Tailoring Household Disaster Preparedness Interventions to Reduce Health Disparities: Nursing Implications from Machine Learning Importance Features from the 2018-2020 FEMA National Household Survey.

Tailored disaster preparedness interventions may be more effective and equitable, yet little is known about specific factors associated with disaster household preparedness for older adults and/or those with African American/Black identities. This study aims to ascertain differences in the importance features of machine learning models of household disaster preparedness for four groups to inform culturally tailored intervention recommendations for nursing practice. A machine learning model was developed and tested by combining data from the 2018, 2019, and 2020 Federal Emergency Management Agency National Household Survey. The primary outcome variable was a composite readiness score. A total of 252 variables from 15,048 participants were included. Over 10% of the sample self-identified as African American/Black and 30.3% reported being 65 years of age or older. Importance features varied regarding financial and insurance preparedness, information seeking and transportation between groups. These results reiterate the need for targeted interventions to support financial resilience and equitable resource access. Notably, older adults with Black racial identities were the only group where TV, TV news, and the Weather Channel was a priority feature for household disaster preparedness. Additionally, reliance on public transportation was most important among older adults with Black racial identities, highlighting priority needs for equity in disaster preparedness and policy.

Health-Care and Supportive Services in General Population Disaster Shelters.

OBJECTIVES: The Communication (C), Maintaining Health (M), Independence (I), Services, Support and Self-Determination (S), and Transportation (T) is a framework (C-MIST) for identifying functional needs in an emergency response. A C-MIST documentation tool provides shelter staff with a list of potential client needs and actions to address them. This retrospective review describes the needs and actions indicated on completed C-MIST documentation tools (ie, records) within domestic general population shelters following Hurricane Florence in 2018. METHODS: A convenience sample of 1209 records completed by shelter disaster health services personnel was provided by the American Red Cross. The records correspond to client stays in 19 shelters between September and October 2018. Data abstracted from hardcopy forms were de-identified and recorded in a database. Summary statistics were computed. RESULTS: High incidence needs included medical supplies for everyday care (including medications) not related to mobility (15.4%), medically or culturally needed diets (12.2%), durable medical equipment (9.7%), mental health care (8.8%), and transportation (8.4%). High incidence actions included replacement medication (9.3%), refer to Disaster Mental Health Services (6.4%), provide assistive mobility equipment (5.1%), provide diabetes management supplies (5.0%), provide alternative food and beverages (4.1%), and provide transportation (3.9%). CONCLUSIONS: The process for identifying health and functional support needs in shelters should be standardized through the use of the C-MIST framework.

Waning of SARS-CoV-2 Seropositivity among Healthy Young Adults over Seven Months.

BACKGROUND: We conducted a longitudinal study to estimate immunity produced in response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among university students over seven months. METHODS: All participants were attending a public university and resided in Pitt County, North Carolina. University students enrolled weekly for 10 weeks between 26 August 2020 and 28 October 2020, resulting in 136 young adults completing at least one study visit by 17 November 2020. Enrolled students completed an online survey and nasal swab collection at two-week intervals and monthly blood collection between 26 August 2020 and 31 March 2021. RESULTS: Amongst 695 serum samples tested during follow-up, the prevalence of a positive result for anti-nucleocapsid antibodies (N-IgG) was 9.78%. In 22 students with more than one positive N-IgG serum sample, 68.1% of the group lost persistence of N-IgG below the positive threshold over 140 days. Anti-spike IgG antibodies were significantly higher among 11 vaccinated compared to 10 unvaccinated. CONCLUSIONS: In healthy young adults, N-IgG wanes below the detectable threshold within five months. S-IgG titer remained consistently elevated months after infection, and significantly increased after vaccination.

Validation and Revision of the Household Emergency Preparedness Instrument (HEPI) by a Pilot Study in the City University of New York.

