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

Abstract

BackgroundThe efficacy of household emergency preparedness interventions for community-dwelling, non-institutionalized people is largely unknown.ObjectiveTo ascertain the state of the science on social support, educational, and behavioral modification interventions to improve all-hazard household disaster preparedness.DesignSystematic review and meta-analysis.MethodsDatabases, 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.Results17 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.ConclusionResearch 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.

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

“…Our findings point to a potential difference in the importance of social interventions and talking to others about a preparedness plan for older adults that supports further research for age-group tailoring in household disaster preparedness planning. This finding is novel compared to the background literature reviewed as a variable rarely considered, and advances previous research in the field [4,37]. The environmental justice movement addresses inequalities in disaster preparedness [60].…”

“…In a systematic review and meta-analysis of social support, education, and behavior modification interventions for household disaster preparedness, we found a substantial gap in health equity evidence by age, place of residence, race, occupation, gender/sex, religion, education, socioeconomic status, and social capital [4]. For example, Gillum and colleagues [5] and Gielen and colleagues [6] studied household preparedness interventions among participants who predominantly identified as Black or African American (83% and >90%, respectively) with no analysis of racial disparities.…”

“…Nurses, as the largest proportion of the health workforce, are in a key position to provide health education, behavior change interventions, and design social support recommendations to improve disaster preparedness outcomes [4]. The need to bolster disaster education and training across all phases of the disaster management cycle (preparedness, response, recovery, and mitigation) for nurses across work settings remains, as does the need to prepare nurses to prevent and address disaster disparities across the disaster management cycle [40][41][42].…”

“…Overall, there is little high-quality evidence on the efficacy of current household disaster preparedness interventions, and tailored interventions are warranted by the state of the science [4]. This study seeks to address the gaps in the disaster preparedness literature by examining disparities in disaster preparedness among older adults (greater than 65 years old) who identify as African American/Black, participants of all ages who identify as African American/Black, older adults of all races and ethnicities, and all participants combined.…”