. Informed by significant engagement with practitioners in Canada, this paper provides a review of the issue of I/I into wastewater systems and its relation to pluvial flooding. The paper will address concerns related to private property engagement in I/I and urban pluvial flood reduction programs. Both improved technical standards and administrative support are needed to ensure that wastewater infrastructure is less susceptible to I/I over its lifecycle.

Effectiveness of education intervention to reduce sugar-sweetened beverages and 100% fruit juice in children and adolescents: a scoping review

OBJECTIVE

To determine the impact of educational intervention in reducing the consumption of sugar-sweetened beverages (SSBs) and 100% fruit juice in children and adolescents.

DESIGN

We conducted a comprehensive Ovid Medline and Scopus search. Articles had to be peer-reviewed, full-text and published in English. Studies had to be controlled intervention, published between 1 January 2010 to 7 February 2021, and in children and adolescents. Study quality was measured using the Quality Assessment Tool for Controlled Intervention Studies.

RESULTS

Forty intervention articles were included in this review involving 25,069 children and adolescents. All studies employed a quantitative research method using the Randomized Controlled Trial designs. Twenty-eight out of forty interventions used psychosocial theories. Study quality ranged from 'fair' to 'good.' Results showed that education intervention effectively reduced SSBs, and reduced 100% fruit juice in children.

EXPERT OPINION

Reducing the SSBs consumption in children should be initiated by conducting school-based programs consisting of interactive learning process, psychosocial theories and the involvement of parents or caregivers. Theories that focus on personal, behavior and environment factors improve the effectiveness of the intervention. More research is warranted to investigate the impacts of 100% fruit juice on obesity, dental caries and risk of co-morbidities in children.

Disaster Preparedness Education among Community: What is effective? An Integrative Literature Review

Background: Community-based disaster preparedness is vital in all types of disaster scenarios. Despite having resources and post-disaster training, growing evidence indicates that many residents struggle to prepare ahead of a disaster. Objectives: The aim of this review was to evaluate the effectiveness of disaster preparedness education for community. Methods: A literature search was conducted using combination of the following keyword: “disaster planning” or “disaster preparedness” or “disaster training” and “evaluation or outcomes of education” and “community” or “family” Medline database via OVID and ProQuest Social Sciences Journals. Results: The review included fourteen articles, seven of which were quantitative, four of which were qualitative, and three of which were mixed-method studies. The education contents were related to psychological first aid, evacuation sites and routes in times of disaster, items to prepare in case of emergency, preparing for safety inside a home, community mapping, and responding to psychological trauma, and how to build sustainability into community work. Conclusion: All of the strategies and content used in disaster preparedness tend to enhance community preparedness. More research is needed to identify best practices for community disaster preparedness by using more rigors method and consider the local needs or barriers in designing education program.

Preventing Unequal Health Outcomes in COVID-19: A Systematic Review of Past Interventions

Background: We sought to identify interventions that reduced disparities in health outcomes in infectious disease outbreaks or natural disasters in the United States to understand whether these interventions could reduce health disparities in the current COVID-19 pandemic. Methods: We searched MEDLINE and other databases to May 2020 to find studies that examined interventions to mitigate health inequalities in previous infectious disease pandemics or disasters. We assessed study quality using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Program (CASP) Checklist for Qualitative Studies. Results: We included 14 articles (12 studies) and 5 Centers for Disease Control (CDC) stakeholder meeting articles on pandemic influenza preparedness in marginalized populations. Studies called for intervention and engagement before pandemic or disaster onset. Several studies included interventions that could be adapted to COVID-19, including harnessing technology to reach disadvantaged populations, partnering with trusted community liaisons to deliver important messaging around disease mitigation, and using culturally specific communication methods and messages to best reach marginalized groups. Discussion: To our knowledge this is the first systematic review to examine interventions to mitigate health inequities during an infectious disease pandemic. However, given that we identified very few disparities-focused infectious disease intervention studies, we also included studies from the disaster response literature, which may not be as generalizable to the current context of COVID-19. Overall, community outreach and tailored communication are essential in disease mitigation. More research is needed to evaluate systemic interventions that target the distal determinants of poor health outcomes among marginalized populations during pandemics and natural disasters.

A Nurse-Led Home Disaster Preparedness Intervention for New Parents

PURPOSE

To evaluate the effectiveness of a nurse-led intervention on the household emergency preparedness (HEP) level of parents with newborns and describe the nurses' perceived facilitators/barriers to providing this intervention.

DESIGN

A non-randomized, non-blinded, quasi-experimental pilot study conducted with maternal/child nurses and neonatal parents. The intervention used an educational booklet on what is needed to prepare for disasters and how to develop evacuation and communication plans. Parents completed booklets during their infant's hospital stay, after which they received a free disaster kit from the nurses.

SAMPLE

68 parents, 13 maternal/child nurses.

MAIN OUTCOME VARIABLE

Level of HEP.

RESULTS

HEP scores increased from 4.75 to 10.66 out of 11 from pre- to post-intervention (p < .001). Barriers to implementing this intervention included the weight of the disaster kit, parent anxiety, and need for follow-up with parents. Facilitators included the booklet, disaster kit, and speed/cost of the intervention.