OBJECTIVE: The aim of this study was to pilot test the Household Emergency Preparedness Instrument (HEPI) with a diverse sample, allowing for assessment of reliability and validity of the instrument. The HEPI is an international, all-hazards questionnaire created to measure disaster preparedness of households, which results in data that can be used to enhance health promotion/disease prevention for individuals and promote resilience for communities. METHODS: A cross-sectional study of faculty, staff, and students (N = 284) was completed to perform factor analysis to establish the HEPI's construct validity and compare preparedness across groups. RESULTS: The factor analysis revealed 2 dimensions of general preparedness, explaining 35% of the sample variance (Cronbach's α = 0.89): preparedness actions and planning (α = 0.86) and disaster supplies and resources (α = 0.80). This factor analysis resulted in the revision of the subscaling of HEPI questions. Consistent with previous studies, faculty/staff, older age, higher income, and those with previous disaster experience were more prepared. The mean score was 15.28 out of 40 points. CONCLUSIONS: The HEPI is easy to administer and explains an acceptable amount of variance. The reliability was strong in this assessment, particularly for a pilot test. Construct, criterion, face, and content validity support the adequacy of the HEPI to capture essentials of household emergency preparedness.

Household Emergency Preparedness Instrument Development: A Delphi Study.

OBJECTIVE: The main objective of this research was to generate a consensus on the conceptual definition of household emergency preparedness from experts representing multiple disciplines and countries, in order to facilitate the development of an all-hazards, comprehensive, valid, and reliable instrument. METHODS: Questions were generated via 3 methods: literature search, using existing instruments, and expert panels using the Delphi technique. RESULTS: Panelists (n = 154) representing 36 countries came to a consensus that household emergency preparedness is defined as the completion of several preparedness actions and assembling a kit that can be transported in an evacuation. The new 51-question instrument demonstrates face, content, and criterion validity and internal consistency reliability (α = 0.96). The instrument assesses whether specific preparedness actions have been taken, and the presence or absence of essential supplies that could enable households to safely endure conditions that disasters would likely present (loss of power, water limitations, and/or lack of access to additional supplies for a few days). CONCLUSION: A valid and reliable instrument provides researchers with a replicable approach to assessment of preparedness levels, which is necessary to plan mitigation strategies, enhance health promotion, prevent injuries, and increase resilience for individuals and communities. The instrument can provide evidence to support interventions addressing health needs of community members following a disaster.

Household emergency preparedness: A multidisciplinary concept analysis.

BACKGROUND: Household emergency preparedness, at the individual and family micro-level, is often identified as below national disaster preparedness standards. AIMS: Conceptual clarity of household emergency preparedness is foundational for disaster preparedness research, theory construction, and instrument use. MATERIALS & METHODS: Adhering to Walker and Avant's (2019) concept analysis method, the purpose of this paper is to outline the concept of household emergency preparedness by identifying the uses of the concept, the defining attributes, antecedents, consequences, and empirical referents. Literature sources were identified using the Cumulative Index for Nursing and Allied Health (CINAHL), ProQuest Central, PsycInfo, PubMed, and government websites. CONCLUSION: Concept clarification is critical for future selection of research designs involving multidisciplinary community-based interventions for household emergency preparedness, as well as to understand how preparedness efforts at the individual and family micro-level may influence larger disaster preparedness system outcomes.

Life-space constriction in aging adults.

BACKGROUND: Early indicators of declining function and frailty, such as life-space constriction (LSC), are important in identifying those at risk for frailty. PURPOSE: Examine factors associated with LSC and the influence on function and frailty. METHODS: A cross-sectional, descriptive study was conducted using a convenience sample of community dwelling persons 55 and older living in the South. RESULTS: Most participants (N = 72) were female (69%; n = 50) and half were White (53.5%; n = 38). Individual factors including challenges (age-related physiological changes, disease burden, mental health limitations) and buoy (assistive devices, and other compensatory strategies) explained 22% variance in self-reported frailty (F = 3.099 (6, 65); p = .01). LSC explained 34% variance in function (F = 3.805 (8, 59); p = .001) when environmental supports (family ties, and social network) and challenges (area deprivation, built environment, and social disorganization) and individual factors were controlled for. Number of assistive devices was the only significant predictor of frailty.

Using Yoga to Reduce Anxiety in Children: Exploring School-Based Yoga Among Rural Third- and Fourth-Grade Students.

