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.

Key Factors Related to Household Emergency Preparedness Among Parents of Newborn Infants.

BACKGROUND: A natural disaster can have devastating consequences for newborn infants. Despite this fact, there are few studies that have explored household emergency preparedness (HEP) among parents of newborn infants or factors affecting HEP in this population. PURPOSE: The purpose of this study was to explore the relationship between various demographic and socioeconomic variables and levels of HEP among parents of newborn infants. METHODS: Parents of newborn infants born at a single medical center in Brooklyn, New York, completed a pre- and posttest to determine their level of HEP before and after implementing the Nurses Taking on Readiness Measures (N-TORM) intervention. For this study, a secondary statistical analysis was performed on the HEP scores gathered prior to the intervention and the demographic data collected from participants. RESULTS: There was a statistically significant relationship between HEP scores and homeownership t(62) = 2.75, P = .008, level of education t(66) = 2.31, P = .024, and income t(46) = 2.39, P = .021. IMPLICATIONS FOR PRACTICE AND RESEARCH: Findings from this study indicate that there are various demographic and socioeconomic factors that influence HEP. Another critical finding was that most participants were significantly underprepared for an emergency with an average HEP score of 4.75 (SD = 2.61) out of a possible 11 points. Findings from this study support the need for neonatal and pediatric providers to develop targeted interventions to enhance the preparedness of parents of newborns in general, and in particular, those with lower household incomes, lower levels of education, and those who rent their homes.

Social support, educational, and behavioral modification interventions for improving household disaster preparedness in the general community-dwelling population: a systematic review and meta-analysis.

Background: The efficacy of household emergency preparedness interventions for community-dwelling, non-institutionalized people is largely unknown. Objective: To ascertain the state of the science on social support, educational, and behavioral modification interventions to improve all-hazard household disaster preparedness. Design: Systematic review and meta-analysis. Methods: Databases, trial registers, reports, and websites were searched, and citation trails followed utilizing replicable methods. Individual, cluster, and cross-over randomized controlled trials of non-institutionalized, community-dwelling populations and non-randomized controlled trials, controlled before-after, and program evaluation studies were included. At least two review authors independently screened each potentially relevant study for inclusion, extracted data, and assessed the risk of bias. Risk of bias was assessed using Cochrane's RoB2 tool for randomized studies and ROBINS-I tool for nonrandomized studies. Meta-analyses were applied using a random-effects model. Where meta-analysis was not indicated, results were synthesized using summary statistics of intervention effect estimates and vote counting based on effect direction. The evidence was rated using GRADE. Results: 17 studies were included with substantial methodological and clinical diversity. No intervention effect was observed for preparedness supplies (OR = 6.12, 95% 0.13 to 284.37) or knowledge (SMD = 0.96, 95% CI -0.15 to 2.08) outcomes. A small positive effect (SMD = 0.53, 95% CI 0.16 to 0.91) was observed for preparedness behaviors, with very low certainty of evidence. No studies reported adverse effects from the interventions. Conclusion: Research designs elucidating the efficacy of practical yet complex and multi- faceted social support, educational, and behavioral modification interventions present substantial methodological challenges where rigorous study design elements may not match the contextual public health priority needs and resources where interventions were delivered. While the overall strength of the evidence was evaluated as low to very low, we acknowledge the valuable and informative work of the included studies. The research represents the seminal work in this field and provides an important foundation for the state of the science of household emergency preparedness intervention effectiveness and efficacy. The findings are relevant to disaster preparedness practice and research, and we encourage researchers to continue this line of research, using these studies and this review to inform ongoing improvements in study designs.

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.

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.

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.

A qualitative survey of household emergency preparedness for the elderly and the medically frail living in coastal urban communities.

OBJECTIVE: To understand how elderly and medically frail adults have experienced disasters and how this experience impacts what they do now to prepare for disasters and to generate theory regarding the process through which community members prepare for disasters. DESIGN: This study employed a qualitative descriptive methodology, Situational Analysis (SA), to explore the social processes of disaster preparedness in vulnerable community members. The Protective Action Decision Model was used to inspire the interview guide and initial coding of the data. Discourse analysis was performed on noninterview data. SETTING: A coastal urban community heavily damaged by Hurricane Sandy in 2012. PARTICIPANTS: Convenience sample of 33 elderly or medically frail community members. RESULTS: Based on the findings, it was theorized that these community members are unprepared for disasters. Their lack of preparedness is due in large part to a lack of education on how best to prepare. If these community members are incidentally prepared, it is largely due to their past experience with disaster or their professional experience. The preparedness discourse did not recognize the extent to which elderly and medically frail populations rely on institutions and social support networks to meet their disaster resilience antecedents. CONCLUSIONS: Community interventions such as distributing disaster supply kits and offering evacuation assistance can help to overcome situational impediments to preparedness and provide the best chance for community members to survive disasters without becoming ill or injured. Study results can inform emergency plans and policy efforts to better meet the needs of these community members during disasters.

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.

Disaster-Related Community Resilience: A Concept Analysis and a Call to Action for Nurses.

A paucity of nursing literature is available on disaster-related community resilience. Using a nursing method for analyzing concepts, this article attempts to clarify the meaning of this novel concept to encourage nursing research and practice. This concept analysis provides an introduction to the phenomenon of disaster-related community resilience for nurses and consumers of nursing research. The article proposes the definition, antecedents, attributes, consequences, and empirical referents of disaster-related community resilience and provides suggestions for nursing research and practice. It also provides nurses a foundation for participating in resilience-building activities that may save lives and allow communities to recover more rapidly postdisaster.

Lack of Evidence Supporting the Effectiveness of Disaster Supply Kits.

We reviewed the available evidence in support of the effectiveness of disaster supply kits presently used in household emergency preparedness in the United States. The expectation that people should take responsibility for their own disaster preparedness has largely not taken into account contextual influences on disaster preparedness. The efficiency of current disaster supply kits used during critical postdisaster periods has not been empirically tested. Professional recommendations regarding the composition of disaster supply kits containing at least water, food, first aid, hygiene, and clothing have not been universally defined. This lack of consensus may lead to the assembling of disaster supply kits yielding suboptimal results. The use of disaster supply kits should continue to be nationally recommended, although additional research is needed to demonstrate their beneficial impact on survival and resilience after a disaster.