Predictors of emergency preparedness among parents in Hawaii: A cross-sectional survey.

OBJECTIVE: To determine factors predicting emergency preparedness (EP) behaviors among Hawaii parents. METHODS: A cross-sectional online survey of parents of children (age 0-12 years) living in Honolulu, Hawaii in March 2023 examined associations with 1) having an EP kit (supplies for use during emergencies) and 2) having a family emergency plan (what to do, where to go, how to communicate during emergencies) with demographics/household characteristics and theoretical constructs of the Health Belief Model. A multivariable regression model obtained odds ratios and 95% confidence intervals. RESULTS: Participants (N=278) were mainly female (84%), college-educated (68%), and were similar in diverse racial/ethnic composure (White, 13.3%) to the overall Honolulu County. Logistic regression determined participants with lower perceived susceptibility to disasters, greater time barriers, and those who needed help to prepare for emergencies were less likely to have an EP kit. Among participants without an EP kit, a website able to create personalized instructions for household EP would be useful. Participants who needed help to prepare for emergencies were less likely to have a family emergency plan. CONCLUSION: Future interventions should focus on evidence-based strategies that improve self-efficacy associated with developing EP kits and family emergency plans.

Perspectives on Emergency Preparedness Among Indigenous Pacific People in Hawaii: A Qualitative Study.

PURPOSE: This study sought an improved understanding of household emergency preparedness (EP) among Native Hawaiian, Pacific Islander, and Filipino (Indigenous Pacific People [IPP]) parents in Hawaii. DESIGN: We conducted an exploratory qualitative descriptive study with 60-minute interviews occurring from October 2022 through March 2023. A semi-structured interview guide exploring participant household EP was employed. METHODS: Prospective participants were females who identified as IPP, caregivers of a 0-12-year-old child, spoke English, and received health services at a federally qualified health center clinic. Two researchers conducted qualitative content analysis on interview transcripts. Initial coding of transcripts identified broad categories or themes. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified final themes and subthemes. FINDINGS: Participants (N=25) were female, between 30-49 years of age (68%), had received some college education (60%), and were fully employed (68%). Major themes included: 1) Perceptions of family EP and current behaviors, 2) Barriers and challenges to family EP, and 3) Perspectives on strategies to improve family EP. Subthemes included risk perception for emergencies; family EP practices; health protection and pandemic preparedness; lack of knowledge and experience; social, cultural and economic barriers; and clinic-based, technology-driven, and community-based interventions. CONCLUSION: Factors impeding access to healthcare services also impede family EP among IPP groups and their ability to mitigate the impact of future public health emergencies. CLINICAL EVIDENCE: Targeted, innovative interventions, including ones led by health clinics and those that utilize technology, are needed to overcome common barriers faced and to facilitate the uptake of household EP behaviors among IPP families.

Impact of the COVID-19 pandemic on social media utilization, influences related to parental vaccine decision making, and opinions on trustworthy social media vaccination campaigns: A qualitative analysis.

There is a continued need for research to better understand the influence social media has on parental vaccination attitudes and behaviors, especially research capturing the effects of the COVID-19 pandemic. The goal of this study was to explore parents' perspectives related to the impact the pandemic had on 1) social media engagement, 2) vaccine messaging on social media, and 3) factors to guide future intervention development. Between February and March 2022, 6 online, synchronous, text-based focus groups were conducted with parents of adolescents aged 11 to 17 years. Participants who all utilized social media were recruited from across the United States. Qualitative data were analyzed using content analysis. A total of 64 parents participated. Average age was 47 years, and participants were predominantly White (71.9%), female (84.3%), and engaged with social media multiple times per day (51.6%). Participants (95.3%) viewed obtaining all recommended vaccines as important or very important; however, overall vaccination rates for their adolescents were varied (50% ≥1 dose HPV; 59.4% MenACWY; 78.1% Tdap; 65.6% Flu; 81.3% COVID-19). Three themes emerged highlighting the pandemic's impact on parent's (1) general patterns of social media use, (2) engagement about vaccines on social media and off-line behaviors related to vaccination, and (3) perspectives for developing a credible and trustworthy social media intervention about vaccination. Participants reported fatigue from contentious vaccine-related content on social media and desired future messaging to be from recognizable health institutions/associations with links to reputable resources. Plus, providers should continue to provide strong vaccine recommendations in clinic.