INTRODUCTION: Anxiety is becoming more common in children and can negatively affect social and academic performance. The purpose of this study was to explore the impact of 10 min of yoga on anxiety in third- and fourth-graders over 8 weeks. METHOD: Participants completed 10 min of yoga daily during the school week. Participants completed the Screen for Child Anxiety Related Emotional Disorders anxiety screening tool at the beginning and after the program. RESULTS: Paired sample t test noted a significant difference between pretest and posttest raw scores in the category of generalized anxiety disorder. On average, participants had significantly decreased raw anxiety scores after completing the program (mean = -0.0308), t(60) = -3.137, p < .05. DISCUSSION: This study demonstrates that yoga practiced as little as 10 min a day over 8 weeks can have a significant impact on decreasing anxiety in children aged 8-10 years.

Emergency Preparedness Competencies Among Nurses: Implications for Nurse Administrators.

OBJECTIVE: The aim of this study was to examine current levels of self-reported professional emergency preparedness competence among nurses. In addition, relationships between nurse professional emergency preparedness competence, personal preparation for a disaster, and perceived likelihood of reporting to work after a disaster are examined. BACKGROUND: Evidence suggests wide gaps in nurses' familiarity with the dimensions of professional emergency preparedness competence and their likelihood to report, potentially impacting human life after a disaster. METHODS: An exploratory, cross-sectional survey design was used with a sample of 186 RNs and licensed practical nurses. RESULTS: Results indicate significant weaknesses in nurses' professional emergency preparedness competence. There are positive correlations between likelihood to report, personal preparedness, and professional emergency preparedness competence. CONCLUSIONS: Nurses across the United States lack sufficient competence in professional emergency preparedness. Results demonstrate the need to improve the education of nurses to meet the demands of populations in urgent situations. Action items nurse administrators can take are provided.

Characterization of nurses' duty to care and willingness to report.

BACKGROUND: Nurses must balance their perceived duty to care against their perceived risk of harm to determine their willingness to report during disaster events, potentially creating an ethical dilemma and impacting patient care. RESEARCH AIM: The purpose of this study was to investigate nurses' perceived duty to care and whether there were differences in willingness to respond during disaster events based on perceived levels of duty to care. RESEARCH DESIGN: A cross-sectional survey research design was used in this study. PARTICIPANTS AND RESEARCH CONTEXT: Using a convenience sample with a snowball technique, data were collected from 289 nurses throughout the United States in 2017. Participants were recruited through host university websites, Facebook, and an American Nurses Association discussion board. ETHICAL CONSIDERATIONS: Institutional review board approval was obtained from the University of Texas at Tyler and the University of Arkansas. FINDINGS: Analysis of willingness to report to work based on levels of perceived duty to care resulted in the emergence of two groups: "lower level of perceived duty to care group" and "higher level of perceived duty to care group." The most discriminating characteristics differentiating the groups included fear of abandonment by co-workers, reporting because it is morally the right thing to, and because of imperatives within the Nursing Code of Ethics. DISCUSSION: The number of nurses in the lower level of perceived duty to care group causes concern. It is important for nursing management to develop strategies to advance nurses' safety, minimize nurses' risk, and promote nurses' knowledge to confidently work during disaster situations. CONCLUSION: Level of perceived duty to care affects nurses' willingness to report to work during disasters. Primary indicators of low perceived duty to care are amenable to actionable strategies, potentially increasing nurses' perceived duty to provide care and willingness to report to work during disasters.

Individual emergency-preparedness efforts: A social justice perspective.

