Psychosocial Influences on Disaster Preparedness in San Francisco Recipients of Home Care.
Psychosocial Influences on Disaster Preparedness in San Francisco Recipients of Home Care.
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心理社会对旧金山家庭护理接受者备灾的影响。
DOI：
10.1007/s11524-016-0104-3
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Raveis,VictoriaH
中科院分区：
文献类型：
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作者：
Gershon,RobynR;Portacolone,Elena;Nwankwo,EzinneM;Zhi,Qi;Qureshi,KristineA;Raveis,VictoriaH
灾害对人口的某些部分造成不成比例的影响，包括儿童、孕妇、残疾人和慢性病患者以及那些得不到充分服务和资源不足的人。最脆弱的群体之一包括居住在社区的老年人。灾后分析表明，这些人与灾害相关的发病率和死亡率较高。就其就地避难或疏散到避难所的能力而言，他们的备灾水平也低于最佳水平。造成这种情况的原因尚未得到很好的定性，尽管健康受损、财政限制和社会孤立被认为是灾害期间和灾后环境变化的防备和适应能力的障碍。为了确定应对准备障碍的策略，我们最近对居住在旧金山的50名老年家庭护理接受者进行了一项定性研究。数据是在家庭面谈期间收集的，使用的是半结构化访谈指南，其中包括基于社会认知准备模型的心理社会结构和新的13项准备检查表。平均准备分数为4.74(最大13分，范围1-11，SD。2.11)。超过60%的参与者报告说，他们在危机时期没有为照顾者援助制定后备计划，74%的人没有制定运送到避难所的计划，56%的人缺乏停电情况下的电气设备的后备计划，44%的人没有准备紧急联系人名单--这是准备工作的最基本要素。伤残、残疾和资源限制是防备的障碍。缺乏作为准备行为动机和意图基础的认知过程。在危险的关键意识(显着性)、自我效能、结果预期和感知责任方面存在局限性。还缺乏对应急机构和当局的信任，社区意识有限。参与者希望做好准备并欢迎培训，但身体限制使他们中的许多人被困在家里。培训家庭护理助理、提供所需资源和改进社区宣传可能有助于改善这一弱势群体的灾害后果。
Disasters disproportionately impact certain segments of the population, including children, pregnant women, people living with disabilities and chronic conditions and those who are underserved and under-resourced. One of the most vulnerable groups includes the community-dwelling elderly. Post-disaster analyses indicate that these individuals have higher risk of disaster-related morbidity and mortality. They also have suboptimal levels of disaster preparedness in terms of their ability to shelter-in-place or evacuate to a shelter. The reasons for this have not been well characterized, although impaired health, financial limitations, and social isolation are believed to act as barriers to preparedness as well as to adaptability to changes in the environment both during and in the immediate aftermath of disasters. In order to identify strategies that address barriers to preparedness, we recently conducted a qualitative study of 50 elderly home care recipients living in San Francisco. Data were collected during in-home, in-person interviews using a semi-structured interview guide that included psychosocial constructs based on the social cognitive preparedness model and a new 13-item preparedness checklist. The mean preparedness score was 4.74 (max 13, range 1–11, SD. 2.11). Over 60 % of the participants reported that they had not made back-up plans for caregiver assistance during times of crisis, 74 % had not made plans for transportation to a shelter, 56 % lacked a back-up plan for electrical equipment in case of power outages, and 44 % had not prepared an emergency contacts list—the most basic element of preparedness. Impairments, disabilities, and resource limitations served as barriers to preparedness. Cognitive processes that underlie motivation and intentions for preparedness behaviors were lacking. There were limitations with respect to critical awareness of hazards (saliency), self-efficacy, outcome expectancy, and perceived responsibility. There was also a lack of trust in response agencies and authorities and a limited sense of community. Participants wanted to be prepared and welcomed training, but physical limitations kept many of them home bound. Training of home care aides, the provision of needed resources, and improved community outreach may be helpful in improving disaster outcomes in this vulnerable segment of the population.