Emergency preparedness is a healthcare issue: COVID-19 pandemic's influence on attitudes and behaviors among a national sample of parents.

BACKGROUND: Improving household emergency preparedness (EP) is a public health priority, yet little is known about what influence the COVID-19 pandemic had on families' EP. This study aimed to explore current EP attitudes and behaviors. METHODS: We conducted online focus groups in Winter 2022 with a nationwide sample of parents of adolescents. We held six 90-min focus groups of 9-15 participants using a semi-structured interview script that elicited parental knowledge and attitudes related to household EP. Two researchers conducted qualitative content analysis on focus group transcripts. First-level coding within and across scripts was used to identify broad categories or themes regarding EP. The process was reviewed continuously to verify data and coding procedures. Three investigators independently verified the final themes that emerged. RESULTS: Participants (N = 64) were mostly female (n = 54, 84.3%), white (n = 46, 71.9%), and college-educated (n = 49, 76.6%). Major themes included: 1) Expanded awareness and behavioral change related to EP due to the COVID-19 pandemic, 2) Reconceptualization of planning for family health as part of EP, 3) Changing perspectives related to vaccination as a component of EP, and 4) Perspectives related to discussing EP with their health care provider. CONCLUSIONS: EP was described as a healthcare issue and healthcare providers were identified as trusted sources of EP information. Interventions to support providers' ability to assist with individual EP health action plans, including discussing vaccination as part of preparedness are needed.

Impact of the COVID-19 Pandemic on the Hawai'i Nursing Workforce: A Cross-sectional Survey.

The coronavirus disease (COVID-19) pandemic has placed extraordinary strain on health care systems. This has led to increased stress among health care workers, and nurses in particular, which has had a negative impact on their physical and psychosocial wellbeing. This is likely to negatively impact the nursing workforce at the state and national levels as the pandemic continues. The purpose of this study was to assess whether nurses licensed in Hawai'i have considered leaving the workforce. A cross-sectional online survey was conducted among Hawai'i nurses at all levels of licensure, with 421 responding. Of these nurses, 97 (23.0%) reported considering leaving the workforce, with safety (39.2%) and family/caregiver strain (32.0%) being the most common reasons. Reconsidering whether they should stay employed in their current roles (Odds ratio [OR] 2.05; 95% CI 1.56 - 2.69) and fear to continue providing direct patient care (OR 1.97; 95% CI 1.54 - 2.54) were associated with increased odds of having considered leaving the workforce. Based on these results, the State of Hawai'i and local health care organizations need to adjust their nursing workforce estimates and address how to alleviate nurses' stressors and safety concerns to mitigate a potential workforce shortage. Research is needed to develop interventions to support and empower nurses in their current roles but also address future emergency preparedness.

Experience of parents of preschool children in Hawaii during the COVID-19 pandemic.

OBJECTIVE: The COVID-19 pandemic has resulted in major disruption to economic, health, education, and social systems. Families with preschool children experienced extraordinary strain during this time. This paper describes a qualitative study examining the experience of parents of preschool children in Hawaii during the COVID-19 pandemic. SAMPLE: Thirteen (N = 13) parents of preschool children living on the island of Oahu, Hawaii, participated in small group discussions occurring in February and March 2021, approximately 1 year after the start of the pandemic in the state. Discussion transcripts were coded and sorted into themes. RESULTS: Four themes emerged: stressors due to the COVID-19 pandemic, family coping and resources, meaning of the COVID-19 crisis to the family, and family adaptation patterns. Themes mapped to the Family Adjustment and Adaptation Response model. CONCLUSION: Families relied on various resources to cope with stressors experienced due to the COVID-19 pandemic, and adopted new patterns related to seeking healthcare and household emergency preparedness. Findings may inform policies and interventions to support families during the ongoing COVID-19 pandemic and future public health emergencies.

Interprofessional Disaster Simulation During the COVID-19 Pandemic: Adapting to Fully Online Learning.