BACKGROUND: Since 2010, the United States has experienced 228 disasters, affecting over 86 million people. Because of population shifts, the growing number of people living with chronic conditions or disabilities, and the growing number of older citizens living independently, access and service gaps often exist for those without money or other transferable resources. There is a lack of evidence regarding individual community members' capacity to prepare for emergencies. RESEARCH OBJECTIVE: The purpose of this study is to highlight participant experiences in becoming better prepared for emergencies and provide insight from a social justice perspective. RESEARCH DESIGN: This is a descriptive qualitative study, staying very close to the data as an end product rather than a beginning for interpretation. PARTICIPANTS AND RESEARCH CONTEXT: A total of 13 low-income, uninsured, or under-insured attendees at a medical outreach clinic were interviewed. ETHICAL CONSIDERATIONS: Institutional Review Board approval was obtained from the University of Texas at Tyler. FINDINGS: Four themes emerged from the interview data: (a) evaluation of the emergency-preparedness education, (b) making emergency plans, (c) challenges in preparing for emergencies, and (d) facilitators of emergency preparedness. DISCUSSION: Identifying the potential challenges to individual emergency preparedness among vulnerable populations is the first step in overcoming them. The capacity to comply with such measures, especially the ability of those with limited incomes and other vulnerable populations, must be considered. CONCLUSION: Synchronized, well-ordered assistance will close gaps in recovery and enhance efficiency in pre- and post-event aid. Theoretically, doing so will promote engaged and resilient members of society who are better able to withstand adverse events. The importance of the relationship between individual preparedness levels and the resiliency of nations supports the social justice imperative to address the needs of vulnerable populations in the mitigation and planning phase of the emergency management cycle.

In-Home Strategic National Stockpile Dispensing by Means of Home Health Agencies: An Alternative Means of Dispensing to Vulnerable Populations.

The Federal Emergency Management Agency prescribes a 48-h timeline between the declaration of an emergency and the treatment of the last person with Strategic National Stockpile (SNS) medical countermeasures (MCM). Many states struggle to meet the 48-h window. Issues surrounding adequate staffing, critical to maintaining necessary Points Of Dispensing (POD) throughput, are noted in the literature. The use of public and private partnerships in the health-care sector may improve POD throughput. This study describes a novel strategy for partnering with home health agencies (HHAs) to augment MCM distribution. The HHA In-Home Dispensing Model we propose authorizes HHAs to act as Closed PODs following a head of household model. Here, we evaluate the effectiveness of the model using a case study. First, we provide an overview of the methods used to estimate the duration of in-home nurse dispensing shifts. We then present the results for our case study area. Next, we discuss how the model can be used and its limitations. We conclude that the HHA In-Home SNS Dispensing Model shows promise and should receive further consideration, as it can decrease demand at open PODs and increase the reach of MCMs to vulnerable populations who might otherwise have difficulty receiving them.

Development and Implementation of the How to Talk to Your Doctor HANDbook Health Literacy Program in Rural Counties.

BACKGROUND: Improvements in health literacy are unlikely without intervention in community settings. However, interventions appropriate for delivery in these settings are lacking, limiting reach to rural adults who are disproportionately affected by low health literacy and poor health outcomes. The How to Talk to Your Doctor (HTTTYD) HANDbook Program was developed through a research-practice partnership to educate rural residents to effectively advocate and participate in their own health care. BRIEF DESCRIPTION OF ACTIVITY: We describe development of the HTTTYD HANDbook Program delivered through the Cooperative Extension Service to educate adults who are eligible for Medicaid and have low health literacy. HTTTYD HANDbook implementation is described using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework (and specifically the reach, adoption, implementation, and maintenance dimensions). IMPLEMENTATION: The HTTTYD HANDbook was developed using health literacy best practices with user-centered design, and it was field tested with community members with varying levels of health literacy. Reach, adoption, implementation, and maintenance of the HTTTYD HANDbook were assessed by tracking distribution of HTTTYD HANDbook Program materials, return submission of evaluation and tracking instruments, adherence to program and data collection/submission protocols, and program continuation. RESULTS: Overall reach into the population was 6 per 10,000; about 25% were Medicaid recipients and 28.2% had low health literacy. Most participants were age 65 years or older. Of the 72 counties with program access, 52.7% requested HTTTYD HANDbook Program materials; 31% adopted the program, but only 30% of these counties adhered to program implementation and data collection protocols. Reach and adoption were higher among rural counties, and rural counties were more likely than nonrural counties to maintain the HTTTYD HANDbook Program. LESSONS LEARNED: The HTTTYD HANDbook Program addresses barriers to engagement in patient-provider communication for rural, low-income community members. Programs can be implemented in community settings through established local organizations, such as county extension offices, to increase access for rural adults. Implementation barriers included staff turnover and transportation of program materials. Online facilitator training availability had little impact on adherence to program protocols. Organizational context and established procedures for program delivery and evaluation should be considered in adoption decisions and integrated into implementation protocols. [HLRP: Health Literacy Research and Practice. 2019;3(3):e205-e215.]. PLAIN LANGUAGE SUMMARY: The How to Talk to Your Doctor HANDbook Program was created with people from the community to help patients prepare for doctor visits. The How to Talk to Your Doctor HANDbook Program helps patients to overcome barriers to talking to their doctor so that they can better understand how to get healthy and stay healthy.

