Author Profile

Douglas Paton

Affiliation: School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Northern Territory, Australia

Recent Posts

Application of Behavioral Theories to Disaster and Emergency Health Preparedness: A Systematic Review

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Background: Preparedness for disasters and emergencies at individual, community and organizational levels could be more effective tools in mitigating (the growing incidence) of disaster risk and ameliorating their impacts. That is, to play more significant roles in disaster risk reduction (DRR). Preparedness efforts focus on changing human behaviors in ways that reduce people’s risk and increase their ability to cope with hazard consequences. While preparedness initiatives have used behavioral theories to facilitate DRR, many theories have been used and little is known about which behavioral theories are more commonly used, where they have been used, and why they have been preferred over alternative behavioral theories. Given that theories differ with respect to the variables used and the relationship between them, a systematic analysis is an essential first step to answering questions about the relative utility of theories and providing a more robust evidence base for preparedness components of DRR strategies. The goal of this systematic review was to search and summarize evidence by assessing the application of behavioral theories to disaster and emergency health preparedness across the world.

Methods: The protocol was prepared in which the study objectives, questions, inclusion and exclusion criteria, and sensitive search strategies were developed and pilot-tested at the beginning of the study. Using selected keywords, articles were searched mainly in PubMed, Scopus, Mosby’s Index (Nursing Index) and Safetylit databases. Articles were assessed based on their titles, abstracts, and their full texts. The data were extracted from selected articles and results were presented using qualitative and quantitative methods.

Results: In total, 2040 titles, 450 abstracts and 62 full texts of articles were assessed for eligibility criteria, whilst five articles were archived from other sources, and then finally, 33 articles were selected. The Health Belief Model (HBM), Extended Parallel Process Model (EPPM), Theory of Planned Behavior (TPB) and Social Cognitive Theories were most commonly applied to influenza (H1N1 and H5N1), floods, and earthquake hazards. Studies were predominantly conducted in USA (13 studies). In Asia, where the annual number of disasters and victims exceeds those in other continents, only three studies were identified. Overall, the main constructs of HBM (perceived susceptibility, severity, benefits, and barriers), EPPM (higher threat and higher efficacy), TPB (attitude and subjective norm), and the majority of the constructs utilized in Social Cognitive Theories were associated with preparedness for diverse hazards. However, while all the theories described above describe the relationships between constituent variables, with the exception of research on Social Cognitive Theories, few studies of other theories and models used path analysis to identify the interdependence relationships between the constructs described in the respective theories/models. Similarly, few identified how other mediating  variables could influence disaster and emergency preparedness. 

Conclusions: The existing evidence on the application of behavioral theories and models to disaster and emergency preparedness is chiefly from developed countries. This raises issues regarding their utility in countries, particularly in Asisa and the Middle East, where cultural characteristics are very different to those prevailing in the Western countries in which theories have been developed and tested. The theories and models discussed here have been applied predominantly to disease outbreaks and natural hazards, and information on their utility as guides to preparedness for man-made hazards is lacking. Hence, future studies related to behavioral theories and models addressing preparedness need to target developing countries where disaster risk  and the consequent need for preparedness is high. A need for additional work on demonstrating the relationships of variables and constructs, including more clearly articulating roles for mediating effects was also identified in this analysis. 

Community Disaster Resilience: a Systematic Review on Assessment Models and Tools

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Introduction: Recent years have witnessed community disaster resilience becoming one of the most heavily supported and advocated approach to disaster risk management. However, its application has been influenced by the lack of assessment tools. This study reviews studies conducted using the resilience concept and examines the tools, models, and methods adopted. It examines the domains, indicators, and indices have been considered in the tools. It provides a critical analysis of the assessment tools available for evaluating community disaster resilience (CDR).

Methods: We investigated international electronic databases including Scopus, MEDLINE through PubMed, ISI Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar with no limitation on date, and type of articles. The search terms and strategy were as follow: (Disaster* OR Emergenc*) AND (Resilience OR Resilient OR Resiliency) that were applied for titles, abstracts and keywords. Extracted data were analyzed in terms of studied hazards, types of methodology, domains, and indicators of CDR assessment.

Results: Of 675 publications initially identified, the final analysis was conducted on 17 full text articles. These studies presented ten models, tools, or indices for CDR assessment. These evinced a diverse set of models with regard to the domains, indicators and the kind of hazard described. Considerable inter dependency between and among domains and indicators also emerged from this analysis.

Conclusion: The disparity between the articles using the resilience concept and those that offer some approach to measurement (675 vs. 17) indicates the conceptual and measurement complexity in CDR and the fact that the concept may be being used without regard to how CDR should be operationalized and assessed. Of those that have attempted to assess CDR, the level of conceptual diversity indicates limited agreement about how to operationalize the concept. As a way forward we summarize the models identified in the literature and suggest that, as a starting point for the systematic operationalization of CDR, that existing indicators of community disaster resilience be classified in five domains. These are social, economic, institutional, physical and natural domains. A need to use appropriate and effective methods to quantify and weigh them with regard to their relative contributions to resilience is identified, as is a need to consider how these levels interrelate to influence resilience. Although assessment of disaster resilience especially at the community level will inform disaster risk reduction strategies, attempts to systematically do so are in preliminary phases. Further empirical investigation is needed to develop a operational and measurable CDR model.