BACKGROUND: This paper describes the rapid conversion of a face-to-face interprofessional (IP) disaster simulation to an online format in response to COVID-19 campus closures. METHODS: The online disaster simulation utilized internet-based tools allowing real-time collaboration between IP students. Team exercises involved disaster triage, disease outbreak investigation, and disaster response. Surveys measuring self-assessment of various IP skills and simulation learning outcomes (SLOs) were compared with responses from previous face-to-face simulations. RESULTS: Results indicated mean scores for IP skills were higher for online students when compared with in-person simulations, and all SLOs were met. CONCLUSIONS: The online disaster simulation provided an effective, innovative IP educational opportunity.

Community/Public Health Nurses' Awareness of Residential High-Rise Fire Safety issues.

High-rise (HR) building fires remain a tragic cause of preventable injury and death in the United States. Recent incidences of HR building fires have served as high-profile reminders of the persistent threat that HR fires pose to public health. Fire safety is an important aspect of household emergency preparedness addressed by community/public health nurses (C/PHNs). This study aimed to address a gap in the literature regarding C/PHNs' awareness of fire safety for people and families who reside in HR buildings. A descriptive qualitative study using key-informant and focus group interviews was conducted involving C/PHNs (n = 19) in Honolulu, Hawaii. Qualitative data analysis revealed three main themes related to this issue: (1) C/PHN awareness of HR fire safety issues, (2) C/PHN perceived barriers for HR building occupant fire safety, and (3) C/PHN suggested strategies to address HR fire safety for occupants. Findings highlight how more needs to be done to assure that C/PHNs are adequately prepared to work with occupants of residential HR buildings on matters related to fire safety.

A Report on the Impact of the COVID-19 Pandemic on the Health and Social Welfare of the Filipino Population in Hawai'i.

Hawai'i's Filipino community has been deeply impacted by coronavirus disease 2019 (COVID-19). This article reports the findings for the Filipino population from the Hawai'i Emergency Management Agency (HI-EMA) Community Care Outreach Unit (CCO) Unit evaluation assessment of the impact of COVID-19 on the health and social welfare of individuals across the state. The survey was conducted from August-September 2020. We propose recommendations to mitigate the impact of the pandemic on this community, including the following actions: (1) developing linguistically and culturally appropriate support for all COVID-19 related services, especially for the high number of older Filipinos with limited English proficiency, (2) providing support and resource information in locations that are accessible to Filipino communities, and (3) supporting those already doing work to address the deep and diverse needs in the Filipino community with funding. Building partnerships between existing Filipino organizations, health and social service providers, and state agencies will contribute to sustainability over time.

Rapid Implementation of a Statewide Observational Surveillance System to Monitor Wearing of Face Masks in Public Spaces.

This report describes the rapid implementation of a statewide observational surveillance program to monitor the public's wearing of face masks in public spaces during community spread of Coronavirus disease 2019 (COVID-19). It describes how the Hawai'i State Department of Health partnered with University of Hawai'i faculty to develop and implement the surveillance program. The surveillance program involved organizing volunteers to conduct weekly direct observations in designated locations. A smartphone application (app) was created to record real-time observational surveillance data. From September 5, 2020, to March 13, 2021, a total of 84 577 observations were conducted across the state. Eighty-three percent of those observed were correctly wearing a face mask, 7% were wearing a face mask incorrectly, and 10% were not wearing a mask. Following the 2-week pilot phase of the project, volunteers were surveyed regarding facilitators and barriers for conducting observations and motivations for volunteering. Feedback was used to refine project procedures. With few states having implemented such a surveillance program, the information reported in this article may inform communities interested in tracking mask-wearing behaviors in the context of the COVID-19 pandemic.

2019 Writing Contest Post-graduate Winner: Fire Safety Behaviors Among Residential High-Rise Building Occupants in Hawai'i: A Qualitative Study.