Evaluating the Effectiveness of the How to Talk to Your Doctor HANDbook Program.

BACKGROUND: Millions of Americans have low health literacy, potentially leading to a number of issues including medication errors, hospital admissions, unnecessary emergency department visits, skipped screenings and shots, and misinterpretation of treatment plans. People with low health literacy have less knowledge of illness management, less ability to share in decision-making, and poorer self-reported health status. Addressing health literacy is necessary to improve health care quality, reduce costs, and reduce disparities. OBJECTIVE: The How to Talk to Your Doctor (HTTTYD) HANDbook Program addresses health literacy among rural participants who have low incomes, with a focus on improving health communication among populations that are medically vulnerable by using the HANDbook tool. METHODS: Participants were recruited from 55 rural counties by county extension agents (CEA) to participate in the 1-hour HTTTYD session. Pre- and post-test surveys were completed. A subset of the sample completed a 3-month follow-up survey. KEY RESULTS: Of the 548 participants who fully completed the survey, a Wilcoxon Signed-Rank Test was performed on 484 of the participants who completed both the pre- and post-test. A statistically significant median increase in overall confidence among the participants from pre- (M = 15.99) to post-test (M = 17.76), (z = 13.454, p = .000), was noted. A subset of 166 participants also completed the 3-month follow-up survey. A significant increase in health literacy after participation in the HTTTYD HANDbook program from pre-test to 3-month follow-up was noted; effect sizes ranged from moderate to large. CONCLUSION: The HTTTYD HANDbook program meets recommendations for successful health literacy programs; significant positive outcomes demonstrate program effectiveness. HTTTYD HANDbook program delivery in rural communities by CEAs demonstrates access to understudied and often difficult-to-reach populations. [HLRP: Health Literacy Research and Practice. 2019;3(2):e103-e109.]. PLAIN LANGUAGE SUMMARY: The How to Talk to Your Doctor HANDbook program delivered by county extension agents in rural communities showed capacity to access understudied and often difficult-to-reach populations. The significant, sustained improvement in health literacy noted among program participants demonstrated program effectiveness among those with low health literacy.

The Relationship Between Perceptions of Emergency Preparedness, Disaster Experience, Health-Care Provider Education, and Emergency Preparedness Levels.

Objective The purpose of this study was to assess the self-reported level of individual emergency preparedness, the dependent variable, of people who attended a community health-related fair. The study's independent variables included demographic characteristics, perceptions of preparedness, previous disaster experience, and the presence of a medical condition and were used to examine the variability in self-reported emergency preparedness levels. Methods Data came from attendees at two community health-related fairs. Multivariate analysis on 188 participants was performed. A model predicting preparedness levels with demographic variables was constructed; successive models were built adding perceptions of preparedness, personal experiences with disasters, and presence of a medical condition. Results Preparedness levels varied little across sociodemographic dimensions explaining virtually no variance in overall preparedness. Subsequent models adding perceptions of preparedness and personal experiences significantly increased the explained variance to 40%. Of participants who reported a medical condition, the model including discussions about emergency preparedness with health-care providers explained 67% of the variance in overall preparedness levels. Conclusion The strong, positive relationship between the health-care provider and preparedness levels indicates a pathway for effecting change in preparedness levels and ultimately community health after an emergency. The inclusion of such education at community events should be considered. Research agendas should include providing evidence for the contents of disaster supply kits.