The Fix-it face-to-face intervention increases multihazard household preparedness cross-culturally

Vulnerability to natural disasters is increasing globally^1-3. In parallel, the responsibility for natural hazard preparedness has shifted to communities and individuals⁴. It is therefore crucial that households increase their preparedness, yet adoption of household preparedness measures continues to be low, even in high-risk regions^5-8. In addition, few hazard-preparedness interventions have been evaluated longitudinally using observational measures. Therefore, we conducted a controlled intervention with a 12-month follow-up on adults in communities in the United States and Turkey that focused on improving household earthquake and fire preparedness. We show that this Fix-it intervention, involving evidence-based, face-to-face workshops, increased multihazard preparedness in both cultures longitudinally. Compared to baseline, the primary outcome-overall preparedness-increased significantly in the intervention groups, with more improvement in earthquake preparedness in the Turkish participants and more improvements in fire preparedness in the US participants. High baseline outcome expectancy and home ownership predicted overall preparedness change in both intervention groups longitudinally, implying that a sense of agency influences preparedness. An unintended consequence of observation is that it may increase preparedness, as even the control groups changed their behaviour. Therefore, observation of home preparatory behaviours by an external source may be a way to extend multihazard preparedness across a population.

Who Participates in the Great ShakeOut? Why Audience Segmentation Is the Future of Disaster Preparedness Campaigns

Background: In 2008, the Southern California Earthquake Center in collaboration with the U.S. Geological Survey Earthquake Hazards Program launched the first annual Great ShakeOut, the largest earthquake preparedness drill in the history of the United States. Materials and Methods: We collected online survey data from 2052 campaign registrants to assess how people participated, whether audience segments shared behavioral patterns, and whether these segments were associated with five social cognitive factors targeted by the ShakeOut campaign. Results: Participants clustered into four behavioral patterns. The Minimal cluster had low participation in all activities (range: 0–39% participation). The Basic Drill cluster only participated in the drop, cover and hold drill (100% participation). The Community-Oriented cluster, involved in the drill (100%) and other interpersonal activities including attending disaster planning meetings (74%), was positively associated with interpersonal communication (β = 0.169), self-efficacy (β = 0.118), outcome efficacy (β = 0.110), and knowledge about disaster preparedness (β = 0.151). The Interactive and Games cluster, which participated in the drill (79%) and two online earthquake preparedness games (53% and 75%), was positively associated with all five social cognitive factors studied. Conclusions: Our results support audience segmentation approaches to engaging the public, which address the strengths and weaknesses of different segments. Offering games may help “gamers” gain competencies required to prepare for disasters. Targeting the highly active Community-Oriented cluster for leadership roles could help build community resilience by encouraging others to become more involved in disaster planning. We propose that the days of single, national education campaigns without local variation should end.

A Cognitive-Affective Scale for Hurricane Risk Perception

The aim of this study was to develop a reliable and valid measure of hurricane risk perception. The utility of such a measure lies in the need to understand how people make decisions when facing an evacuation order. This study included participants located within a 15-mile buffer of the Gulf and southeast Atlantic U.S. coasts. The study was executed as a three-wave panel with mail surveys in 2010-2012 (T₀ baseline N = 629, 56%; T₁ retention N = 427, 75%; T₂ retention N = 350, 89%). An inventory based on the psychometric model was developed to discriminate cognitive and affective perceptions of hurricane risk, and included open-ended responses to solicit additional concepts in the T₀ survey. Analysis of the T₀ data modified the inventory and this revised item set was fielded at T₁ and then replicated at T₂ . The resulting scales were assessed for validity against existing measures for perception of hurricane risk, dispositional optimism, and locus of control. A measure of evacuation expectation was also examined as a dependent variable, which was significantly predicted by the new measures. The resulting scale was found to be reliable, stable, and largely valid against the comparison measures. Despite limitations involving sample size, bias, and the strength of some reliabilities, it was concluded that the measure has potential to inform approaches to hurricane preparedness efforts and advance planning for evacuation messages, and that the measure has good promise to generalize to other contexts in natural hazards as well as other domains of risk.

Preparedness Perceptions, Sociodemographic Characteristics, and Level of Household Preparedness for Public Health Emergencies: Behavioral Risk Factor Surveillance System, 2006-2010

Our objective was to inform state and community interventions focused on increasing household preparedness by examining the association between self-reported possession of household disaster preparedness items (ie, a 3-day supply of food and water, a written evacuation plan, and a working radio and flashlight) and perceptions of household preparedness on a 3-point scale from "well prepared" to "not at all prepared." Data were analyzed from 14 states participating in a large state-based telephone survey: the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS) (n = 104,654). Only 25.3% of the population felt they were well prepared, and only 12.3% had all 5 of the recommended items. Fewer than half the households surveyed had 4 or more of the recommended preparedness items (34.1%). Respondents were more likely to report their households were well prepared as the number of preparedness items possessed by their household increased. Risk factors for having no preparedness items were: younger age, being female, lower levels of education, and requesting the survey to be conducted in Spanish. To increase household disaster preparedness, more community-based preparedness education campaigns targeting vulnerable populations, such as those with limited English abilities and lower reading levels, are needed.