The world's population is rapidly urbanizing. Today, the majority of people live in cities and many live in high-rise buildings. High-rise buildings pose many challenges with regards to occupant safety, including fire prevention and evacuation safety. The purpose of this study was to describe factors that influence fire safety behaviors among residents of high-rise buildings and the strategies that population health nurses can use to support health education for people living in high-rise environments. An exploratory, descriptive qualitative research design with purposive sampling was used. Twelve residents from 8 high-rise buildings in Honolulu, Hawai'i participated in this study. In-depth semi-structured interviews were conducted and recorded, followed by thematic analysis of the interview transcripts. Five key themes emerged from the study: (1) attitudes towards fire safety, (2) building fire safety culture, (3) perceived ability to prepare for fires, (4) intentions to prepare, and (5) occupant fire preparedness behaviors. Gaps in knowledge regarding high-rise building fire safety were identified that contributed to residents' risk and vulnerability. Fire safety is of relevance to all nurses who work with populations. Population health nursing practice addresses the health, safety, and emergency preparedness needs of clients and communities. More research should be done to improve understanding of fire safety behaviors among high-rise residents to help population health nurses and other professionals mitigate the risk of fire in residential high-rise buildings and keep individuals and families safe during actual emergencies.

Disaster Aftermath Interprofessional Simulation: Promoting Nursing Students' Preparedness for Interprofessional Teamwork.

BACKGROUND: Nurses are members of interprofessional cadres of health care professions with vital roles as disaster shelter volunteers and leaders for recovery efforts. Nurses must be equipped with the skills needed to care for communities postdisaster. Providing students with opportunities to engage in interprofessional simulated disaster experiences is an effective method for preparing them to work in leadership roles during disasters. This article describes a case study in the use of simulation to enhance health care students' knowledge and interprofessional collaboration roles in disaster management. METHOD: The Disaster Aftermath Interprofessional Simulation (DAIS) tabletop exercise was developed by nursing and public health faculty. RESULTS: Students prioritized health interventions and investigated a foodborne outbreak in an emergency shelter. Students applied knowledge from their respective disciplines, collaborating to develop plans to protect populations. CONCLUSION: The DAIS is an innovative method for preparing nursing students to work as interprofessional team members in disaster response and recovery. [J Nurs Educ. 2020;59(6):353-356.].

Scoping review of fire safety behaviors among high-rise occupants: Implications for public health nursing.

OBJECTIVE: The purpose of this review was to identify gaps in the research literature regarding high-rise (HR) building occupant fire safety behaviors. Findings from this review will inform further development of the role of public health nurses (PHNs) in promoting population-based strategies to enhance HR occupant fire safety. DESIGN AND SAMPLE: The search included peer-reviewed English language articles published after 2001 describing fire safety behaviors among HR building occupants in the United States. RESULTS: Fourteen articles were included in the final review. Twelve articles reported exclusively on commercial HR building fire safety; two reported on both the residential and commercial HR building fire safety; 10 reported on events related to the September 11, 2001 attack on the World Trade Center (WTC) towers. Various factors influenced HR occupants' fire safety behaviors, including knowledge about building fire safety features and emergency plans, participation in drills, and organizational emergency preparedness. People with mobility impairments required special considerations. Two theoretical models explaining HR occupants' fire safety behaviors were identified. CONCLUSIONS: Gaps in the research literature exist regarding residential HR occupant fire safety behaviors. Further research regarding ways that PHNs are currently engaged in this important public health issue should be further explored.

Exploratory Qualitative Study of Fire Preparedness Among High-rise Building Residents.

INTRODUCTION: Fire hazards are an extreme risk to occupants of high-rise buildings. Little attention has been paid to emergency and evacuation preparedness among people living in high-rise buildings. This paper reports on emergency fire preparedness among residents of a high-rise building that has experienced multiple fires in the past. METHODS: An exploratory qualitative pilot study was conducted using key informant interviews. Six residents participated. Themes on preparedness for fires and emergency evacuation were extracted. RESULTS: Findings indicated varying levels of preparedness for fires and emergency evacuation among residents. Factors influencing residents' emergency preparedness included fire risk perception, owner or renter status, and building-level emergency preparedness. Fire alarms were considered to be an ineffective evacuation cue. Severe cues such as seeing fire or smoke were more likely to prompt evacuation. Participants provided a series of suggestions to keep high-rise residents safe during fire emergencies. DISCUSSION: The study revealed fire preparedness knowledge, decision-making processes, and actual behaviors of residential high-rise occupants who experienced a fire emergency in their building. Main findings of the study are discussed in two themes: influences on fire emergency and evacuation preparedness, and evacuation decision-making and response to fire. Results from this pilot study will be used as the basis for a follow up study involving residents from multiple high-rise buildings.